Benign Premature Thelarche

Aka: Benign Premature Thelarche, Premature Thelarche

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II. Epidemiology

  1. Onset as early as age 18 months

III. Pathophysiology

  1. Benign self-limited cause of Precocious Puberty

IV. Exam

  1. Examine with girl lying down
  2. Identify if Breast glandular tissue beneath areola

V. Signs

  1. Early Breast development of glandular Breast tissue (not to mature Breast contour)
  2. Isolated glandular Breast tissue on palpation
  3. No other signs of Puberty
  4. Normal prepubertal growth rate

VI. Differential Diagnosis

  1. See Precocious Puberty Causes
  2. Lipomastia
    1. Fatty Breast tissue in obese girls

VII. Imaging

  1. Bone Age consistent Chronological Age
  2. Ovarian Ultrasound normal

VIII. Labs

  1. Serum Gonadotropin levels normal
  2. Serum Estradiol normal

IX. Management

  1. Reassurance
  2. Indications for pediatric endocrinology referral (based on serial exams every 3-6 months)
    1. Progressive Breast development
    2. Associated other signs of pubertal development
    3. Increased Growth Velocity
    4. Advanced Bone Age
  3. Do not biopsy Breast
    1. Biopsy results in partial Mastectomy
    2. Further Breast development abnormal post-biopsy

X. Course

  1. Spontaneous resolution

XI. References

  1. Brown (2025) Am Fam Physician 112(5): 513-21 [PubMed]
  2. Klein (2017) Am Fam Physician 96(9): 590-99 [PubMed]

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