Exaggerated mini-puberty in a preterm girl: a case report and review of literature
-
Martina Lattuada
,
Maria Laura Nicolosi
,
Daniela Doni
Abstract
Objectives
Mini-puberty is the physiological and transient activation of the hypothalamic–pituitary–gonadal axis occurring during the first months after birth. In preterm infants, the hormonal surge is more pronounced and longer-lasting than in at-term-peers. To date, only few cases of vaginal bleeding in the setting of an exaggerated mini-puberty have been reported.
Case presentation
At the corrected age of 3 months, an ex-very-preterm girl presented with breast enlargement and recurrent vaginal bleeding. A remarkable increase in gonadotropins and estradiol levels was detected, while pelvic ultrasound highlighted a large right ovarian cyst. As brain and pituitary MRI showed negative findings, an exaggerated mini-puberty was suspected and no additional investigations were undertaken. The subsequent progressive regression of clinical, biochemical and sonographic findings confirmed the diagnosis.
Conclusions
Although exaggerated mini-puberty of infancy in ex-preterm girls is a rare event, it is important to raise knowledge of this para-physiological condition in order to avoid unnecessary investigations and treatment.
-
Research funding: None declared.
-
Author contributions: ML and AC designed the study. ML, MC, VE, and LO wrote the manuscript. AC drew graphics. SM, MLN, PP, SP, CL, DD, and AC critically revised the paper for important intellectual contents. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
-
Competing interests: The authors declare that they have no conflicts of interest.
-
Informed consent: Informed consent was obtained from the parents of the patient included in this study.
-
Ethical approval: This study adhered to the ethical guidelines for medical and health research involving human subjects established by the government of Italy.
References
1. Kuiri-Hänninen, T, Sankilampi, U, Dunkel, L. Activation of the hypothalamic-pituitary-gonadal axis in infancy: minipuberty. Horm Res Paediatr 2014;82:73–80.10.1159/000362414Suche in Google Scholar
2. Chellakooty, M, Schmidt, IM, Haavisto, AM, Boisen, KA, Damgaard, IN, Mau, C, et al.. Inhibin A, inhibin B, follicle-stimulating hormone, luteinizing hormone, estradiol, and sex hormone-binding globulin levels in 473 healthy infant girls. J Clin Endocrinol Metab 2003;88:3515–20. https://doi.org/10.1210/jc.2002-021468.Suche in Google Scholar
3. Abreu, AP, Kaiser, UB. Pubertal development and regulation. Lancet Diabetes Endo 2016;4:254–64. https://doi.org/10.1016/s2213-8587(15)00418-0.Suche in Google Scholar
4. de Lange, AH, Bocca, G. Vaginal bleeding in a 4-month-old preterm girl: extreme minipuberty mimicking central precocious puberty. J Pediatr Endocrinol 2013;26:595–7. https://doi.org/10.1515/jpem.2011.363.Suche in Google Scholar PubMed
5. Vogiatzi, MG, Pitt, M, Oberfield, S, Craig, AA. Menstrual bleeding as a manifestation of mini-puberty of infancy in severe prematurity. J Pediatr 2016;178:292–5. https://doi.org/10.1016/j.jpeds.2016.08.021.Suche in Google Scholar PubMed PubMed Central
6. Perez-Milicua, G, Kaiserman, J, Oleka, C, Bercaw-Pratt, JL. Mini-puberty of infancy in extreme prematurity. J Pediatr Adolesc Gynecol 2017;30:295–6. https://doi.org/10.1016/j.jpag.2017.03.061.Suche in Google Scholar
7. Poon, WY, Tung, JY. Vaginal bleeding in an infant with extreme prematurity. Case Rep Pediatr 2020;2020:8881634. https://doi.org/10.1155/2020/8881634.Suche in Google Scholar PubMed PubMed Central
8. Santos, MC, Limão, S, Ferreira, P. Exacerbated mini-puberty of infancy in an ex-extreme preterm girl. BMJ Case Rep 2020;13:e235492. https://doi.org/10.1136/bcr-2020-235492.Suche in Google Scholar PubMed PubMed Central
9. Kida, A, Nakada, Y, Kitano, H, Ueno, Y. Extreme mini-puberty in an extremely low-birth-weight infant. Pediatr Int 2021;63:1245–7. https://doi.org/10.1111/ped.14586.Suche in Google Scholar PubMed
10. Kuiri-Hänninen, T, Haanpää, M, Turpeinen, U, Hämäläinen, E, Seuri, R, Tyrväinen, E, et al.. Postnatal ovarian activation has effects in estrogen target tissues in infant girls. J Clin Endocrinol Metab 2013;98:4709–16.10.1210/jc.2013-1677Suche in Google Scholar PubMed
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Newborn screening for propionic, methylmalonic acidemia and vitamin B12 deficiency. Analysis of 588,793 newborns
- Use of letrozole to augment height outcome in pubertal boys: a retrospective chart review
- Study of the frequency and clinical features of maturity-onset diabetes in the young in the pediatric and adolescent diabetes population in Iran
- Iatrogenic hyperthyroidism in primary congenital hypothyroidism: prevalence and predictive factors
- Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA
- Newborn screening and genetic variation of medium chain acyl-CoA dehydrogenase deficiency in the Chinese population
- Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study
- Effects and dose-response relationship of exercise training on cardiometabolic risk factors in children with obesity
- Biochemical indicators of euthyroid sick syndrome in critically ill children
- Short Communication
- Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes
- Case Reports
- Late onset Bartter syndrome: Bartter syndrome type 2 presenting with isolated nephrocalcinosis and high parathyroid hormone levels mimicking primary hyperparathyroidism
- Three pediatric cases of symptomatic hyponatremia in Prader–Willi syndrome
- Identification of a novel mutation in FGFR1 gene in mother and daughter with Kallmann syndrome
- Exaggerated mini-puberty in a preterm girl: a case report and review of literature
- Diabetic ketoacidosis masquerading behind alkalemia an undiagnosed or missed variant of diabetic ketoacidosis
Artikel in diesem Heft
- Frontmatter
- Original Articles
- Newborn screening for propionic, methylmalonic acidemia and vitamin B12 deficiency. Analysis of 588,793 newborns
- Use of letrozole to augment height outcome in pubertal boys: a retrospective chart review
- Study of the frequency and clinical features of maturity-onset diabetes in the young in the pediatric and adolescent diabetes population in Iran
- Iatrogenic hyperthyroidism in primary congenital hypothyroidism: prevalence and predictive factors
- Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA
- Newborn screening and genetic variation of medium chain acyl-CoA dehydrogenase deficiency in the Chinese population
- Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study
- Effects and dose-response relationship of exercise training on cardiometabolic risk factors in children with obesity
- Biochemical indicators of euthyroid sick syndrome in critically ill children
- Short Communication
- Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes
- Case Reports
- Late onset Bartter syndrome: Bartter syndrome type 2 presenting with isolated nephrocalcinosis and high parathyroid hormone levels mimicking primary hyperparathyroidism
- Three pediatric cases of symptomatic hyponatremia in Prader–Willi syndrome
- Identification of a novel mutation in FGFR1 gene in mother and daughter with Kallmann syndrome
- Exaggerated mini-puberty in a preterm girl: a case report and review of literature
- Diabetic ketoacidosis masquerading behind alkalemia an undiagnosed or missed variant of diabetic ketoacidosis
