An 8-year-old girl develops breast budding (Tanner stage 2) and pubic hair. Her bone age is 11 years. GnRH stimulation test shows pubertal LH/FSH response (LH/FSH > 1 post-stimulation). Pelvic ultrasound shows multicystic ovaries. What is the diagnosis and the PREFERRED treatment?
- A Central (GnRH-dependent) precocious puberty; GnRH agonist (leuprolide) therapy ✓
- B Premature adrenarche; no treatment required
- C McCune-Albright syndrome; aromatase inhibitor
- D Peripheral (GnRH-independent) precocious puberty; ketoconazole
Explanation
This is central precocious puberty (CPP): early breast development in a girl <8 years, advanced bone age, and a pubertal LH response to GnRH stimulation (LH > FSH post-GnRH, LH:FSH ratio >1). Treatment with GnRH agonists (leuprolide depot, triptorelin) downregulates the HPG axis via receptor desensitization, halting progression of puberty and preserving adult height potential. McCune-Albright shows café-au-lait spots, polyostotic fibrous dysplasia, and GnRH-independent (peripheral) puberty with a low LH:FSH ratio. Premature adrenarche is isolated pubic hair without breast development or bone age advance.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.