Case (1)

Mariam is a 6.5-year-old girl who presents to the Pediatric clinic with a 1-year history of breast development. She sweats more than previously and has body odour. She has no acne. Her periods have not started. Her mother feels that she has been growing taller at a faster rate in the past year. She has headaches but these occur less than once a month and are not severe. She has no visual problems. Her mother had her menarche at the age of 13 years. There is no past medical history of note. 

Examination revealed that her breasts are Tanner stage B 3, and her pubic hair Tanner stage P2. There is sparse axillary hair. There are no neurological signs and no abdominal masses or organomegaly. Her height, at 133 cm, is just over the 99th centile and her weight, at 27 kg,

is on the 91st centile (mid-parental height between 50th and 75th centile). 

Investigations showed:

Elevated serum estradiol level 

Luteinizing hormone-releasing hormone (LHRH) test: Showed elevated FSH and LH to pubertal levels  both before and after stimulation

Pelvic ultrasound – bilaterally enlarged ovaries

Bone age – 9.5 years


Answer the following questions

  • What is the type of this girl precocious puberty


  • What is the next single most important investigation to be done for this girl


  • What is the most important single medication to be used to arrest progression of her precocious puberty