Aa
bone age
My daughter is 10.5 and her bone age came back of a 14 girl. Were seeing a second ped endo on monday. She has elevated TSH 5.4 and elevated prolactin 22.0. She already started her period a year already and has stated developing breast. What do you think is wrong??? She has no symptoms of any problems
A related discussion, Diagnosis of ?overgrowth sydrome was started.
A related discussion, bone advancement in my 16mo old daughter was started.
MEDICAL PROFESSIONAL
see above response, thanks!
Thank you so much, I forgot to point out the first endo wants MRI WITH CONTRAST AND WITHOUT contrast. My guess she wants to rule out prolactinoma. But my reasearch shows she has no symptoms also her levels are not so high, mildly elevated as told to me by the first endo. I don't want her to have go through that exoerience if it is unnecesssary. What are your thoughts. Also her projected height is 5'2 she is now 4'10.5" I am 5 feet and my husband is 5'9.
MEDICAL PROFESSIONAL
Her bone age is advanced, this means that the growth plates are more mature and her final height may be shorter than originally possible. The cause of this can be many things, insulin resistance and overproduction of insulin in itself can lead to an advanced bone age as is seen in overweight and obese children.
Early puberty can also cause this as estrogen is another factor influencing the maturation of the growth plate, so if she is already having menses at age 10 this may have been due to excess estrogen at an early age. Also the adrenal gland can be producing excessive androgens in children with adrenal hyperplasia and they will present with and advanced bone age.
So firstly the bone age is an xray of the left hand and is compared to an atlas and standards of Gruelich and Pyle (fancy name for the guys who made these things). Make sure your endocrinologist reads the xray himself or herself, I often disagree with our radiologists and we go back and forth at times since it can be a subjective reading, also if it is a nonpediatric radiologist they may not interpret these very often.
Work with the peds endo and talk about whether lupron is considered in her case, I usually don't stop puberty at 10 1/2 but if the bone age is really advanced and her final height is below her genetic potential then maybe a year of this could preserve some height, it is a medicine that halts the signal temporarily and is given as a shot monthly, once stopped the body starts back again slowly over several months. Also there is another medication letrozole-this is a sex hormone blocking medication per se and can be considered, it is highly specialized and not used often but may preserve her bone age at its present state till she gets a little older and "catches up" making the difference between the two closer.
I hope this doesn't confuse you more
So firstly, ask the second peds endo to read the bone age and look at a growth curve with them so you can see the projected height with the bone age also plotted, this will give you more idea about your options.
Now the other things, the tsh sounds ok range, just very very slightly above normal so repeated is necessary as is the prolactin and if this is still elevated and the prolactin is too, this may be hypothyroidism which in itself in some girls can lead to early puberty when the elevated tsh cross reacts at the receptors that stimulate puberty , but this is usually very high tsh not slight like this.
Keep us informed and I hope they find good news
Early puberty can also cause this as estrogen is another factor influencing the maturation of the growth plate, so if she is already having menses at age 10 this may have been due to excess estrogen at an early age. Also the adrenal gland can be producing excessive androgens in children with adrenal hyperplasia and they will present with and advanced bone age.
So firstly the bone age is an xray of the left hand and is compared to an atlas and standards of Gruelich and Pyle (fancy name for the guys who made these things). Make sure your endocrinologist reads the xray himself or herself, I often disagree with our radiologists and we go back and forth at times since it can be a subjective reading, also if it is a nonpediatric radiologist they may not interpret these very often.
Work with the peds endo and talk about whether lupron is considered in her case, I usually don't stop puberty at 10 1/2 but if the bone age is really advanced and her final height is below her genetic potential then maybe a year of this could preserve some height, it is a medicine that halts the signal temporarily and is given as a shot monthly, once stopped the body starts back again slowly over several months. Also there is another medication letrozole-this is a sex hormone blocking medication per se and can be considered, it is highly specialized and not used often but may preserve her bone age at its present state till she gets a little older and "catches up" making the difference between the two closer.
I hope this doesn't confuse you more
So firstly, ask the second peds endo to read the bone age and look at a growth curve with them so you can see the projected height with the bone age also plotted, this will give you more idea about your options.
Now the other things, the tsh sounds ok range, just very very slightly above normal so repeated is necessary as is the prolactin and if this is still elevated and the prolactin is too, this may be hypothyroidism which in itself in some girls can lead to early puberty when the elevated tsh cross reacts at the receptors that stimulate puberty , but this is usually very high tsh not slight like this.
Keep us informed and I hope they find good news
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