Effect of excess estrogen on breast and external genitalia development in growth hormone deficiency

Abstract

Background: The progress of sexual maturation and development in cases with growth hormone (GH) and insulin-like growth factor-I (IGF-I) deficiency is not well documented in females.

Case: We observed breast and genitalia development in a 2-year-old girl with GH deficiency following neonatal asphyxia; this girl later developed central precocious puberty. Markedly pigmented stimulated areolas and nipples without an apparent breast mound, and non-enlarged labia minora in the external genitalia were observed as features of sexual maturation in the patient. The hormonal condition was characterized by increased circulating estradiol levels and extremely low IGF-I levels.

Summary and conclusion: This case indicates that IGF-I is necessary for exerting the full effect of estrogen on the development of breasts and maturation of external genitalia.