Endocrine Abstracts

A 6-month-old, ex premature 25-week-old girl, presented with 7 episodes of painless vaginal bleeding over 48 hours period and breast development. She was born to a non-consanguineous couple and had normal female genitalia at birth with slightly enlarged clitoris. Her mother had pre-eclampsia and focal segmental glomerulonephritis. Baseline investigations (full blood count, liver/kidney/thyroid function and clotting) were all normal. Endocrine investigations included urine for steroid profile and brain MRI, both normal [ND1]. Transabdominal pelvis ultrasound revealed normal adrenals and prepubertal uterus and follicular appearance of the ovaries measuring 18×10×12 mm on the right, and 12×5z13 mm on the left. The first LHRH test showed a pubertal, LH predominant response. As it was felt this could represent atypical mini-puberty (due to prematurity), puberty suppression was withheld. The repeat LHRH test after 2 months is shown below. She remained under regular follow-up for 6 months. There has not been any further vaginal bleeding, and pubertal signs regressed. LH and oestradiol have remained prepubertal.

Discussion: Mini-puberty in preterm babies is similar to full-term babies but follows a slightly different pattern. The hypothalamic-pituitary-gonadal axis activation is more prolonged. In preterm girls, there is a more pronounced and prolonged increase in FSH levels, and it is a self-resolving condition that gradually returns to the pre-pubertal state without the need for hormonal treatment. However, close monitoring by a paediatric endocrinologist is recommended.