Eight year-old with enlarged ovary

[Momma111]

Our eight year-old daughter has had three pelvic ultrasounds since October 2007.  The first ultrasound, in October 2007, showed ovarian volumes of 2.8cc and 2.9cc, with no free fluid.  Everything else was normal.  The second one, in November 2007, showed ovarian volumes of 0.4cc and 0.5cc, with no free fluid.  Everything else normal.  The third ultrasound, done last week (May 1, 2008), showed ovarian volumes of 1.7cc and 3.2cc, with a small amount of free fluid in the cul-de-sac.  Her blood work has always been normal for her age and Tanner Stage 1.  Bone-age xray was normal, actually coming back three months younger than chronological age.  She had a one day event, in August 2007, of vaginal spotting that started all testing.  The first ultrasound with enlarged ovaries was worrisome, but one bit of good news was that the enlargement was bilateral.  However, the third ultrasound now shows two very different size ovaries, and the appearance of free fluid.  How accurate are the transabdominal ultrasounds?  We would like to know your interpretation of the results and suggestions for further testing.
Thank you.

[Annekathryn Goodman, M.D.]

Hi There,
I apologize for my delay. I do not feel knowledgeable enough to answer you question. I have queried a few people . I will let you know if I receive any useful advice. What I have been told so far is the your daughter should be evaluated by a pediatric gynecologist.
If you are comfortable telling me where  you live, I can ask my colleagues for some names of appropriate physicians in your area
take care

[Momma111]

Dr. Goodman,

Thank you for your response, and for your efforts on behalf of our daughter.  We would be grateful for any advice or information you can pass on to us.  

We live in the Sacramento, CA area.

Thank you, again.

[Annekathryn Goodman, M.D.]

Hi There, I have pasted Dr. Emans response below
best wishes

This doesn't sound worrisome to me.   8 year old girls often have
episodic stimulation of their ovaries and can have pubertal ovaries with
GnRH pulsatile release.  The varying size suggests to me variable
measurement as well.  The fact that she has one episode of vaginal
bleeding probably means that she has an estrogen withdrawal.  When an 8
year old has bleeding I would be more concerned that someone look for a
foreign body, tumor, trauma, etc. However, with nearly a year having
gone by without any additional bleeding, that is moderately reassuring.


Given that you don't really know the family or patient, I suggest having
her continue to see who ever is ordering the ultrasounds - perhaps fewer
of them would be better!
Jean






S. Jean Emans, MD

Chief, Division of Adolescent Medicine; Vice Chair, Clinical Affairs,
Dept of Medicine; Director, Office of Faculty Development; Children's
Hospital Boston 300 Longwood Ave, Boston MA 02115; 617-355-7170 (fax 617
730-0185); Professor of Pediatrics, Harvard Medical School

[Momma111]

Thank you for passing on the response from Dr. Emans.  It does give us some reassurance.  

Thank you, also, for seeking out someone you thought to be knowledgable when you didn't feel comfortable answering yourself.  It was very admirable and appreciated.