A 6-year-old girl presents with breast development (Tanner stage II), pubic hair (Tanner stage II), and accelerated growth velocity. Bone age is 9 years. GnRH stimulation test shows LH >8 IU/L (LH>FSH). MRI brain is normal. What is the MOST appropriate management?
- A Reassurance and observation; reassess in 6 months
- B Letrozole (aromatase inhibitor) to slow bone age advancement
- C Cyproterone acetate to suppress androgen-mediated effects
- D GnRH agonist (leuprolide acetate depot) every 4 weeks ✓
Explanation
This is central (GnRH-dependent) precocious puberty (CPP) in a girl under 8 years, confirmed by GnRH stimulation showing a pubertal LH response (LH >8 IU/L, LH>FSH pattern). The standard treatment is a GnRH agonist (e.g., leuprolide acetate long-acting depot, or histrelin implant) which suppresses the pituitary-gonadal axis through receptor downregulation after initial stimulation. This halts pubertal progression, decelerates bone age advancement, and improves predicted adult height. Letrozole is used as an adjunct in some cases but is not first-line monotherapy. Cyproterone acetate blocks androgen receptors and is used in peripheral precocious puberty (McCune-Albright, CAH) but not in GnRH-dependent CPP. Reassurance is inappropriate given significant bone age advancement.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.