An 8-year-old girl presents with breast budding (B2), sparse pubic hair, and a bone age of 11 years. She has no neurological symptoms. FSH and LH are suppressed; estradiol is mildly elevated; GnRH stimulation test shows prepubertal LH response. DHEAS is elevated. The most likely diagnosis is:

• A Central (GnRH-dependent) precocious puberty
• B McCune-Albright syndrome
• C Premature adrenarche with pseudoprecocious puberty ✓
• D Congenital adrenal hyperplasia (non-classical)

Explanation

Premature adrenarche with pseudoprecocious puberty features pubic hair due to early adrenal androgen (DHEAS) production before age 8 in girls, with normal or mildly advanced bone age and suppressed GnRH-dependent axis (FSH, LH suppressed; prepubertal LH response to GnRH). The breast budding here is possibly thelarche as part of the overall hormonal milieu. McCune-Albright is associated with autonomous FSH-independent follicular cysts causing elevated estradiol AND suppressed LH, but classically presents with café-au-lait spots and fibrous dysplasia. Central PP shows pubertal LH response to GnRH stimulation. Non-classical CAH presents with androgen excess symptoms and elevated 17-OHP.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.