USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

GYN TRIAD

Granulosa   Cell    Ovarian Tumor

Precocious  complete    isosexual   puberty

6-year-old  girl

Pelvic  mass

Gonadotropin-dependent occurs because of increased secretion of estrogens
that are dependent on premature release of gonadotropins from the
hypothalamus and pituitary.
Idiopathic (80% of cases): The most common explanation is
constitutional without a pathologic process present. Patient typically age 6–

7. The diagnosis is usually one of exclusion after CNS imaging is shown to
   be normal. Management: GnRH agonist suppression (leuprolide or
   Lupron) of gonadotropins until appropriate maturity or height has been
   reached.
   CNS pathology (rare): A CNS pathologic process stimulates
   hypothalamic release of GnRH, which leads to FSH release and ovarian
   follicle stimulation of estrogen production. This may include
   hydrocephalus, von Recklinghausen disease, meningitis, sarcoid, and
   encephalitis. CNS imaging is abnormal. Patient typically age <6.
   Management: Directed at the specific pathologic process.
   Gonadotropin-independent occurs when estrogen production is independent
   of gonadotropin secretion from the hypothalamus and pituitary.
   McCune-Albright syndrome (or polyostotic fibrous dysplasia) (5% of
   cases) is characterized by autonomous stimulation of aromatase enzyme
   production of estrogen by the ovaries. The syndrome includes multiple
   cystic bone lesions and café au lait skin spots. Management: Aromatase