Gynecomastia and Premature Thelarche: A Guide for Practitioners

Division of Pediatric Endocrinology, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL, USA.
Pediatrics in Review (Impact Factor: 0.82). 10/2007; 28(9):e57-68. DOI: 10.1542/pir.28-9-e57
Source: PubMed


Gynecomastia in males and premature thelarche in females are common conditions in the pediatric population. Although gynecomastia and premature thelarche represent benign physiologic conditions in most cases, it is important to recognize and treat those patients who may have underlying pathologic conditions. Clues to underlying disease include age of onset, extent and progression, presence of accompanying signs of pubertal development, and use of drugs. If clues to underlying conditions are identified, referral to a specialist is warranted.

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    • "Five of the EP girls (pts 1, 3, 4, 7, 8 and 15) had a history of being born SGA. They all achieved catch-up growth, defined as at least 0.67 SDS increase in weight SDS and height SDS around 3 years of age compared with birth weight and height (22). Two of these girls (pts 3 and 15) were started on GnRH analogue (GnRHa) treatment at 7.3 and 7.7 years of age, respectively. "
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    ABSTRACT: Objective: Premature thelarche (PT) refers to isolated onset of thelarche in girls younger than 8 years of age. Most cases have an onset under 2 years of age. We aimed to establish whether the onset of thelarche under 2 years of age certifies a transient clinical course, as suggested by several authors. Methods: Sixty-seven girls with an onset of PT under 2 years of age were classified as having early puberty (EP) or classical PT after one year of follow-up. Progression of pubertal findings or absolute growth velocity (GV) standard deviation score (SDS) above 1 SDS constituted the criteria for a diagnosis of EP. Results: Twenty (29.1%) girls were classified as having EP and 47 (70.1%) girls as having classical PT. Basal serum luteinizing hormone (LH; ICMA) values at a cut-off level of 0.3 IU/L were found to be a significant risk factor for having an atypical course [OR=7.8; CI (95%): 2.04– 30.4, p=0.003]. Conclusions: Onset of thelarche under 2 years of age does not assure a transient course in a remarkable proportion of girls with PT. An absolute GV value of >1 SDS or a basal LH level ≥0.3 IU/L are suggested as indicators for close follow-up. Conflict of interest:None declared.
    Journal of Clinical Research in Pediatric Endocrinology 09/2012; 4(3):140-5. DOI:10.4274/Jcrpe.709
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    • "accelerated growth velocity, advanced bone maturation, axillary and pubic hair development) in girls below the age of 8 years. Although the onset of PT shows a peak around the first two years of life, it may also occur during any period between the ages of 2 and 8 years (1,2). PT may be a mild benign form of hypothalamic-pituitary-gonadal (HPG) axis activation and occasionally, may develop as a result of an accelerated maturation of HPG axis activation. "
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    ABSTRACT: Premature thelarche (PT) is defined as isolated breast development without secondary sex characteristics in girls below the age of eight. We aimed to determine whether the level of kisspeptin, which plays a role in the release of gonadotropins, is associated with PT. The patient group included children with PT aged 3-8 years (n=20) and the control group included healthy children in the same age range (n=20). Height standard deviation scores (HSDSs), bone maturation and growth velocity were evaluated in the two groups. Basal follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and sex hormone-binding globulin (SHBG) levels were also measured in the two groups by immunochemiluminometric assay (ICMA). A gonadotropin-releasing hormone (GnRH) test was also conducted in the patient group and the peak levels of FSH and LH were determined. Kisspeptin levels were measured using enzyme immunoassay (EIA). No differences were found between the groups in terms of age, HSDS, annual growth rate and bone age. While the plasma basal FSH, LH and E2 levels in the patient and control groups did not show statistically significant differences, PRL levels were higher in the patient group (p<0.05). Peak LH response to GnRH test was at the prepubertal level (<5 ng/mL) in patients with PT. In the patient group, kisspeptin levels were significantly higher compared to the levels in the control group (2.96 ± 1.21 ng/dL vs. 1.19 ± 0.41 ng/dL, p<0.05), and kisspeptin levels showed a significant correlation with PRL, FSH, LH, and E2 levels (p<0.05). In this study, plasma kisspeptin levels were found to be higher in patients with PT and to show a positive correlation with increased PRL levels. Kisspeptin is one of the neuropeptides that plays a role in the onset of puberty. Our results support the hypothesis that PT may result from the temporary activation of central stimulants.
    Journal of Clinical Research in Pediatric Endocrinology 06/2012; 4(2):61-5. DOI:10.4274/jcrpe.615
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    ABSTRACT: Gynecomastia is often benign, but it can be the sign of serious endocrine disease and the source of significant embarrassment and psychological stress. Understanding its pathogenesis is crucial to distinguish a normal developmental variant from pathological causes. There is a growing list of potential causes of gynecomastia. Rare and unique case reports continue to supplement the literature to augment our understanding of this common physical finding. However, the exact basis for the pathogenesis of gynecomastia remains unknown. There appears to be a local imbalance between estrogen stimulation and the inhibitory action of androgens on breast tissue proliferation. Gynecomastia in a prepubertal boy is rare and should prompt an immediate evaluation for possible endocrine disorder. Pubertal gynecomastia, on the contrary, is common and usually physiological, with sympathetic reassurance and watchful waiting the mainstays of treatment. There is some evidence that early pharmacological intervention with antiestrogens may diminish persistent pubertal gynecomastia, but treatment with an aromatase inhibitor has not been shown to be more effective than placebo. Treatment of gynecomastia is geared toward its specific cause. Currently, there are insufficient data to recommend medical therapy in children with idiopathic gynecomastia.
    Current opinion in pediatrics 09/2008; 20(4):465-70. DOI:10.1097/MOP.0b013e328305e415 · 2.53 Impact Factor
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