Question

How will you investigate a girl presenting with menarche at 8 years of age?

Hint:

Early intervention and management are important in cases of precocious puberty to prevent long-term physical and psychological effects.

Answer 1

Step 1: Taking a Detailed History.
The first step is to gather a detailed medical and family history, including the onset of secondary sexual characteristics, any possible trauma or medications, and family history of early puberty or endocrine disorders.

Step 2: Physical Examination.
A thorough physical examination should be performed to assess the development of secondary sexual characteristics, such as breast development, pubic hair, and the size of the uterus and ovaries.

Step 3: Hormonal Assays.
Blood tests should be done to measure gonadotropins (LH, FSH), estrogen levels, and thyroid hormones to assess for hormonal imbalances. Elevated levels of estrogen and gonadotropins would suggest central precocious puberty, while low levels could indicate peripheral causes.

Step 4: Imaging Studies.
An ultrasound of the pelvis may be performed to evaluate the uterus and ovaries. In cases where central precocious puberty is suspected, an MRI of the brain may be necessary to rule out CNS tumors or abnormalities in the hypothalamic-pituitary region.

Step 5: Conclusion.
The investigation of early menarche in a young girl should be comprehensive to determine whether it is a normal variant or indicative of precocious puberty due to underlying pathology.