Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
-
Aikaterini A. Nella
,
Paul B. Kaplowitz
Abstract
Objective: Premature menarche is an uncommon, benign condition characterized by isolated or recurrent menstrual bleeding in the absence of secondary sexual characteristics.
Methods: We performed an observational retrospective study to further characterize the clinical, biochemical and imaging features of benign prepubertal vaginal bleeding (BPVB). Out of 1037 girls evaluated for precocious puberty over a 5-year period, 24 girls with BPVB were identified based on ≥1 episodes of vaginal bleeding, Tanner I or non-progressive Tanner II breast development, and lack of physical findings suggesting genital infection, trauma or foreign body.
Results: Age at presentation ranged from 3 years 2 months to 9 years 11 months. Ten patients (42%) had one episode of vaginal bleeding, six (25%) had two episodes and eight patients (33%) had three or more. First bleeding episode lasted 3 days (range; 1–30 days). Six girls had intermittent spotting for up to 1 year. No breast development was noted in 19 (79%) patients. Minimal breast was present in five girls; early pubic hair was present in 2. LH and FSH were prepubertal; estradiol was >20 pg/mL in two girls. Pelvic ultrasound, performed in 11 patients, showed pre-pubertal uterus and ovaries without adnexal masses.
Conclusion: Isolated prepubertal vaginal bleeding is typically benign and self-limited, in the absence of sexual precocity signs or other vaginal pathology. Laboratory and imaging studies are generally unrevealing.
References
1. Heller ME, Dewhurst J, Grant DB. Premature menarche without other evidence of precocious puberty. Arch Dis Child Jun 1979;54:472–5.10.1136/adc.54.6.472Search in Google Scholar PubMed PubMed Central
2. Blanco-Garcia M, Evain-Brion D, Roger M, Job JC. Isolated menses in prepubertal girls. Pediatrics Jul 1985;76:43–7.10.1542/peds.76.1.43Search in Google Scholar
3. Murram D, Dewhurst J, Grant DB. Premature menarche: a follow-up study. Arch Dis Child Feb 1983;58:142–3.10.1136/adc.58.2.142Search in Google Scholar PubMed PubMed Central
4. Kaplowitz P. Clinical characteristics of 104 children referred for evaluation of precocious puberty. J Clin Endocrinol Metab Aug 2004;89:3644–50.10.1210/jc.2003-031532Search in Google Scholar PubMed
5. Greulich WW, Pyle, SI. Radiographic atlas of skeletal development of the Hand and Wrist, 1st ed. Stanford, California: Stanford University Press, 1950.Search in Google Scholar
6. Griffin IJ, Cole TJ, Duncan KA, Hollman AS, Donaldson MD. Pelvic ultrasound measurements in normal girls. Acta Paediatr May 1995;84:536–43.10.1111/j.1651-2227.1995.tb13689.xSearch in Google Scholar PubMed
7. Razzaghy-Azar M, Ghasemi F, Hallaji F, Ghasemi A, Ghasemi M. Sonographic measurement of uterus and ovaries in premenarcheal healthy girls between 6 and 13 years old: correlation with age and pubertal status. J Clin Ultrasound 2011;39: 64–73.10.1002/jcu.20723Search in Google Scholar PubMed
8. Qublan HS, Abdel-hadi J. Simple ovarian cysts: frequency and outcome in girls aged 2–9 years. Clin Exp Obstet Gynecol 2000;27:51–3.Search in Google Scholar
9. Saggese G, Ghirri P, Del Vecchio A, Papini A, Pardi D. Gonadotropin pulsatile secretion in girls with premature menarche Horm Res 1990;33:5–10.10.1159/000181436Search in Google Scholar PubMed
10. Pinto SM, Garden AS. Prepubertal menarche: a defined clinical entity. Am J Obstet Gynecol 2006;195:327–9.10.1016/j.ajog.2005.09.005Search in Google Scholar PubMed
11. Houk CP, Kunselman AR, Lee PA. Adequacy of a single unstimulated luteinizing hormone level to diagnose central precocious puberty in girls Pediatrics 2009;123:e1059–63.10.1542/peds.2008-1180Search in Google Scholar PubMed
©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?
Articles in the same Issue
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?
