Endocrine Abstracts

Background: Appearance of the secondary pubertal signs before the age of 7 years.

Case report: In the Children’s Department of the Republican Specialized Scientific Practical Medical Center of Endocrinology the patient N., date of birth 2012, under the examination during the period from 22 January 2014 to 01 February 2014.

Complains at admission were included that increasing size of mammary glands, menstruation is appearanced, frequent to catch a cold.

From medical history: The girl who is first daughter is family was not born consanguinity. The head delivery was at term. Examination showed increasing size of the mammary glands (stage 2 by Tanner), sparse pubic hair.

The patient was being followed up by a neuropathologist because of her convulsive syndrome. The recently treatment was: drug Oxapin 300 mg/1/2 tab 2 times a day and drug Letiram 500 mg/1/2 tab 2 times a day.

The patient’s state at admission was relatively satisfaction. The skins are pale and moderately moist. Auscultation: in the lung there was vesicular breathing, without wheezing. The respiration rate was 24 in min. The heart sounds are clear, heart rate was 130 b/min., AP 90/60 mmHg. Diffusive goiter was on the 1st stage. The pubertal development; Ma2Ax1P1 Me 1 year, Height – 88 cm (norm 81), weight – 18 kg 3 S.D.

By Roentgenography of the hand (2014), Bone age was 12-15 years. Growth plate was open.

Ultrasonography of the small pelvis (2014.08.07), Sizes of the uterine length together with cervix was 30 mm, thickness was 8 mm, width – 15 mm (norm 36×14×30 mm). Ovaries: the right ovary located at the ½ of fallopian tube. Sizes: 17–16 mm/follicles: 8.7, 15, 12, 5.3 mm. Conclusion: Show PPD.

MRI of the brain and pituitary gland (15.06.2013) – MRI findings of the mass (hamartoma). There were indirect signs of the intracranial hypertension.

Hormonal analysis: TTG – 1.8 (0.17–4.05 mME/l, T₄ – 105 (60–160 ng/dl), GH – 24 (2–20 mME/l), LH-16.1 (0.3–1.0) mIU/ml, FSH – 18.3 (1.0–4.2) IU ml, Estradiol – 53.1 (<14.9) pg/ml. An analysis of investigations showed that significant increase in LH by 16 times, FSH – by 4.4 times, estradiol – by 3.6 times and insignificant level of GH by 1.2 times in comparison with normal values. The treatment was recommended with Difirilini 3.75.

Conclusions: On the basis of clinical-laboratory data and MRI findings, the diagnosis was established: the true precocious pubertal development, hamartoma in the pituitary body.