IMPE Abstracts

Introduction: Menarche praecox is the appearance of endometrial bleeding without other puberty activities. It can be an isolated symptom, as well as a preliminary phase to GnRH-independent premature puberty. Patients do not show accelerated growth or advanced skeletal maturity, and hormonal studies do not show stimulation of the hypothalamic-pituitary-gonadal axis. Its most likely cause is increased sensitivity of the endometrium to estrogen.

A Case Report: An 8 and 10/12 - year-old girl, with subclinical hypothyroidism was first referred to the Pediatric Endocrinology Clinic in Katowice in October 2018 with symptoms of precocious puberty. According to the child's parents, spontaneous bleeding from the genital tract lasting 1-3 days was observed twice until admission to the Department, with no other signs of puberty. On admission to the Department, she was found to be overweight, with no signs of puberty (M1P1). On the basis of X-ray of the hand and wrist, bone age was estimated at 9 years (Greulich Pyle atlas). Blood laboratory tests showed no abnormalities. A stimulation test with a gonadoliberin analog was performed, which unequivocally ruled out central precocious puberty. The girl was consulted gynecologically - no abnormalities were found in the examination. After discharge from the Ward, according to the parents, bleeding from the genital tract in the form of minor spotting, but also quite heavy bleeding requiring several times a day to change the pad. The girl was hospitalized at our Clinic two more times - each time the results of laboratory tests were normal, and subsequent gynecological examinations did not reveal a possible source of bleeding. Given that the bleeding may not have involved the reproductive tract, urology consultation (including cystoscopy and vaginoscopy) and gastroenterology consultation with endoscopic examination of the gastrointestinal tract were carried out - all the results were normal, the cause of the bleeding could not be found. Over these several months of follow-up, the girl's rate of puberty and growth were normal. The last time the patient was hospitalized in our Department was in October 2019 - that was when the bleeding occurred for the first time during hospitalization.

Conclusion: Premature isolated genital bleeding is an extremely rare form of premature puberty. It is not uncommon that bleeding from the genital tract is one-off, and the patients undergo normal puberty on time. However, as we present on the example of our patient, diagnosis of menarche praecox can be tedious and time-consuming, and the final diagnosis can surprise everyone.