Ovarian microcysts in girls with isolated prematurethelarche

Menstrual Bleeding in a Female Infant with Congenital Adrenal Hyperplasia: Altered Maturation of the Hypothalamic-Pituitary-Ovarian Axis

“…Technical advances in ultrasonography, including methods of enhanced anatomical resolution, have revealed that microcysts of the ovary can be a normal finding in females during the later part of infancy and early childhood (5,6). Maturation of the ovaries begins in early childhood, with the ovarian volumes correlated with age.…”

Normal and Almost Normal Precocious Variations in Pubertal Development Premature Pubarche and Premature Thelarche Revisited

“…Several lines of evidence now indicate that the pituitary-ovarian axis is active during midchildhood. Luteinizing hormone (LH) and folliclestimulating hormone (FSH) are detectable in blood and urine by both bioassay and immunoassay [16,17], Appar ently in response to gonadotropin stimulation, antral folli cle formation increases during childhood according to both histologic and ultrasonographic assessment [18,19], Furthermore, estrogen secretion is occasionally detected both by bioassay (genitourinary tract cytology) and immu noassay [20,21], GnRH testing suggests that the normal prepubertal pattern of gonadotropin synthesis is one of FSH predominance, that FSH predominance increases in early puberty ( fig. 3), and that increasing LH responsive ness coincides with pubertal progression in girls [22], GnRH agonist testing gives similar results [23,24], with the possible exception that the author's group found no change in FSH responsiveness in early puberty, perhaps because the assay used detected different molecular spe cies of FSH than other assays.…”

“…3) [23,24], Premature thelarche is typically associated with a de gree of FSH secretion, antral follicular development and ovarian function above that of prepubertal controls. Basal levels of plasma FSH and its response to GnRH are signif icantly increased, whereas the basal levels and response to GnRH of LH are prepubertal [25,26], Although ovarian follicular development is detectable in normal prepuber tal girls as 'microcysts' discerned by ultrasonography, sev eral studies have shown that the prevalence of these ovari an microcysts is increased in girls with premature the larche [19]. In many patients, plasma estradiol or genito urinary cytology shows evidence of estrogenization [25], The meager data available suggest that girls with prema ture thelarche respond to a GnRH agonist challenge with an early pubertal amount of estrogen secretion, which is predominantly FSH driven [23,27], Thus, the current concept is that premature thelarche is typically a manifes tation of a subtle excess of pituitary-ovarian secretory activity, which is cyclic, as it is in normal premenarcheal girls and mature women [28], A slight revision is proposed to Wilkins' concept [1] that: 'apparently the breast has a lower threshold of response to estrogen than do other female sex organs'.…”

Clinical characteristics of children referred for signs of early puberty before age 3

“…One theory is that it may result from the development of microcysts within the ovary that produce a small amount of estradiol and then regress. In support of this is a study that found microcysts in 56% of girls 6 months to 3 years of age with premature thelarche vs. 21% of age-matched controls (9). The key to recognition of this condition and its differentiation from CPP is normal linear growth and lack of progression over time.…”