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Pediatric Annals Jan 2018Premature thelarche is a benign condition that affects young girls and may be interpreted as a sign of central precocious puberty (CPP). Parental concern is common when... (Review)
Review
Premature thelarche is a benign condition that affects young girls and may be interpreted as a sign of central precocious puberty (CPP). Parental concern is common when breast development is noted in a young girl. It is important to differentiate premature thelarche from CPP, as the latter is a more serious disorder that may affect final adult height and menarcheal age, and may have psychological implications as well. Distinguishing between the two conditions clinically may help the patients avoid unnecessary testing. Pediatricians can play a pivotal role by providing reassurance to families and helping alleviate parental anxiety. This article reviews the clinical presentation of premature thelarche, its usual course, and implications. [Pediatr Ann. 2018;47(1):e12-e15.].
Topics: Breast; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Puberty; Puberty, Precocious
PubMed: 29323691
DOI: 10.3928/19382359-20171214-01 -
Current Pediatric Reviews Jul 2023Premature thelarche is the most common pubertal disorder in girls. The condition should be differentiated from central precocious puberty which may result in early...
BACKGROUND
Premature thelarche is the most common pubertal disorder in girls. The condition should be differentiated from central precocious puberty which may result in early epiphyseal fusion and reduced adult height, necessitating treatment.
OBJECTIVE
The purpose of this article is to familiarize physicians with the clinical manifestations of premature thelarche and the clinical features and laboratory tests that may help distinguish premature thelarche from central precocious puberty.
METHODS
A search was conducted in September 2022 in PubMed Clinical Queries using the key term " Premature thelarche". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used to compile the present article.
RESULTS
Premature thelarche denotes isolated breast development before the age of 8 years in girls who do not manifest other signs of pubertal development. The condition is especially prevalent during the first two years of life. The majority of cases of premature thelarche are idiopathic. The condition may result from an unsuppressed hypothalamic-pituitary-gonadal axis in the early years of life, an "overactivation" of the hypothalamic-pituitary axis in early childhood secondary to altered sensitivity to steroids of the hypothalamic receptors controlling sexual maturation, increased circulating free estradiol, increased sensitivity of breast tissue to estrogens, and exposure to exogenous estrogens. The cardinal feature of premature thelarche is breast development which occurs without additional signs of pubertal development in girls under 8 years of age. The enlargement may involve only one breast, both breasts asymmetrically, or both breasts symmetrically. The breast size may fluctuate cyclically. The enlarged breast tissue may be transiently tender. There should be no significant changes in the nipples or areolae and no pubic or axillary hair. The vulva, labia majora, labia minora, and vagina remain prepubertal. Affected girls have a childlike body habitus and do not have mature contours. They are of average height and weight. Growth and osseous maturation, the onset of puberty and menarche, and the pattern of adolescent sexual development remain normal. Most cases of premature thelarche can be diagnosed on clinical grounds. Laboratory tests are seldom indicated. No single test can reliably differentiate premature thelarche from precocious puberty.
CONCLUSION
Premature thelarche is benign, and no therapy is necessary apart from parental reassurance. As enlargement of breasts may be the first sign of central precocious puberty, a prolonged follow-up period every 3 to 6 months with close monitoring of other pubertal events and linear growth is indicated in all instances.
PubMed: 37496240
DOI: 10.2174/1573396320666230726110658 -
The Journal of Clinical Endocrinology... Nov 2019Previous case reports associated prepubertal gynecomastia with lavender-containing fragrances, but there appear to be no reports of premature thelarche.
CONTEXT
Previous case reports associated prepubertal gynecomastia with lavender-containing fragrances, but there appear to be no reports of premature thelarche.
OBJECTIVE
To add to a case series about lavender-fragranced product use and breast growth in children and to measure endocrine-disrupting chemical activity of essential oil components.
DESIGN, SETTING, AND PATIENTS
Patients experiencing premature thelarche or prepubertal gynecomastia with continuous exposure to lavender-fragranced products were evaluated in the pediatric endocrinology departments of two institutions. Mechanistic in vitro experiments using eight components of lavender and other essential oils were performed at National Institute of Environmental Health Sciences.
MAIN OUTCOME MEASURES
Case reports and in vitro estrogen and androgen receptor gene expression activities in human cell lines with essential oils.
RESULTS
Three prepubertal girls and one boy with clinical evidence of estrogenic action and a history of continuous exposure to lavender-containing fragrances were studied. Breast growth dissipated in all patients with discontinuation of the fragranced products. Some of the components tested elicited estrogenic and antiandrogenic properties of varying degrees.
CONCLUSION
We report cases of premature thelarche that resolved upon cessation of lavender-containing fragrance exposure commonly used in Hispanic communities. The precise developmental basis for such conditions could be multifactorial. In vitro demonstration of estrogenic and antiandrogenic properties of essential oil components suggests essential oils in these cases could be considered a possible source and supports a possible link with idiopathic prepubertal breast development. Whether the level of lavender oil estrogenic potency is sufficient to cause these effects is unknown.
Topics: Breast; Cell Line, Tumor; Child; Child, Preschool; Endocrine Disruptors; Estrogen Receptor alpha; Female; Gynecomastia; Humans; Lavandula; Male; Nuclear Receptor Coactivator 2; Oils, Volatile; Plant Oils; Puberty, Precocious; Receptors, Androgen
PubMed: 31393563
DOI: 10.1210/jc.2018-01880 -
The Journal of the Singapore Paediatric... 1989
Review
Topics: Breast; Diagnosis, Differential; Female; Humans; Hypothalamo-Hypophyseal System; Ovarian Cysts; Puberty, Precocious
PubMed: 2671495
DOI: No ID Found -
Pediatric Endocrinology Reviews : PER Mar 2008Premature thelarche is a benign condition, which has been described as a "variant of puberty". Early breast development is especially prevalent during the first year of... (Review)
Review
Premature thelarche is a benign condition, which has been described as a "variant of puberty". Early breast development is especially prevalent during the first year of life, when the gonadal axis is usually active. Ultrasensitive bioassays have described higher estrogen levels in these girls compared to controls. Some cases of premature thelarche may also exhibit increased growth velocity and/or bone age, despite prepubertal gonadotropin secretion. These cases have been labeled as exaggerated thelarche and may represent an intermediate state between benign premature thelarche and precocious puberty. Several factors have been associated with the etiology of premature thelarche, such as endocrine disruptors, and genetic and nutritional factors. Recently, it has been shown that some girls with exaggerated or fluctuating thelarche may have an activating mutation in the GNAS gene, which codifies for alpha subunit of G stimulating protein (Gsalpha). We discuss the different phenotypes that may be associated with PT and its etiology.
Topics: Breast; Child; Chromogranins; Female; GTP-Binding Protein alpha Subunits, Gs; Genotype; Humans; Phenotype; Puberty, Precocious
PubMed: 18367996
DOI: No ID Found -
Hormone Research in Paediatrics 2020
Topics: Adrenarche; Breast; Female; Humans; Male; Puberty, Precocious; Unnecessary Procedures; Watchful Waiting
PubMed: 33352558
DOI: 10.1159/000512764 -
Archives of Disease in Childhood Aug 1982
Topics: Age Factors; Breast; Child; Child, Preschool; Dehydroepiandrosterone; Female; Humans; Infant; Puberty, Precocious
PubMed: 6214219
DOI: 10.1136/adc.57.8.642 -
TouchREVIEWS in Endocrinology Nov 2023Various studies, conducted since 2007, have reported a total of eight boys with prepubertal gynaecomastia and four girls with premature thelarche following exposure to... (Review)
Review
Various studies, conducted since 2007, have reported a total of eight boys with prepubertal gynaecomastia and four girls with premature thelarche following exposure to lavender and/or tree tea oil. All patients experienced regression of the breast tissue after they stopped using these oils. Both of these essential oils, and several of their constituents, have oestrogenic and antiandrogenic activity . However, limited dermal penetration of some of the components means that the findings cannot be extrapolated to the situation. There are unanswered questions as to how much lavender or tea tree oil was actually present in the skincare products used by the children and a lack of information about exposure to other agents. Furthermore, since both prepubertal gynaecomastia and premature thelarche often spontaneously regress, it cannot be concluded that the use of lavender and/or tree tea oil is the cause of the gynaecomastia and thelarche in these children.
PubMed: 38187077
DOI: 10.17925/EE.2023.19.2.9 -
Journal of Pediatric Endocrinology &... Jul 2000Not only is the diagnosis of isolated premature thelarche difficult to distinguish from other variants of premature sexual maturation, but within the subgroups of... (Review)
Review
Not only is the diagnosis of isolated premature thelarche difficult to distinguish from other variants of premature sexual maturation, but within the subgroups of isolated premature thelarche, there are probably at least two subgroups: "classical" and "atypical". We do not appreciate how potential treatment could affect each group, although it seems likely that those in the "classical" group would not have an indication for treatment. The longer-term follow-up of large numbers of patients is essential if we are to understand the long-term sequelae of this condition.
Topics: Aging; Brain Diseases; Breast; Female; Follow-Up Studies; Humans; Puberty, Precocious
PubMed: 10969928
DOI: 10.1515/jpem.2000.13.s1.827 -
Best Practice & Research. Clinical... Apr 2018Over the past 20 years, a clear secular trend toward the earlier onset of puberty has been described. A better knowledge should help clinicians attempting to define both... (Review)
Review
Over the past 20 years, a clear secular trend toward the earlier onset of puberty has been described. A better knowledge should help clinicians attempting to define both precocious and delayed puberty (PP and DP, respectively). The definition of PP for girls is the appearance of secondary sex characteristics development before the age of 8 years, while DP is based on the absence of thelarche at the age of 13 years. Regarding PP, one should clinically distinguish between true precocious puberty, i.e., complete or central PP, and incomplete PP, which refers to premature thelarche, premature pubarche, and isolated menarche. Evaluation of girls of PP requires careful examination of the clinical expression, a GnRH test, and imaging of the central neurosystem. GnRH analog is considered the gold standard treatment of central precocious puberty. Peripheral PP should be managed according to the underlying causes. DP is suspected in girls with no breast development by the age of 13 years, or absence of menarche at 15 years with secondary sex characteristics. The clinical examination along with endocrine, radiological, and genetic investigation should be able to identify girls with permanent hypogonadism as opposed to those with transitory hypogonadism, who undergo spontaneous but DP. Estrogen therapy should be discussed according to the causes of DP. In all cases, emotional and psychosocial disorders should be considered for these girls with disorders of puberty.
Topics: Adolescent; Child; Female; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Menarche; Puberty, Delayed; Puberty, Precocious
PubMed: 29422239
DOI: 10.1016/j.bpobgyn.2017.11.004