Dear Michelle,

I would not be that concerned about your daughter. My daughter is 9 1/2 with non-classical. She has had pubic hair for over 2 1/2 years. Now, some of her friends ' moms tell me that their daughters are developing hair as well. This is within the normal range. I am attaching below the Lawson-Wilkins and Endocrine Society statment on precocious puberty. It states that parents should be concerned about early puberty when signs are present under the age of 8 in girls and 9 in boys. It sounds like she has been checked by an endo. I would not be too alarmed. It sounds like everything is normal to me, but you could run her symptoms by your endo to be on the safe side.

You also mention that she was a preemie. There was an article published last year that showed a correlation between prematurity at birth and early onset of puberty.  I will find the article for you and email it to you.

Take Care,

Kelly

Bethesda, MD, March 1, 2001-The Endocrine Society and the Lawson Wilkins Pediatric Endocrine Society reported today that additional research is necessary in order to define what constitutes precocious puberty in young girls. This action follows a surge of public and media attention, which reported that early puberty could occur normally in girls as young as five years old. The two Societies, which represent both adult and pediatric endocrinologists, also stress that future studies on precocious puberty should examine the tempo with which pubertal changes are progressing rather than just the point at which puberty begins. "Recent media attention has made it appear as if there is a deep rift within the endocrine community on this issue," said Dr. Benita Katzenellenbogen, an endocrinologist, professor and researcher at the University of Illinois and the President of The Endocrine Society. "Although endocrinologists may have different views, I think that we all agree that more research is needed before any definite conclusions can be made. We all recognize that there are questions that have not been answered." Dr. Edward Reiter, a pediatric endocrinologist at Baystate Medical Center Children's Hospital in Massachusetts and President of the Lawson Wilkins Pediatric Endocrine Society stresses that endocrine researchers must locate an appropriate population for future studies on this topic. "We need to study precocious puberty through physical exams that include palpation of breast tissue as well as other methods of pubertal assessment," said Dr. Reiter. While most pediatric endocrinologists support a 1997 study by Dr. Marcia E. Herman-Giddens, referred to as the Herman-Giddens study, which found that "girls&. are developing pubertal characteristics at younger ages than currently used norms," some pediatric endocrinologists still feel that the results of the Herman-Giddens study may be flawed for a variety of reasons, including the fact that the sample subjects were not selected at random. However, this study does represent the most current and comprehensive assessment of normal puberty to date. Pediatric endocrinologists representing both societies also emphasize that since many children in the United States and throughout the world are overweight, some doctors might have difficulty distinguishing between breast tissue and fatty tissue in young girls. "Since the Herman-Giddens study showed that the age of menstruation has not changed and that the interval between the onset of breast budding and menarche is prolonged," said Dr. Reiter, "it is possible that the issue of early puberty is due to the mistaken assessment of fatty tissue as breast tissue. For this reason, a carefully controlled trial would be able to assess if breast development is truly occurring much earlier than in the past and is disconnected from uterine maturity." Pediatric endocrinologists also note that minimal breast development in young girls may not necessarily indicate the onset of puberty. Both The Endocrine Society and the Lawson Wilkins Pediatric Endocrine Society encourage parents of children who appear to be experiencing precocious puberty to see a pediatric endocrinologist as soon as possible. This could include the formation of breast tissue or the growth of pubic hair. In cases where these symptoms occur, the rapid progression of these clinical changes would be of most concern to doctors. "Although we may not agree on an exact definition for the normal age of onset of puberty, pediatric endocrinologists agree that we must conduct comprehensive, case-controlled studies to help us understand if girls are reaching puberty earlier, and, if found to be the case, we need to understand why this is happening," said Dr. Ora Pescovitz, the Executive Associate Dean for Research Affairs; the Edwin Letzter Professor of Pediatrics; a Professor of Cellular and Integrative Physiology; and the Director of Pediatric Endocrinology and Diabetology at Indiana University School of Medicine. Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones, and the clinical practice of endocrinology. Today, The Endocrine Society's membership consists of over 9,000 scientists, physicians, educators, nurses and students, in more than 80 countries. Together, these members represent all basic, applied, and clinical interests in endocrinology. The Endocrine Society is based in Bethesda, Maryland. To learn more about the Society, and the field of endocrinology, visit the Society's web site at www.endo-society.org. The Lawson Wilkins Pediatric Endocrine Society was founded in 1971 and named in honor of Dr. Lawson Wilkins who pioneered the study of pediatric endocrinology in North America. The mission of the LWPES is "to promote acquisition and dissemination of knowledge of endocrine and metabolic disorders of the young from conception through adolescence." It has now grown to more than 800 members from the United States, Canada, and 24 other countries. The LWPES has become the foremost organization of pediatric endocrinologists in the world. To learn more about the LWPES visit the LWPES web site at www.lwpes.org ###