Original studiesLabial Adhesions in a Girl with Isolated Premature Thelarche: The Importance of Estrogenization
Introduction
Premature thelarche is defined as isolated breast development with no other clinical signs of sexual maturation in girls before the age of 8 yrs. It commonly commences as unilateral breast development. The most common age for presentation is under 15 months, and most girls are younger than 2 yrs. There is another peak incidence (nonclassical) between 6 and 8 yrs, but this is less common.1, 2 The mechanism of premature thelarche is unknown, although increased estrogen levels can be detected by serum measurements,1, 2, 3 uterine ultrasound,4 and vaginal cytology.1
Labial fusion is defined as partial or complete adherence of the labia minora. The labia minora adhere together in the midline where a translucent vertical line can usually be seen. This condition is a common pediatric gynecological problem and occurs more frequently between 3 months and 3 yrs, having a peak incidence at 13 to 23 months of age.5 The etiology is not known but is associated with low estrogen status; treatment usually involves administration of topical estrogen cream.6 However, labial fusion may be caused by infections, inflammatory conditions, or dermatological conditions, as well as local irritants. Recurrences of labial fusion are common until the girl starts to produce endogenous estrogen in late prepuberty.6
Section snippets
Case Report
A 2-yr-old girl presented with a 7-month history of itchiness around the vaginal area and a palpable painless unilateral breast bud. There was no vaginal discharge or bleeding and no urinary tract infections or vulvovaginitis. She had been born at 38 weeks' gestation following an elective caesarian section and there were no perinatal complications.
She had an appropriate height for the parental centiles and was growing at a normal rate. Examination revealed unilateral breast enlargement (Tanner
Comment
We have described a 2-yr-old girl with isolated premature thelarche and labial fusion, occurring contemporaneously. The pelvic ultrasound findings and gonadotrophin responses to intravenous LHRH were typical of isolated premature thelarche.7 Moreover, she had an elevated serum estradiol for her age. In our experience, the combination of isolated thelarche and labial adhesions is unusual. Premature thelarche is associated with raised estrogen concentrations.3, 8 Vaginal cytology in these
References (10)
- et al.
Estrogen levels in girls with premature thelarche compared with normal prepubertal girls as determined by an ultrasensitive recombinant cell bioassay
J Pediatr
(1999) - et al.
Success of medical management of labial adhesions
J Pediatr Adolesc Gynecol
(2001) - et al.
Pediatric and Adolescent Gynecology
(2001) Premature thelarcheclinical follow-up and indication for treatment
J Pediatr Endocrinol Metab
(2000)- et al.
Precocious puberty, premature thelarche, hypogonadism and a child with a feminizing ovarian tumor
J Clin Endocr
(1972)
Cited by (23)
Treatment of Prepubertal Labial Adhesions: A Randomized Controlled Trial
2019, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :However, investigators have found no difference in estrogen levels in prepubertal girls with and without labial adhesions.8 In addition, labial adhesion in association with premature thelarche has been reported, suggesting factors other than estrogen insufficiency as the etiology.9 Although the traditional treatment for labial adhesions has been the application of topical estrogen, there have been recent reports of the use of topical betamethasone with similar, albeit relatively low, efficacy.
Labial adhesion and urinary tract problems: The importance of genital examination
2016, Journal of Pediatric UrologyLabial Adhesions and Outcomes of Office Management
2015, Journal of Pediatric and Adolescent GynecologyClinical Recommendation: Labial Adhesions
2015, Journal of Pediatric and Adolescent GynecologyDo hygienic factors affect labial fusion recurrence? A search for possible related etiologic factors
2012, Journal of Pediatric SurgeryCitation Excerpt :The fact that most of the reported cases other than children are postmenopausal women strengthens this hypothesis [13-15]. However, there have been reports in postpubertal, premenopausal patients [4,16], a patient with premature thelarche [17], and a patient under oral estrogen treatment [9]. No study has shown an association between estrogen levels and labial adhesions [7,9].
How should we treat prepubertal labial adhesions? Retrospective comparison of topical treatments: Estrogen only, betamethasone only, and combination estrogen and betamethasone
2011, Journal of Pediatric and Adolescent GynecologyCitation Excerpt :However, a recent study concluded that there was no difference in estrogen levels in children with and without labial adhesions.8 Another study reported labial fusion with isolated premature thelarche, suggesting the existence of factors other than estrogen insufficiency.9 Traditionally, it has been suggested that local irritation may lead to epithelial sloughing of the labia minora.