A 6-year-old girl presents with breast development (Tanner stage 2), pubic hair (Tanner stage 2), and a bone age of 8 years. GnRH stimulation test shows LH rise to 12 IU/L (>8 IU/L). Pelvic ultrasound shows a 2 cm follicular ovarian cyst. MRI brain is normal. What is the most appropriate management?

• A Watchful waiting only
• B Ketoconazole to block androgen synthesis
• C Aromatase inhibitor (letrozole)
• D GnRH agonist (leuprolide) depot injection ✓

Explanation

This child has central (gonadotrophin-dependent) precocious puberty confirmed by an elevated LH response on GnRH stimulation test, indicating hypothalamic-pituitary activation. Despite an apparently reassuring brain MRI, treatment with a GnRH agonist (leuprolide, triptorelin, or histrelin depot) is indicated to suppress the HPG axis, preserve adult height, and prevent psychosocial distress from early puberty. Ketoconazole is used for peripheral precocious puberty (McCune-Albright, familial male-limited precocious puberty). Aromatase inhibitors treat peripheral oestrogen excess.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.