A 6-year-old girl presents with breast development (Tanner stage 2), pubic hair, and a bone age of 8 years. GnRH stimulation test shows LH response of 12 IU/L (basal LH 0.8 IU/L). She has no headache or visual symptoms. MRI brain is normal. What is the most appropriate management?
- A Reassurance and monitoring only
- B Cyproterone acetate oral therapy
- C Ketoconazole to block androgen synthesis
- D GnRH agonist (leuprolide) therapy to suppress puberty ✓
Explanation
This child has central precocious puberty (CPP) — confirmed by GnRH stimulation showing an LH-predominant response (LH >5 IU/L or LH:FSH ratio >1) with advanced bone age. In a 6-year-old girl with CPP, GnRH agonist therapy (leuprolide or triptorelin) is indicated to suppress the HPG axis, halt pubertal progression, and protect final adult height by delaying bone maturation. GnRH agonists cause desensitization of pituitary GnRH receptors. Ketoconazole is used for peripheral (GnRH-independent) precocity (e.g., McCune-Albright). Cyproterone is used for puberty in boys with familial male-limited precocious puberty.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.