Advances in Clinical and Experimental Medicine

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Advances in Clinical and Experimental Medicine

2007, vol. 16, nr 2, March-April, p. 329–334

Publication type: review article

Language: English

Creative Commons BY-NC-ND 3.0 Open Access

Precocious Thelarche – Current Opinions

Przedwczesne izolowane powiększenie gruczołów piersiowych – obecny stan wiedzy

Beata Wikiera1,, Aleksander Basiak1,, Ewa Barg1,, Anna Noczyńska1,

1 Department of Endocrinology and Diabetology of Children and Adolescents, Silesian Piasts University of Medicine in Wrocław, Poland

Abstract

Isolated premature mammary gland enlargement, or precocious thelarche (thelarche praecox, t.p.), is a glandular tissue development which occurs in girls below eight years of age without any other symptoms of systemic estrogen activity. T.p. is usually observed during the first two to three years of life. Ethnic and nutritional factors influence the frequency of t.p. incidence. T.p. is connected with endogenous and exogenous factors. Early stages in the activation of the hypothalamic−pituitary−ovarian axis, activating GNAS1 gene mutation, and FSH receptor polymorphism are the most frequently mentioned endogenous factors. It has been suggested that exposure to estrogenic disrupters, such as dioxins, furans, organic halogens, and phthalates, can cause t.p. epidemics in some geographical areas. FSH levels, both basal and GnRHa stimulated, are significantly higher in t.p. girls than in their peers. The concentrations of inhibin B, leptin, and IGF1 in t.p. patients are in between those of the prepubertal and pubertal periods. Visual examinations, such as pituitary gland MR and breast and pelvic ultrasound, are also useful in the differential diagnose of t.p. and other disorders of puberty. Spontaneous regression of t.p. occurs from six months to six years after establishing diagnosis in most girls. However, in 14% of cases, GnRH−dependent precocious puberty develops. Continued control of the clinical state and use of available diagnostic methods in each suspicious case is essential in the care of t.p. patients.

Streszczenie

Przedwczesnym izolowanym powiększeniem gruczołów piersiowych (thelarche praecox, t.p.) określa się rozwój tkanki gruczołowej u dziewcząt poniżej 8. roku życia, któremu nie towarzyszą objawy układowego działania estrogenów. T.p. jest obserwowane najczęściej w pierwszych 2.–3. latach życia. Czynniki etniczne i żywieniowe mają wpływ na częstość występowania t.p. Pojawienie się t.p. jest wiązane z oddziaływaniem czynników endoi egzogennych. Wczesne stadium aktywacji osi podwzgórzowo−przysadkowo−gonadalnej, aktywujące mutacje genu GNAS1, polimorfizm receptora FSH to najczęściej wymieniane wewnątrzpochodne przyczyny t.p. Estrogenopodobne działanie dioksyn, furanów, organohalogenów, ftalatów jest uważane za powód występowania i okresowego nasilenia częstości t.p. w niektórych rejonach geograficznych. Pacjentki z t.p. mają istotnie większe od rówieśniczek stężenie FSH zarówno w warunkach podstawowych, jak i po stymulacji analogiem GnRH. Stężenia inhibiny, leptyny i IGF1 u dziewcząt z t.p. zajmują pozycję pośrednią między okresem przedpokwitaniowym i pokwitaniowym. Pomocne w różnicowaniu t.p. z innymi zaburzeniami dojrzewania są badania obrazowe: MR przysadki mózgowej, USG piersi i miednicy małej. Samoistna regresja t.p. u większości dziewcząt następuje w okresie od 6 miesięcy do 6 lat od rozpoznania, ale w 14% przypadków dochodzi do rozwoju GnRH−zależnego przedwczesnego dojrzewania płciowego. Okresowa ocena stanu klinicznego z wykorzystaniem dostępnych metod diagnostycznych w każdym niepokojącym przypadku jest niezbędna w opiece nad pacjentkami z t.p..

Key words

precocious thelarche, precocious puberty

Słowa kluczowe

przedwczesne powiększenie gruczołów piersiowych, przedwczesne dojrzewanie

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