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as well as in girls with GDPP; however, a follicular cyst size >9 mm suggests a

diagnosis of GIPP. The presence of multiple cysts (six or more) suggests GDPP,

while a single large cyst is a feature of GIPP. Breast ultrasonography is

recommended to differentiate between lipomastia and true breast budding, as in

current practice, referral for premature thelarche is not uncommon with increas-

ing prevalence of childhood obesity (Fig. 6.14).

Fig. 6.14 (a) A 4-year-old girl with thelarche, B 3 (b) Tanner pubic hair stage 2, (c) X-ray of left
hand showing bone age 5 years and 9 months (d) 99mTc MDP scan was normal. She had a follicular
cyst of 12 mm suggestive of GIPP. Presence of pubarche denotes production of ovarian androgens
by follicular cyst

a b

c

6 Precocious Puberty