1. The patient presented to us at the age of 9½
years but already had menarche at the age of 7½ years of age.
Historically and as per physician records available to us from the
time she presented with menarche, there was no evidence to suggest
breast development at that time. Hence, the title refers to isolated
menarche and not precious puberty.
2. GnRH (LHRH) stimulation test was done to decide
whether precocity was due to a central or peripheral mechanism. As the
patient was actively menstruating, it can be safely assumed that her
estradiol levels would be in the pubertal range. Detailed GnRH test
was done (Table I), but due to the limit of the number of words
permitted in a letter to the Editor, we could publish the entire
results. TeBG was not done both because we did not feel it was
essential and because we did not have the facility to perform the
test.
Table I__ FSH and LH Level (Basal and After GnRH Stimulation)
|
Time (Min)
|
FSH (IU/L)
|
LH (IU/L)
|
|
0
|
5.9
|
0.02
|
|
15
|
6.6
|
0.07
|
|
30
|
5.9
|
0.63
|
|
45
|
5.6
|
0.45
|
|
60
|
6.1
|
0.42
|
|
90
|
6.2
|
0.38
|
|
120
|
6.7
|
0.35
|
GnRH 100 µg iv, Response is prepubertal.
Normal values: FSH (IU/L) = 0.5-3.3
LH (IU/L) = 0.3-1.0
3. We were aware of the two more possible
mechanisms for precocity in hypothy-roidism, but due to space
constraints restricted ourselves to mentioning the more important
mechanisms.
