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Puberdade precoce secundária a quisto ovárico - caso clínico
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Advisor(s)
Abstract(s)
Introdução: Os quistos do ovário são raros na criança pré-púbere, representando os quistos funcionantes 5% dos casos.
A manifestação clínica mais comum é o desenvolvimento de puberdade
precoce isossexual.
Caso clínico: Rapariga de cinco anos e cinco meses, observada
por hemorragia vaginal. Sem antecedentes pessoais ou familiares
relevantes. No exame físico objetivou-se perda hemática
vaginal e botão mamário bilateral. A ecografia abdominopélvica
revelou quisto ovárico direito com 30mm. A investigação hormonal,
incluindo função tiroideia não demonstrou alterações, exceto
estradiol 38pg/mL. Prova LHRH com resposta pré-púbere. Sem
aceleração da idade óssea nem da velocidade de crescimento.
Acompanhada em consulta de Endocrinologia Pediátrica, sem
recorrência de metrorragia, verificou-se regressão da telarca, associada
a involução da lesão quística anexial direita.
Discussão/Conclusões: A maioria dos quistos ovários involuem
espontaneamente com regressão dos sinais de puberdade
precoce, tal como no caso descrito. A terapêutica médica,
com agonista GnRH, poderá ser útil nos casos de transformação
de puberdade precoce periférica em central por quistos ováricos
recorrentes e em situações que cursem com compromisso significativo da estatura alvo.
Introduction: Ovarian cysts are rare in prepubertal girls. Autonomous ovarian cysts represent 5% of cases and can cause isosexual precocious pseudopuberty. Case Report: A five years old girl was observed because of vaginal bleeding. Personal and family history was unremarkable. Physical examination confirmed uterine haemorrhage and bilateral breast development. Pelvic ultrasound examination demonstrated a 30mm right ovarian cyst. Laboratory findings, including thyroid function, were normal, excepting elevated oestrogen levels. GnRH stimulation test showed prepubertal response. There was no advanced bone age nor accelerated height velocity. She was regularly monitored at paediatric endocrinology consultation, without recurrent menorrhagia, there was regression of thelarche, associated with involution of the ovarian cyst. Discussion/Conclusion: Most autonomous ovarian cysts regress spontaneously with regression of pubertal signs, as in the present case. Therapy with a GnRH agonist may become necessary in the case of transformation from precocious pseudopuberty to central precocious puberty after recurrences of the ovarian cysts or when there is significant loss of height potential.
Introduction: Ovarian cysts are rare in prepubertal girls. Autonomous ovarian cysts represent 5% of cases and can cause isosexual precocious pseudopuberty. Case Report: A five years old girl was observed because of vaginal bleeding. Personal and family history was unremarkable. Physical examination confirmed uterine haemorrhage and bilateral breast development. Pelvic ultrasound examination demonstrated a 30mm right ovarian cyst. Laboratory findings, including thyroid function, were normal, excepting elevated oestrogen levels. GnRH stimulation test showed prepubertal response. There was no advanced bone age nor accelerated height velocity. She was regularly monitored at paediatric endocrinology consultation, without recurrent menorrhagia, there was regression of thelarche, associated with involution of the ovarian cyst. Discussion/Conclusion: Most autonomous ovarian cysts regress spontaneously with regression of pubertal signs, as in the present case. Therapy with a GnRH agonist may become necessary in the case of transformation from precocious pseudopuberty to central precocious puberty after recurrences of the ovarian cysts or when there is significant loss of height potential.
Description
Keywords
Quisto ovárico puberdade precoce pseudopuberdade precoce hemorragia uterina análogo GnRH Ovarian cyst precocious puberty precocious pseudopuberty uterine hemorrhage GnRh analog
Citation
Nascer e Crescer 2013; 22(2): 92-94