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A 7-year-old girl is seen in your office after her mother began to notice some changes in her physical appearance. The mother says that she first noticed the development of her daughter’s breasts, and she became more worried when her daughter developed both axillary hair. The patient’s grandmother told the mother not to worry because two of the patient's aunts entered puberty at an early age. The patient has not had any behavioral changes or a decline in her school performance, and she denies headaches, visual changes, or vomiting. Physical examination reveals the presence of axillary hair, and breast development at Tanner stage 3. The rest of the examination is unremarkable. GnRH stimulation test results in an increase of LH. Which of the following is the most appropriate management for this patient?
A ). Reassurance
B ). Cyproterone acetate
C ). Danazol therapy
D ). GnRH agonist therapy
E ). Medroxyprogesterone acetate therapy




why pick b, som?


This pt has increased LH....yes you would expect it in puberty....but she is too young for that. A, C, E are ruled out. not sure about D? Cyproterone inhibits LH.


cyproterone acetate is antiandrogen and used in hirsitism.

a is right. This is imcomplete precocious puberty.
complete precocious pub. Rx leuprolide.


Incomplete precocious puberty do not need treatment as estrogen levels are not increased.

Thank you for sharing this question


som wrote:
Incomplete precocious puberty do not need treatment as estrogen levels are not increased.

Thank you for sharing this question

smiling face




gemma22 wrote:

the answer is a.


why reassurance?
central precocious puberty: GnRH stimulation test leads to LH increase, therefore treat with GnRH agonist therapy... at least that's what i learned


yes kaplan says give leupride to avoid the early closure of bones under the effect of high estrogen levels


BONE AGE (xray of the left wrist). could've realy helped.

I agree with incomplete pp or normal variant.. so..

answer: A (reassurance)

If the dx happened to be Central Pre. Puberty (which I think is not).. then others are right in terms of mgmt... leuprolide being gnrh agonist.

Edited by pepsy3 on May 01, 2010 - 9:00 AM


i just saw this one in UW , and they said that the answer is GnRH agonist to suppress the premature closure of epiphysis


I jus did this question in UW... and it clearly states..

"Both axillary and PUBIC hair".. this question is NOT the same as that of UW as some things were taken OFF.

So if you did UW.. you will have FULL information which clearly allows you to pick D as you answer choice.. dx being CPP.

If above stands as a question on its own.. i stick with A.


gemma22 is the one with white n grey matter.

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