Precocious pseudopuberty associated with autonomous follicular cysts – a case report

Abstract

Background: Precocious pseudopuberty associated with autonomous follicular cysts is a rare disorder in girls. In many cases, symptoms of this condition usually regress spontanously and may not need treatment. However, these cysts may enlarge and produce estrogen, results in signs of sexual precocity. Here we report a case of precocious pseudopuberty due to an autonomous ovarian follicular cyst. Case presentation: A 3.5-year-old girl was admitted to Nation hospital of Obstetrics and Gynecology because of breast development and vaginal bleeding. The first time she had these symptoms was 6 months ago. She was 105cm tall (in the 95thpercentile for her age) and weighs 19.5kg (in the 97th percentile for her age). Her pubertal development was classified as Tanner stage 2 breast development and Tanner stage I pubic hair development. Endocrinology examination showed elevated estrogen level and supressed gonadotropin level in GnRH stimulation test. Her pelvic ultrasound showed a large ovarian cyst. Based on these observations, laparoscopy was performed and histologic analysis confirmed the diagnosis of a follicular cyst. Conclusion: Autonomous ovarian cysts that cause precocious pseudopuberty usually resolve spontanously sothat no treatment is necessary. Surgery should only be considered if symptoms of progressed precocious puberty are clear or the cyst increases in size. In surgery, normal ovarian tissue should be preserved for future fertility. Due to the possibility of recurrent, a careful long-term follow up after surgery may be necessary in such cases.