Constitutional Precocious Puberty in the Female and Its Control by Androgens. A Preliminary Report*

THIS is a joint report of two independent endocrinologists concerned in the management of a case of precocious puberty. To our knowledge this is the first case in a female to be treated with androgens. It is being reported as a clinical experiment, the factual data being offered for consideration. J. E. was referred to one of us (S.C.F.) at the age of 4 years and 10 months by Dr. Maurice Coleman of San Francisco because of precocious development of breasts and pubic hair. She was the only child of normal parents with a normal family history. Her birth weight and length were 6 pounds 15 ounces and 21 inches respectively. There was nothing unusual in her early development until the age of 3½ years, when her parents became aware that she was taller than her contemporaries. Soon thereafter her breasts began to develop and pubic hair appeared. At 4½ years a white vaginal discharge had been noted. The child was tall, precociously developed, of cheerful disposition and superior intelligence. Her height was 50 inches and weight, 55 pounds. Two permanent incisor teeth had erupted six months previously. Her breasts were considerably enlarged, being about 6 cm. in diameter and 3 cm. in height. The areolae were slightly pigmented. A moderate amount of pubic hair was noted. Rectal examination revealed a uterus, slightly large for a child, but no adnexal masses. A heavy caseous vaginal discharge was present. This, on microscopic examination, disclosed fully cornified mucosal cells. The physical findings were otherwise normal. Bone age studies showed a skeletal development of approximately 7 years.