For Premature Thelarche and Premature Adrenarche, the Case for Waiting before Testing

Abstract

Premature thelarche (PT) and premature adrenarche (PA) are the 2 most common variations of early pubertal development seen by pediatric endocrinologists. Typical cases are usually easy to recognize based on their clinical presentation and do not require specific therapy. While more experienced endocrine providers often do not order any tests and opt for follow-up either in person or by the referring physician, it is common for some initial testing to be performed to make sure that something more serious is not missed. The concern is usually either central precocious puberty (CPP) in cases of early breast development, or some form of congenital adrenal hyperplasia (CAH) in cases of early pubic hair development. I will make the case, supported by recent studies and my personal experience, that in typical cases without red flags, testing adds unnecessary expense and sometimes results in an erroneous diagnosis leading to inappropriate initiation of treatment, or a correct diagnosis for which treatment may not be needed.