My 3 year old has advanced bone age of 6 year old

[jean422]

Here is the background. My child is 3 years 3 months. (healthy- consistant 90%tile for height and 75%tile for weight) When she turned three she had  bone scan which indicated advanced bone age of 6 year old. Also a uterus ultrasound which shows endometrial strip and enlarged ovaries. Her blood work up and stimulation test were negative for CPP.  My question is... What is causing these physical changes and advanced bone age?

I have switched to as much organic food as possible. Can that help? Any input on our situation?

[Deanna L Aftab Guy, MD]

The ultrasound findings are thought to show the first signs of the puberty signal before we ever see it on a stim test. She more than likely will be performing what we call a leuprolide stim test to assess the signal that the pituitary makes to the ovary, if mature levels are measured then treatment should be discussed, you are also in good hands., i have many kids on this medication, it is very safe, used as a monthly injection and your pediatricians office can give it monthly with your ped endo seeing you every 4 months or so, basically it stops the signal from the brain till you are ready for it to start sometime between age 8-10. Then once stopped there are no long term side effects that we know, it is a shot so hurts a little, sometimes there can be a local reaction to the medication, rare but important cause if this happens and it is what we call a sterile abscess then it means she may not respond well to further treatment with this med and will have to look to other options-this rarely happens, once in all my patients.
Your peds endo is being open with you and you are in good hands. Discuss your questions with them.

[Deanna L Aftab Guy, MD]

You sound like you are in good hands, the imaging is appropriate once yearly, really does not change that much any sooner. So physical exams and overall impression and then labs may be all that is needed right now. The advanced bone age is bothersome though and the ultrasound as well. I would tend to do a leuprolide stim test again if her development progresses, sometimes the first one is borderline but the overall picture not matching the labs, however from what you have said it sounds like they are on top of things

[HiThere2011]

My daughter is 10 years and almost 5 months old. Her bone age is 7 years 10 months. She is shorter than her friends. Anything that you recommend me to do.

[Deanna L Aftab Guy, MD]

I have a few very young girls on lupron, honestly it is very very safe, little if any side effects other than having to get a shot monthly and rare knot at the sight that makes it hard to continue treatment cause it tends to be ineffective at that time. It basically stops the puberty signal and once stopped things start back up usually a little slower but at a normal tempo. CHOP is an amazing place, they know alot! you are in excellent hands. Dr. Michael Levine is there and has helped me personally(electronically) with many of my patients, also they have other wonderful brains there, you are in excellent hands, rest assured they will talk with you about these questions!

[nacker]

Thank you for your reply Dr. Aftab.  I believe at this point they are still trying to rule out peripheral precosious puberty.  I have done some preliminary research on Lupron and am terrified at the thought of giving it to my 3 year old.  Is there data on the long term effects of this drug beign taken by children?  From what I understand, it basically puts your body in a menopausal state.  Will she be able to have children someday??  And I've also been told that she will need to remain on this drug until puberty???   How can this possibly be safe?  I have read hundreds of horror stories from women who have taken this drug only a few times, with side effects lasting for months after discontinuing use.  I have an appointment at CHOPs in November and hope to learn more.  Again, thank you for your reply and if can provide me with any info I may need before going for a second opinion, I would appreciate that.

[nacker]

My 3 year old has the bone age of a 5 year old and hd an MRI done this week, thankfully normal.  She will have a pelvic ultrasound on Monday, to rule out ovarian cysts & tumors.  My ped. endocronologist suspects that her ovaries may be enlarged and has already begun to discuss therapy (Lupron).  I have numerous concerns about that and was wondering if anyone can tell me if their children are on this medication

[jean422]

thank you so much to take the time to reply. My daughter is going to be followed up clinically with her pediatric endrocrinologist every three months. She won't have repeat uterus scan, bone age xray or blood work until next August.  I checked the Mccune Albright syndrome symptoms and she does not have any birth marks. Should I push for some kind of "test" to rule this out?

She was originally referred from my pediatrician because she has a left breast bud that (to me is small) that has been with her since birth (unchanged since birth). I am glad she did bc i would have never suspected anything. No other puberty changes.

My endrocrinologist did do other labs and stated tha her other hormone levels were normal (throid, adrenal etc)  I was anxious to do an MRI to rule out any other possible problems but the doctors want to wait and watch. I am just anxious that next year possibly her bone age will continue to advance without any answers.

[Deanna L Aftab Guy, MD]

The advanced bone age is concerning, why did they do it to start with, what were her symptoms? There are other causes of early puberty besides central causes, if the brain is not turned on early pulsing to the ovaries she may have a syndrome called McCune Albright Syndrome which is when the LH receptors on the ovary are in a turned on mode, stimulating ovulation and estrogen production leading to the endometrial stripe. These girls can have other hormones that work by the similar mechanism also with a circuit that won't turn off-thyroid, adrenal gland, parathyroid hormone. These girls have usually other signs like a birth mark that we call cafe au lait on one side of the body that does not cross the body usually.
Make sure that she is with a pediatric endocrinologist and that the tests needed have been done thoroughly, ideally we want to preserve height but realistically we do NOT want our 4 year old menstruating! Poorly controlled hypothyroidism can lead to a rare but important cause of early puberty as well. Your peds endo knows all this and more no doubt, work with them.