Approach to precocious puberty Quiz: Ace Your Exams

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A 5-year-old girl is brought to the clinic for evaluation of breast enlargement over the past four months and significant height increase over the past five months. She has no history of headaches, neurological deficits, visual problems, or behavioral changes. Family history is unremarkable, and the pregnancy and perinatal period was uneventful. She has met all her developmental milestones. At the current visit, height is at the 99^th percentile for age and weight is at the 87^th percentile for age. Temperature is 37°C (98.6°F), pulse is 100/min, respirations are 20/min, and blood pressure is 99/56 mmHg. Physical exam reveals an elevated areolar mound above the contour of the breasts, thin pubic hair, and no axillary hair. On abdominal examination, no masses are noted. A radiograph of the left hand and wrist reveals bone age of 9 years. She has pubertal levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol. Thyroid studies are within normal limits. Which of the following is the most appropriate next step in management?

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Obtain pelvic ultrasound

Obtain brain magnetic resonance imaging (MRI)

Measure dehydroepiandrosterone sulfate (DHEA-S) level

Provide reassurance without the need for further testing

Measure alpha fetoprotein (AFP) level