A 7-year-old girl presents with pubic hair (Tanner stage 2) and breast development. Bone age is 10 years. GnRH stimulation test shows LH >5 IU/L (pubertal response). Basal LH is elevated. The most likely diagnosis and first-line treatment is:

• A Premature adrenarche — no treatment needed, observe
• B McCune–Albright syndrome — aromatase inhibitor
• C Central (gonadotropin-dependent) precocious puberty — GnRH agonist (leuprolide) therapy ✓
• D Congenital adrenal hyperplasia — glucocorticoid replacement

Explanation

Pubertal signs before age 8 in girls (6 in African American girls) with elevated basal LH and pubertal LH response to GnRH stimulation confirms central (GnRH-dependent/gonadotropin-dependent) precocious puberty. Treatment with long-acting GnRH agonists (leuprolide, triptorelin) suppresses the HPG axis, slows advancement of bone age, and preserves adult height potential. McCune-Albright is GnRH-independent with cafe-au-lait spots and polyostotic fibrous dysplasia. Premature adrenarche shows isolated pubic/axillary hair without breast or genital development.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.