A 7-year-old girl develops breast buds with Tanner stage 2 breast development, pubic hair, and menarche at 7.5 years. Bone age is 12 years. GnRH stimulation test shows pubertal LH and FSH response. Which management is MOST APPROPRIATE?
- A Reassure parents and observe; early puberty before age 8 in girls is always a normal variant
- B Administer anti-androgens such as cyproterone acetate to suppress adrenal androgen excess
- C Start GnRH agonist therapy to halt pubertal progression and protect adult height potential ✓
- D Brain MRI is not required because GnRH-dependent CPP in girls under 8 is almost always idiopathic
Explanation
Central precocious puberty (CPP) in girls is defined as onset before age 8. This child has GnRH-dependent CPP (pubertal LH/FSH response on GnRH stimulation test) with advanced bone age (12 years). GnRH agonist therapy (leuprolide, triptorelin) suppresses the HPG axis, arrests pubertal progression, and preserves adult height by slowing bone age advancement. Brain MRI is indicated (not contraindicated) in CPP, especially for girls under 6 years and all boys, to rule out CNS lesions. Anti-androgens are used in GnRH-independent (peripheral) precocious puberty, not CPP. Observation alone would allow bone age to advance, reducing adult height.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.