A 7-year-old girl develops breast budding (Tanner stage II), pubic hair, and accelerated growth velocity. Bone age is 10 years. GnRH stimulation test shows LH > FSH response (LH:FSH ratio >1). What is the diagnosis and treatment?
- A McCune-Albright syndrome; treat with aromatase inhibitor
- B Premature adrenarche; reassurance only
- C Congenital adrenal hyperplasia; treat with hydrocortisone
- D Central (gonadotropin-dependent) precocious puberty; treat with GnRH agonist ✓
Explanation
Central precocious puberty (CPP) is defined as puberty beginning before age 8 in girls or 9 in boys, driven by premature activation of the hypothalamic-pituitary-gonadal axis. The GnRH stimulation test showing a pubertal LH:FSH ratio (LH peak >5 IU/L, LH:FSH > 1) confirms gonadotropin-dependent CPP. Treatment with long-acting GnRH agonists (leuprolide, triptorelin) suppresses gonadotropin secretion, preserves adult height, and prevents early menarche and psychological consequences. McCune-Albright is GnRH-independent (peripheral) with café-au-lait spots and fibrous dysplasia. Premature adrenarche shows DHEAS elevation without LH/FSH rise.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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