A case of precocious puberty in a female

Abstract

A detailed study has been made of the first seven years of the life of a child in whom the initial signs of sexual development were observed at the age of 5 months and the first menstrual period occurred at 9 months. The diagnosis of 'constitutional' precocious puberty was based upon the occurrence of premature but orderly sexual maturation, together with the absence of any evidence pointing to an organic lesion. Exploratory laparotomy at the age of 27 months demonstrated normal ovarian tissue with a recent corpus luteum. Weight and height charts were available from birth, while subsequent physical and mental development was assessed on six occasions between the ages of I year 8 months and 6 years 11 months. Studies included somatic measurements, dental examinations, skeletal and dental radiographs, the features of sexual development, an assessment of physical skills, psychometric tests, and detailed investigation of emotional and social adjustment at home and at school. As has been previously observed, the effects of the precocious stimulant upon various anatomical and physiological systems differed considerably in both extent and rate. The most marked degree of precocity occurred in relation to sexual development, followed in descending order by skeletal development and weight and height increments. Mental development proceeded at a uniform rate slightly above average and appeared to be uninfluenced by other factors, while the eruption and calcification of the teeth were normal for age. The child was no more mature socially and emotionally than her high level of intelligence warranted, while psycho-sexual development showed no precocity. Cases of this type require no active medical treatment, but psychological guidance should be available to the patient, the parents and the teachers in order that the various agencies may be co-ordinated to promote the child's optimum adjustment. If reasonable care is taken in these matters there is no reason why the psychological prognosis should not be as good as the medical.