The development of secondary sexual characteristics before the expected age and sex is termed precocious puberty. It is usually due to excessive sex steroids production. Cases of precocious puberty are uncommon worldwide with a prevalence of 1/5000-1/10000 per children population and a female to male ratio of 10:1. In Nigeria, the prevalence is unknown with only a few reported cases, probably due to superstitious and religious beliefs. A high proportion of reported cases globally are of the gonadotropin-dependent (central) type. A case is being reported of a 30-month-old female non-identical twin in Cross River State, South-South of Nigeria, who presented with a 6-month history of bleeding per vagina, premature breast development and pubic hair distribution (Tanner stage 3). The patient had appropriate serum concentrations of the pituitary gonadotrophins and gonadal hormones for age. Precocious puberty was not a finding in the family history, and twin and other siblings had normal growth pattern. Radiological and endocrine investigations were diagnostic of precocious puberty. Hence, being proactive with a high index of suspicion is required of clinicians to be able to identify endocrine abnormalities that are increasing in prevalence and are going unnoticed in our environment, among the pediatric age group.
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