A 7-year-old girl is brought with breast development for the last 8 months. There is Tanner stage 3 breast development but no pubic or axillary hair, and no acceleration of growth. Bone age is 7.5 years. LH and FSH are prepubertal after GnRH stimulation. What is the MOST likely diagnosis?
- A Gonadotropin-dependent (central) precocious puberty
- B McCune-Albright syndrome
- C Ovarian granulosa cell tumor
- D Premature thelarche (isolated breast development) ✓
Explanation
Premature thelarche is isolated, benign breast development without other signs of puberty (no pubic hair, no accelerated growth, no advanced bone age). The GnRH stimulation test showing prepubertal LH and FSH responses confirms the absence of hypothalamic-pituitary axis activation, distinguishing it from true central precocious puberty. It is most common in girls under 3 years but can occur up to 8 years. Most cases are self-limiting and require only observation. McCune-Albright would show autonomous ovarian activation with prepubertal gonadotropins but also café-au-lait spots and polyostotic fibrous dysplasia.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.