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Endocrinology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Mehul Dattani, Catherine Peters
In premature thelarche, girls usually present with isolated early breast development (Fig. 13.30). Over 80% of girls have cyclical breast development that waxes and wanes at intervals of 4–6 weeks. The age of onset is usually below 2 years and frequently continues as an extension of the neonatal breast enlargement, due to placental transmission of maternal oestrogens. Such development is usually associated with isolated ovarian cyst development, which is due to premature but isolated pulsatile FSH secretion. The uterus is of an appropriate size and shape for age, with no endometrial echo and only exceptionally is there a vaginal bleed. Growth is at a normal rate, and the bone age is not advanced. There are no other signs of puberty.
Hormone therapy
Published in Claud Regnard, Margaret Kindlen, Supportive and Palliative Care in Cancer, 2018
Claud Regnard, Margaret Kindlen
Drugs acting against testosterone: a reduced sex-drive is common with some drugs (cyproterone acetate) but is much less likely to occur with others (e.g. flutamide). They can cause breast enlargement in men but other side effects are unusual. Older drugs (e.g. diethylstilboestrol) are used less frequently because, although effective, they initially cause an increase in the growth of prostate cancer – called a ‘tumour flare’.
The breast
Published in Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse, Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse
All males have nipples and rudimentary breasts. Gynaecomastia is an abnormal development of both the ductal and stromal elements, with the following patterns of presentation: Transient breast enlargement in male infants due to ingestion of maternal oestrogens.Breast development in adolescents, presumably caused by a temporary imbalance of adrenal and testicular steroid hormones.Breast enlargement in middle-aged adults, usually idiopathic, but in some cases blamed on repeated minor trauma from belts and harnesses. It is usually bilateral.Breast enlargement in elderly males, almost invariably caused by drugs. This may be an expected part of the action of the drug, as with the use of oestrogens for prostatic carcinoma. (A similar effect occurs in younger males abusing anabolic steroids.) Gynaecomastia may also be a true side-effect of histamine antagonists, diuretics and cardiac drugs. Curiously, it tends to resolve without the offending agent having to be stopped.A very few cases are caused by inappropriate hormone secretion, as may occur in cirrhosis of the liver and bronchial carcinoma.
Identification of rare missense mutations in NOTCH2 and HERC2 associated with familial central precocious puberty via whole-exome sequencing
Published in Gynecological Endocrinology, 2020
Hae Sang Lee, Hwal Rim Jeong, Jung Gi Rho, Chang Dae Kum, Kyung Hee Kim, Do Wan Kim, Jae Youn Cheong, Seon-Yong Jeong, Jin Soon Hwang
NOTCH2 and HERC2 missense variants were identified in two siblings with CPP. Their father and mother each had a missense variant in either the NOTCH2 or HERC2 genes (Figure 1). The proband was referred to our department at the age of 8.8 years because of breast enlargement, which had started 1 year earlier. A physical examination showed Tanner stage III for breast development, and Tanner stage I for pubic hair growth. Her height and weight were within the normal range for her age (height 138.7 cm, 1.5 height standard deviation score (SDS) and weight 30.5 kg, 0.47 weight SDS). Bone age was 11.5 years according to the Greulich and Pyle method. Basal LH and FSH levels were 1.4 IU/l and 7.2 IU/l, respectively. On GnRH stimulation testing, a LH peak level of 13.4 IU/l and an FSH peak level of 8.7 IU/l, were observed, respectively. Her younger sister was also referred for breast development when she was 8.2 years. She exhibited breast development 6 months prior. Her bone age was 10.5 years, and physical examination showed Tanner stage II for breast development and Tanner stage I for pubic hair growth. GnRH stimulation testing was performed at 8.7 years of age, and hormonal levels revealed activation of the hypothalamus-pituitary axis. Their father’s height was within normal range (173 cm and 0.1 SDS, on the basis of the Korean National Growth Chart). Their mother’s height was 153 cm (−1.52 SDS) and her menarche was at approximately 10 years of age, which is earlier than the average menarcheal age in the Korean population. However, she was unable to recall precisely her pubertal history.
Serum Makorin ring finger protein 3 values for predicting Central precocious puberty in girls
Published in Gynecological Endocrinology, 2019
Hwal Rim Jeong, Hye Jin Lee, Yeong Suk Shim, Min Jae Kang, Seung Yang, Il Tae Hwang
Forty-one girls with idiopathic CPP aged 7.0–8.9 years and 35 age-matched normal controls who visited the Pediatric Endocrinology Department at the Hallym Medical Center for their growth checkup between 1 March 2013 and 31 August 2015 were enrolled. The patients all exhibited breast enlargement appearing before the age of 8 years. Bone ages (BA) were found to be at least 1 year ahead of the patients’ chronological age (CA). A GnRH stimulation test was carried out in all patients to confirm that the HPG axis had been activated, as revealed by peak luteinizing hormone (LH) levels ≥ 5.0 IU/L on a chemiluminescent microparticle immunoassay (CLIA). There was no history of familial CPP in the patient group. Cases of precocious puberty with an identified etiology, such as a brain tumor or cranial irradiation, were excluded. Individuals ruled small for gestational age and those with chronic diseases were also excluded. All patients had normal brain magnetic resonance imaging (MRI) and pelvic ultrasonography results. All plasma thyroxine and thyroid-stimulating hormone (TSH) levels were within normal ranges.
Gynecomastia: glandular-liposculpture through a single transaxillary one hole incision
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Yung Ki Lee, Jun Hee Lee, Sang Yoon Kang
The timing of the surgery for adolescent gynecomastia is important to consider. It is evident that treatment in this period should be delayed since spontaneous regression is expected in the majority of patients. Nydick et al. [7] first reported that only 7.7% of adolescent gynecomastia persisted over three years. In addition, other studies also support that less than 10% of gynecomastia persists after 17 years of age [3,26]. We strongly believe that the only indication for surgical intervention during puberty is the unusual case of extreme breast enlargement, which is associated with significant negative psychological effects. Among our patients, one was a middle school student aged 13 years. We tried to dissuade the patient from undergoing surgical intervention. However, the patient was continuously avoiding social interactions and suffering from psychological stress, body dissatisfaction, anxiety and depression, as well as marked breast enlargement. The patient and the parents were notified of the high possibility of spontaneous resolution and the risk of recurrence. Nonetheless, owing to the aforementioned psychological impact, they opted to proceed with the surgical treatment.