Girls over 8 Years
Clinical Findings
Breast development with one or more of the following signs:
- Progressing over time
- Accelerated growth
- Vaginal bleeding
- Headaches and/or visual changes
- Multiple Café au lait spots > 1.5 cm (possible McCune Albright Syndrome)
Referral Timeframe
URGENT: Call MD on-call to discuss and start treatment.
On-Call Phone #
Day: (512) 628-1830
After Hours: (512) 323-5465
Pre-Referral Workup
- Bone age
- TSH and T4 or Free T4 by dialysis
- Pediatric LH (CPL 2776, Esoterix 500234, Lab Corp 502286)
- Pediatric FSH (CPL 2700, Esoterix 500192, LabCorp 502280)
- Ultrasensitive Estradiol (CPL 5678, Esoterix 500152, Lab Corp 500108)
- Please get labs at 8am
Referral Requirements
- Growth chart
- Bone age results- Please have parent bring a copy of film/CD to appointment.
- Lab results
- Relevant clinical notes with physical examination including Tanner stage.
Girls 6-8 Years
Clinical Findings
Breast development without the above signs
Referral Timeframe
Routine
Pre-Referral Workup
Same as above
Referral Requirements
Same as Above
Girls 2-6 Years
Clinical Findings
Breast development without the above signs
Referral Timeframe
URGENT: Call MD on-call to discuss and start treatment.
Pre-Referral Workup
Same as above
Referral Requirements
Same as Above
Girls under 2 Years
Clinical Findings
Breast development without the above signs
Referral Timeframe
May NOT need referral
Pre-Referral Workup
None
Referral Requirements
Call Endocrine with any questions or concerns
Facts to Remember
- Standard LH, FSH, Estradiol or Testosterone assays are not reliable for children, please use test codes provided.
- Consider imaging testing such as pelvic ultrasound or brain and pituitary MRI if warranted.
- In benign premature thelarche, the nipples are not usually dark or enlarged as seen in precocious puberty.
- Fine downy and non-pigmented short hair is not considered secondary sexual pubic hair.
- Pubic hair on the suprapubic area is more indicative of precocious puberty than hair on the labial majora or scrotum.