In Reply.—We would like to reassure Drs Stanhope and Brook that our two patients had more than just premature thelarche; they had precocious pseudopuberty. It would be wrong to suggest that every girl with premature thelarche should be operated on if small cysts were present in the ovaries. In our two patients, the diagnosis of precocious pseudopuberty was based on their ages, on elevated serum estrogen levels, and on clinical findings of estrogen excess, eg, increased nipple and areolar pigmentation, increased bone age, and morning sickness. In our second patient, the morning nausea was so severe that it interfered for almost two months with our patient's school attendance. Both sets of parents were extremely (justifiably) anxious about the rapidly progressive breast enlargement of their little girls.
Precocious pseudopuberty is rare, and these two children were highly selected. Our pediatric endocrine clinic serves as the tertiary referral center for a population of