乳房早熟女童的預後

Prognosis of Young Girls with Premature Thelarche

目的：本研究為瞭解家庭醫學科門診乳房早熟個案的預後；瞭解個案乳房以外的第二性徵是否也提早出現，以及是否演變成性早熟。方法：本研究的研究對象為六位小於八歲的小女孩，在2011年至2015年3月間因乳房提早發育至家庭醫學科門診就診。第一次就診時，研究者以Tanner 氏分期評估個案乳房及陰毛發育階段，以左手腕X光評估其骨骼發育年齡，並檢驗血中濾泡刺激素（FSH）、黃體刺激素（LH）、甲狀腺刺激素（TSH）、泌乳激素（prolactin）、促腎上腺皮質刺激素（ACTH）、生長激素（ GH ）、雌二醇（ E2 ）， 及睪酮素（testosterone）評估其內分泌狀況。於2015年7月，以電話訪談的方式，訪談所有個案的母親，追蹤個案就診後乳房發育的狀況、陰毛出現的時間，及初經時間。結果：第一次就診時所有個案的骨齡皆未超前，除了一位兩歲個案的泌乳激素值高於參考值，其他所有個案的血中賀爾蒙數值皆正常。追蹤的結果發現部分個案的乳房發育停留在初期發育階段，其他個案則經過一段時間後乳房回復至未發育的狀態。所有個案陰毛出現及初經的時間皆未提早，皆未發展成性早熟。結論：家庭醫學科醫師遇到以乳房早熟為臨床表現的個案，若賀爾蒙及骨齡皆在正常範圍，或未符合性早熟的診斷標準，只有乳房提早發育，可在基層門診追蹤，定期評估的項目應包括各種第二性徵的Tanner氏分期以及骨齡。

Purposes: Some patients with premature thelarche will progress to precocious puberty, and their epiphyseal plates will fuse earlier, affecting their final height. Our intention was to ascertain the prognosis of primary care clinic patients presenting with isolated premature thelarche on their initial visit. Methods: A total of six premature thelarche patients visited our primary care clinic from 2011 to 2015. On their first visit, we rated all patients for breast development and pubic hair growth by the use of the Tanner stages, and estimated their bone ages using left hand X-rays. In addition, we tested their hormone profiles, including FSH(follicular-stimulating hormone), LH(luteinizing hormone), TSH(thyroid-stimulating hormone), prolactin, ACTH(adrenocorticotropic hormone), GH(growth hormone), estradiol, and testosterone levels. In July 2015, we collected the patients’ data with regards to their sexual maturity history by telephone interviews with the patients’ mothers. Results: We found all patients’ bone ages matched their chronological ages, and their hormone profiles were within normal limits, except for one patient who had a higher prolactin level. Some of the patients’ breasts stayed at the early stage of development, and some of them returned to being undeveloped. All the patients did not progress into precocious puberty, and none had early pubic hair development or menarche. Conclusions: Primary care practitioners should determine whether a patient with premature thelarche has already met the diagnostic criteria of precocious puberty at their initial clinic visit. For girls with isolated premature thelarche, practitioners should regularly follow up the patients’sexual maturity stages using the Tanner scales and ascertaining bone age using X-rays in outpatient clinics.