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Radiographics : a Review Publication of... 2000Ultrasonography (US) is of value in the evaluation and characterization of breast masses in children. Most masses represent either normal breast tissue, cysts, or... (Review)
Review
Ultrasonography (US) is of value in the evaluation and characterization of breast masses in children. Most masses represent either normal breast tissue, cysts, or fibroadenomas. Premature thelarche may be unilateral, and normal breast tissue is found at US. Cysts are commonly retroareolar; when they become infected, they appear sonographically as a complex mass. Fibroadenoma is the most frequent breast tumor in adolescent girls, and it is usually solitary, homogeneous, and hypoechoic. Malignant breast lesions are very rare in children; most are due to metastatic disease secondary to rhabdomyosarcoma, leukemia, lymphoma, and neuroblastoma, and their US appearance is nonspecific. Gynecomastia in boys can be mimicked by general obesity and pectoral hypertrophy; US is helpful in the diagnosis, especially when gynecomastia is asymmetric. Most breast lesions in children and adolescents are benign, and surgery should be avoided to prevent later deformity. US is the ideal imaging modality to evaluate breast lesions and may be used to guide a fine-needle aspiration biopsy. Color Doppler US evaluation is helpful; cysts are avascular, fibroadenomas may be avascular or hypovascular, and abscesses show peripheral increased flow. Bloody nipple discharge is more common in prepubertal patients, may occur in infants, and may be secondary to mammary ductal ectasia. Discharge commonly resolves spontaneously, and findings at US are frequently normal.
Topics: Adolescent; Breast Diseases; Child; Diagnosis, Differential; Female; Humans; Male; Ultrasonography, Mammary
PubMed: 11112814
DOI: 10.1148/radiographics.20.6.g00nv171605 -
Puerto Rico Health Sciences Journal Mar 2001To describe the natural history and estimate the incidence of premature thelarche in girls aged 6 months to 8 years living in Puerto Rico and diagnosed between 1990 and...
OBJECTIVE
To describe the natural history and estimate the incidence of premature thelarche in girls aged 6 months to 8 years living in Puerto Rico and diagnosed between 1990 and 1995.
BACKGROUND
In the 1970s and 1980s, several pediatric endocrinologists, based on their clinical experience, acknowledged a dramatic increase in the number of cases of precocious sexual development in Puerto Rico. In 1987, the Puerto Rico Health Department developed the Registry of Premature Thelarche and Precocious Sexual Development, which began to operate in 1989. Data regarding the long-term outcomes of girls diagnosed with premature thelarche are insufficient. Knowledge about the natural history of this condition is relevant for predicting the long-term prognosis and therapeutic management of the affected population.
METHODS
Of 2,716 cases of precocious sexual development reported to the Premature Thelarche and Precocious Sexual Development Registry, 1,916 (70.5%) were premature thelarche. The clinical characteristics and evolution during follow-up of premature thelarche cases were described and compared by age group at diagnosis.
RESULTS
Incidences were 6.2 and 1.62 per 1,000 live births for girls aged < 2 years and 2 to 8 years, respectively. These estimates were 10 and 15 times higher than those reported in Olmsted, MN. When the average change in mammary tissue diameter during follow-up was evaluated, a slight reduction in girls aged < 2 years was observed; however, it remained constant for girls aged 2 to 8 years.
CONCLUSIONS
The results of this study underscore the need to continue an active search of premature thelarche cases and to perform analytical investigations of precocious sexual development to expand the understanding of the etiology of this important public health problem.
Topics: Age Factors; Breast; Child; Child, Preschool; Cohort Studies; Female; Follicle Stimulating Hormone; Follow-Up Studies; Humans; Incidence; Infant; Luteinizing Hormone; Poisson Distribution; Puberty, Precocious; Puerto Rico; Uterus
PubMed: 11394211
DOI: No ID Found -
The Journal of Clinical Endocrinology... Sep 2020
Topics: Breast; Endocrine Disruptors; Gynecomastia; Humans; Lavandula; Male; Puberty, Precocious
PubMed: 32579676
DOI: 10.1210/clinem/dgaa392 -
Hormone Research in Paediatrics 2016Polybrominated diphenyl ethers (PBDEs) are widely used as flame retardants and have shown endocrine disruption properties in experimental studies. The aim of this study... (Clinical Trial)
Clinical Trial
BACKGROUND/AIMS
Polybrominated diphenyl ethers (PBDEs) are widely used as flame retardants and have shown endocrine disruption properties in experimental studies. The aim of this study was to investigate the association between the exposure to PBDEs and alterations of puberty in girls referred for idiopathic central precocious puberty (ICPP) and premature thelarche (PT).
METHODS
A case-control study was conducted in 124 girls: 37 girls with ICPP (mean age 7.4 ± 0.9 years), 56 with PT (mean age 5.7 ± 2.1 years) and 31 controls (mean age 5.4 ± 1.9 years). PBDE serum concentrations, hormone levels and anthropometry were assessed. PBDE concentrations were corrected for total serum lipid content. Individual exposure to PBDEs was evaluated through ad hoc questionnaires.
RESULTS
PBDE serum concentrations corrected for total lipid content were significantly higher in girls with PT (mean 1.49 ± 0.63 log ng/g) than in controls (mean 1.23 ± 0.54 log ng/g; p < 0.05). PT girls showed higher levels of PBDE than ICPP girls (1.49 ± 0.63 vs. 1.37 ± 0.49 log ng/g), though this was not significant. An analysis of the questionnaires revealed no significant differences in exposure between the three groups.
CONCLUSION
Our findings suggest that higher concentrations of serum PBDEs are associated with PT in girls.
Topics: Breast; Child; Child, Preschool; Cross-Sectional Studies; Female; Halogenated Diphenyl Ethers; Humans; Puberty, Precocious
PubMed: 27035145
DOI: 10.1159/000444586 -
The Journal of Clinical Endocrinology... Jul 2020
Topics: Breast; Endocrine Disruptors; Gynecomastia; Humans; Lavandula; Male; Puberty, Precocious
PubMed: 32379886
DOI: 10.1210/clinem/dgaa227 -
Endocrine Development 2012Premature development of breast and/or pubic hair in a prepubertal girl used to raise questions and concerns from the families. There is actually a wide range of... (Review)
Review
Premature development of breast and/or pubic hair in a prepubertal girl used to raise questions and concerns from the families. There is actually a wide range of clinical expressions of precocious puberty in girls and not all presentations are considered to be true precocious puberty. Central precocious puberty occurs in 10-20% of girls, but beside the typical forms other clinical presentations have been identified. In 50-60% of the cases, only one secondary sex characteristic shows premature development and raises the diagnosis of premature thelarche, premature pubarche or isolated metrorrhagia. In 10% of the cases, autonomous ovarian overproduction of estrogens causes peripheral precocious puberty. Lastly, hyperestrogenism may have exogenous causes, such as exposure to environmental chemical pollutants. A decision on therapeutic management is based on clinical, biological and radiologic examinations, and LHRH analogous treatment should be limited to central precocious puberty before the age of 8 years.
Topics: Age Determination by Skeleton; Age Factors; Age of Onset; Breast; Child; Female; Humans; Models, Biological; Ovary; Puberty, Precocious
PubMed: 22846523
DOI: 10.1159/000334304 -
Italian Journal of Pediatrics Dec 2019Premature thelarche (PT) is a benevolent ailment affecting young girls. Multiple factors are reported to correlate with this condition, but the mechanisms responsible... (Comparative Study)
Comparative Study
BACKGROUND
Premature thelarche (PT) is a benevolent ailment affecting young girls. Multiple factors are reported to correlate with this condition, but the mechanisms responsible for the onset of PT have not yet been fully investigated. This study aimed to evaluate the relationship of nutrient intake, insulin resistance and lipid profile with PT.
METHODS
Two hundred sixty-three girls with PT, and 222 healthy girls of similar age were enrolled into this study. Their demographics, Tanner stage of breast development, nutrient intake, insulin resistance and lipid profiles were compared.
RESULTS
Daily protein and fat intakes, insulin resistance parameters including serum insulin-like growth factor 1, fasting glucose to insulin ratio, quantitative insulin check index and homeostasis model of assessment of insulin resistance, as well as serum levels of triacylglycerol, total cholesterol and low-density lipoprotein, were all significantly altered in PT patients. Daily intake of energy and carbohydrate, and serum level of high-density lipoprotein protein were statistically indistinguishable between PT patients and healthy controls.
CONCLUSION
Chinese girls with PT are potentially insulin resistant, which warrants more clinical attention and further investigation to address the underlying etiology.
Topics: Age Factors; Blood Glucose; Case-Control Studies; Child; China; Energy Intake; Female; Humans; Insulin; Insulin Resistance; Lipid Metabolism; Nutrients; Puberty, Precocious; Reference Values; Risk Assessment; Statistics, Nonparametric
PubMed: 31856872
DOI: 10.1186/s13052-019-0758-z -
Journal of Clinical Research in... Jun 2012Premature thelarche (PT) is defined as isolated breast development without secondary sex characteristics in girls below the age of eight. We aimed to determine whether...
OBJECTIVE
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.
METHODS
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).
RESULTS
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).
CONCLUSIONS
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.
Topics: Age Determination by Skeleton; Breast; Child; Child, Preschool; Estradiol; Female; Follicle Stimulating Hormone; Humans; Immunoenzyme Techniques; Kisspeptins; Luteinizing Hormone; Prolactin; Puberty, Precocious; Sex Hormone-Binding Globulin
PubMed: 22672861
DOI: 10.4274/jcrpe.615 -
Steroids 1988Premature thelarche is defined as the isolated development of breast tissue in girls less than 8 years of age. Although breast development is an estrogen-dependent...
Premature thelarche is defined as the isolated development of breast tissue in girls less than 8 years of age. Although breast development is an estrogen-dependent process, these girls do not have elevated serum estrogen levels, and the hormonal basis for their condition is unclear. We studied the levels of two estrogen-dependent transport proteins, sex hormone-binding globulin (SHBG) and thyroxine-binding globulin (TBG), in order to determine if there was evidence for a more subtle estrogen effect in girls with premature thelarche. SHBG levels in girls with premature thelarche were not significantly different from those of prepubertal girls of the same ages and were significantly lower than those in girls undergoing pubertal development at the appropriate age (P less than 0.05) and in normal women (P less than 0.001). There was no statistically significant difference in TBG levels between the girls with premature thelarche and prepubertal controls. There was also no significant difference in TBG levels between prepubertal girls and girls in early puberty. In contrast, women had TBG levels that were significantly lower than those in all girls studied. We conclude that the estrogen exposure (whether endogenous or exogenous) of girls with premature thelarche is less than that of girls in early true puberty and similar to that of other prepubertal girls. Further, changes in serum TBG are not as sensitive an indicator of estrogen effect as is breast development or changes in SHBG. This study also suggests that large amounts of exogenous estrogens are not an element in the development of premature thelarche.
Topics: Adolescent; Adult; Breast; Child; Child, Preschool; Data Interpretation, Statistical; Estrogens; Female; Humans; Infant; Puberty, Precocious; Radioimmunoassay; Sex Hormone-Binding Globulin; Thyroxine-Binding Proteins
PubMed: 3151139
DOI: 10.1016/0039-128x(88)90121-3 -
The Journal of Pediatrics Feb 1993We compared the frequency of ovarian microcysts in girls with premature thelarche (n = 27) to that in age-matched control subjects (n = 24). There was an increased...
We compared the frequency of ovarian microcysts in girls with premature thelarche (n = 27) to that in age-matched control subjects (n = 24). There was an increased prevalence of detectable ovarian microcysts in girls with premature thelarche. The presence or absence of cysts did not correlate with basal gonadotropin or estradiol levels.
Topics: Breast; Child, Preschool; Estradiol; Female; Follicle Stimulating Hormone; Humans; Incidence; Infant; Luteinizing Hormone; Ovarian Cysts; Puberty, Precocious; Ultrasonography
PubMed: 8429440
DOI: 10.1016/s0022-3476(06)80123-x