Pseudoprecocious puberty refers to premature onset of secondary sexual characteristics in a female without ovulation or the ability to become pregnant. Causes of pseudoprecocious puberty include juvenile granulosa cell tumors or other ovarian tumors, ovarian cysts, primary hypothyroidism, adrenal insufficiency, feminizing adrenal tumors and exogenous estrogen.


Clinical features:

(1) breast enlargement

(2) development of axillary and pubic hair

(3) enlargement of internal and external secondary sex organs, often with palpable ovaries

(4) irregular uterine bleeding (breakthrough)

(5) a whitish vaginal discharge


Becoming pregnant would indicate true precocious puberty and exclude pseudoprecocious puberty.


Laboratory features:

(1) evidence of elevated levels of estrogens (in serum or plasma, hyperestrogenic effects on the Pap smear, endometrial biopsy, other)

(3) no cyclic increase in progesterone

(2) no signs of ovulation

(3) urinary FSH is usually decreased, associated with inhibition by high estrogen levels

(4) urinary levels of 17-ketosteroids and 17-hydroxyketosteroids are normal

(5) pregnanediol is absent


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