An 18-month-old girl was referred to our hospital for evaluation of bloody vaginal discharge for the previous month. Physical examination was remarkable for Tanner stage 2 breast, development. There was no axillary hair and developmental milestones were consistent with her age. Neurological and ophthalmological examination was unremarkable. She had an elevated serum estradiol level of 220.2 pmol/L (pre-pubcrtal level <84.41 pmol/L) and a predominant pubertal luelinising hormone (LH) response to the lueitnising hormone releasing hormone (LHRH) stimulation test. Pelvic ultrasound showed enlarged ovaries and uterus compared to age-specific date.
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