A 5-year-old girl presents with breast development (Tanner stage 2) and pubic hair. She has no vaginal bleeding. Bone age is 2 years advanced. GnRH stimulation test shows a pubertal LH response. Which is the MOST appropriate first-line treatment for this condition?
- A Cyproterone acetate (anti-androgen) oral therapy
- B Aromatase inhibitor (anastrozole) to block estrogen synthesis
- C Observation only; treatment is not indicated before age 6
- D GnRH agonist (leuprolide acetate) depot injection ✓
Explanation
This presentation is consistent with central precocious puberty (CPP) — GnRH-dependent, onset <8 years in girls, with advanced bone age and pubertal GnRH response. The treatment of choice for CPP is GnRH agonist (depot leuprolide acetate or triptorelin), which causes downregulation of pituitary GnRH receptors, leading to suppression of LH/FSH and halting of secondary sexual development. This preserves adult height potential by slowing bone age advancement. Aromatase inhibitors are used in GnRH-independent (peripheral) precocious puberty (e.g., McCune-Albright). Cyproterone is not first-line. Observation is inappropriate with 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.