Precocious childhood breast hypertrophy
Introduction
Introduction to precocious children with breast hypertrophy The phenomenon that secondary sexual characteristics appear earlier than normal puberty is called precocious puberty and is more common in girls. It is generally believed that the second sexual body is well developed or partially developed before 8 to 9 years old. If there is obvious breast development, the vulva develops well, the pubic hair and the mane appear, and the body increases rapidly, or the menstrual cramps before the age of 10 are called precocious puberty. . The phenomenon of early development of female breast caused by precocious puberty is called early maternal breast hypertrophy or precocious female breast development. basic knowledge Proportion of disease: 1.6% of infants and young children Susceptible people: more common in girls Mode of infection: non-infectious Complications: meningitis
Cause
Causes of breast hypertrophy in precocious children
(1) Causes of the disease
According to the pathogenic factors, early maturing children with breast hypertrophy can be divided into two categories: primary precocious breast hypertrophy and secondary precocious breast hypertrophy.
1. Primary precocious breast hypertrophy: also known as true precocious breast hypertrophy or constitutional precocious breast hypertrophy, clinically unable to find an organic cause, patients before the puberty and normal sexual maturity have been established early" The normal secretion function of the hypothalamic-pituitary-ovarian axis, the study found that the secretion of sex hormones in such children is often increased, such as the excretion of estrogen, androgen and 17-corticosterone, all reach the level of normal adults, and This type of child can have normal development and normal childbirth without other abnormal findings, so it is also called idiopathic precocious puberty. Novak believes that primary precocious breast hypertrophy may be more than secondary precocious breast hypertrophy. See, Novak also reported 6 cases of primary hypertrophy caused by breast hypertrophy, no fine ovary, adrenal and pituitary tumors or other lesions were found.
2. Secondary precocious breast hypertrophy: Because the breast enlargement of the child is not based on the early maturity of the hypothalamic-pituitary-ovarian axis, but is secondary to other diseases, it is also called false Precocious breast hypertrophy, the cause of which is related to the following diseases.
(1) Central nervous system organic damage: such as encephalitis, tuberculous meningitis, head injury, congenital brain hypoplasia, microcephaly, hydrocephalus, hypothalamus, third ventricle ventricular hamartoma, etc. .
(2) Adrenal hyperplasia or tumor: Among the various hormones secreted by the adrenal gland, women have estrogen and progesterone. When the adrenal gland hyperplasia or tumor, the secretion of these hormones will increase, which may stimulate the girl's breast development.
(3) primary hypothyroidism: primary thyroid dysfunction, but not pituitary thyroid stimulating hormone secretion, when hypothyroidism, pituitary in the negative feedback regulation, resulting in increased thyroxine secretion, but also caused Gonadotropin and prolactin are also secreted and cause precocious puberty.
(4) Functional ovarian tumors: about 10%, granulosa cell-follicular cell tumor is more common, ovarian teratoma is second, can cause precocious puberty, these tumors can secrete a large amount of estrogen, so that breast development and emergence Vaginal bleeding.
(two) pathogenesis
1. Pathogenesis: Primary precocious breast hypertrophy is a sign of the child's vital signs. Before the puberty, the normal secretion function of the hypothalamic-pituitary-ovarian axis has been established, and the gonadotropin-releasing hormone is secreted early. The anterior pituitary gland secretes follicle maturation hormone and luteinizing hormone. Under the stimulation, ovarian follicles develop early and secrete estrogen, which causes the mammary gland and reproductive tract to mature. Therefore, these children may have normal development and normal labor.
Secondary precocious breast hypertrophy, due to various diseases, premature endogenous or exogenous hormones, excessive stimulation of the corresponding organs, resulting in secondary sexual characteristics and sexual organ development, such as direct stimulation of central nervous system organic disease Or destroy the nerve structure of the gonad ganglion in the child, so that the hypothalamus and pituitary secretion function is advanced. Such children are not developed due to gonads, although there is breast enlargement, vaginal bleeding, but no ovulation and fertility.
2. Pathological morphology
(1) General form: The mammary gland is obviously hypertrophy, the texture is soft, the epidermis is unchanged, and some discs are visible under the nipple, and the soft induration is soft.
(2) Histomorphology: Microscopic examination revealed that the enlarged breasts were mostly composed of fat cells and fibrous tissues, with a small amount of mammary glands in the middle.
Prevention
Precocious child breast hypertrophy prevention
1. Minimize the effects of sex hormones in the environment: such as pollen, honey, royal jelly, chicken embryo, silkworm cocoon; animal food that grows very fast, anti-season fruit, soybean and its products, adult tonics such as ferrets, Cordyceps sinensis, ginseng, some Some of the oral liquids that can make children "long and strong", "high hormone" foods such as poultry neck, fried foods, etc.
2. Adult washing and cosmetics, etc. Avoid contact with footage and text about sexual content in movies and magazines. Avoid excessive light exposure: turn off the lights at night. Exercise more, eat a balanced diet, avoid high-calorie foods, and prevent overweight and obesity.
Complication
Early maternal complications of breast hypertrophy Complications meningitis
meningitis.
Symptom
Early maturity children with breast hypertrophy symptoms Common symptoms Vaginal bleeding pubic hair early development elderly women breast enlargement breast hypertrophy vision defect growth too fast visual impairment follicle stimulating hormone (F...
1. The presence of secondary sexual characteristics of women with primary precocious breast hypertrophy includes breast development, vulvar development, pubic hair, menstrual cramps, etc. Breast development can be divided into 5 stages (Table 1).
(1) Mammary gland development: The characteristics of breast development are similar to those of normal adolescent breast development. The nipple, areola coloring, and the discoidous nodular breast tissue can be touched under the areola. The quality is medium, the boundary is clear, the surface is smooth, and the activity is non-adhesive with the skin. The breast under the areola has tenderness. The degree of breast enlargement varies from 1 to 2 cm to 7 to 8 cm in diameter. With the development of the breast, the mass of the areola gradually shrinks and disappears, and the breast can reach the size of an adult (Fig. 1).
(2) appearance of accessory sexual characteristics: In addition to breast development, the genital area tends to mature, pubic hair appears, and the internal genitalia and vagina also mature in advance. The most prominent one is the advancement of ovarian function, the follicular maturation and ovulation, menarche Occurs in advance and can be pregnant and fertile.
(3) Rapid growth of height: As in normal adolescence, the body is suddenly growing and the bone development is higher than that of girls of the same age.
(4) The content of blood gonadotropin does not match the age, but consistent with the developmental stage, the urinary 17-ketosteroid increases, but it is consistent with the bone age.
2. Secondary precocious breast hypertrophy Although there are some precocious puberty, the gonads are not developed, and the hypothalamic-pituitary function is determined to be consistent with age.
(1) Functional ovarian tumor: In addition to secondary sexual characteristics such as breast development and/or menstrual cramps, the child may be asymptomatic, or may consciously bloating, abdominal pain, and touching the mass in the abdomen or pelvis. Patients with vaginal bleeding usually develop before the development of secondary sexual characteristics, which is one of its clinical features.
(2) Central nervous system lesions: When the lesion is small, precocious puberty is the only symptom, which is easily misdiagnosed as primary precocious breast hypertrophy. It needs to be observed dynamically. The history of the disease may have a history of brain diseases such as hydrocephalus and meninges. Inflammation, mental retardation, etc. Some brain tumors may have hypothalamic dysfunction after a period of time, such as diabetes insipidus, obesity or other psychiatric symptoms. When the intracranial pressure is increased, the optic nerve is oppressed, and visual impairment may occur. Defect.
(3) primary hypothyroidism: mostly manifested as delayed development of secondary sexual characteristics, a small number of precocious puberty, breast development, lactation, vaginal bleeding, increased blood LH and FSH, but slow response to LH-RH, serum female The hormone is several times that of adults. The pituitary hyperplasia can be seen by X-ray or CT examination. The symptoms of precocious pubic thyroxine can disappear.
(4) Multiple bone fibrosis dysplasia: There is no familial tendency, and its clinical features are:
1 fibrous osteitis occurs on one side of the bone tissue;
2 non-prolonged brown pigmentation skin, mostly occurs on the affected side;
3 endocrine disorders, vaginal bleeding occurs early in sexual development, blood LH and FSH values increase, the pituitary hormone releasing hormone (LH-RH) is a true precocious reaction, some patients with serum LH and FSH is not high, not for LH-RH The X-ray examination revealed a loose area of the long bones of the extremities, forming a pseudocyst, which may cause pathological fractures, and a thickened area of the skull base.
(5) Exogenous hormone intake: Many cases of taking estrogen drugs or taking traditional Chinese medicine tonics, blood E2 content is high, up to 340pg/ml, breast enlargement, nipple, areola coloring, vaginal discharge Or vaginal bleeding, but naturally subsided after stopping the drug, return to normal.
Examine
Examination of breast hypertrophy in precocious children
1. Ovarian function tests such as vaginal smear for exfoliated cell examination, blood estrogen, androgen detection and dynamic observation.
2. Thyroid, adrenal cortical function tests routinely check T3, T4, PB1, TSH and plasma T, urine 17 hydroxyl, 17 ketosteroid content.
3. Pituitary function test blood FSH, LH content determination, in order to determine the cyclical changes in pituitary secretion, to determine whether the hypothalamic-pituitary secretion function is premature.
4. Fundus, visual field examination and intelligence detection.
5. X-ray inspection
(1) Sella positive lateral slice: observe the shape, size, saddle nodule angle, and saddle bottom of the sella to exclude pituitary tumors.
(2) Positive side of the skull: Whether there is any change in the bone quality of the skull, whether there is calcification or hardening area at the base of the skull.
(3) bone age examination of hands, wrists, etc.: primary or craniocerebral injury precocious puberty is often greatly advanced, and ovarian tumors are often not obvious.
(4) Long bone X-ray film: to rule out the possibility of having McCune-Albright syndrome.
(5) retroperitoneal angiography: observation of bilateral adrenal gland enlargement and space-occupying lesions.
6. According to the needs of B-ultrasound, CT, laparoscopy and other examinations, is necessary to exclude intracranial tumors, ovarian tumors, adrenal tumors and other diseases.
Diagnosis
Diagnosis and diagnosis of breast hypertrophy in precocious children
Girls aged 8 to 12 have secondary sexual characteristics, and have menstrual cramps, that is, precocious puberty. If there is breast hypertrophy, it can be diagnosed as early maturity breast hypertrophy. In order to diagnose the cause, it is often necessary to distinguish the primary. Sexual or secondary breast hypertrophy, that is, in the diagnosis of primary precocious breast hypertrophy, secondary precocious breast hypertrophy caused by diseases of the ovary, adrenal gland, pituitary gland, thyroid gland and central nervous system must be excluded. The main points of diagnosis and differential diagnosis are as follows:
1. Detailed medical history: Carefully ask if there is any history of trauma and surgery; whether there is high fever, convulsions, history of epilepsy, sexual development, vaginal bleeding; whether or not to take estrogen-containing drugs or health care products.
2. General physical examination: including height, weight, sitting height, general nutritional status and health status, nervous system examination, fundus, visual field examination, intelligent detection, etc., secondary sexual development, pelvic examination except ovarian tumors.
3. Laboratory examination and imaging examination: Exclusion of thyroid dysfunction, ovarian tumor, adrenal tumor, intracranial space-occupying lesions and multiple bone fibrous dysplasia.
Generally not confused with other diseases.
