The Etiology And Long-term Follow-up For Prepubertal Vaginal Bleeding

Background:The vaginal bleeding of pre-pubertal girls will raise great concerns of patients,due to this kind of symptom is extraordinary rare.In addition,a majority of emergency doctors and even pediatricians lack professional knowledge and clinical experience when receiving these patients,which may lead to misdiagnosis,delaying the timing of treatment and even causing serious consequences.The causes of prepubertal vaginal bleeding are diverse according to previous domestic and foreign literatures.However,there are large differences in the description of the etiology,because reporting come from different units where the source of the receiving patients various.Common causes include vaginal foreign bodies,trauma,especially for riding injuries,vulvovaginitis,urethral mucosal prolapse,precocious puberty,sexual abuse and even tumors.The etiology of vaginal bleeding would be as simple as vulvovaginitis and foreign body or as devastating as sexual abuse or malignancy,which endanger physical and mental health condition.With the extraordinary progress made in economy and education,patients place more concern on children well-being,which promote the number of patients who suffer from vaginal bleeding of prepuberty girls and seek medical treatment.Therefore,clinicians should be familiar with the process of diagnosis and treatment for these patients to ensure their healthy development both of physical and mental.However,most of the domestic literatures with vaginal bleeding in prepubertal girls are mostly case reports,and lack of detailed discussion about these causes,diagnostic procedures,and follow-up results of these children.Objective:1.To summary etiologies of the 73 cases of prepubertal vaginal bleeding girls and analyze difference among various groups included in this study.2.To follow up these vaginal bleeding patients after therapied in our study and observe for complications and sequelae.Methods:Seventy-three girls with prepubertal vaginal bleeding from the Department of Pediatric Endocrinology in our hospital from August 2010 to March 2019 were retrospectively reviewed.Patients clinical information was collected through medical record system.We divided these children into different group according to etiology and then analyzed these clinical characteristics.Results:1.etiologies analysis:The most common causes of prepubertal vaginal bleeding in this study were central precocious puberty(28 cases of idiopathic central precocious puberty,5 cases of gray nodular hamartoma,and 1 case of hydrocephalus),and 22 cases of peripheral precocious puberty(15 cases of ovarian cysts,2 cases of McCune-Albright syndrome,5 cases of other causes),12 cases of partial precocious puberty,3 cases of vulvovaginitis,and 2 cases of riding injury.2.Compassion between groups:(1)there is a significant difference in terms of average age of diagnosis between hypothalamic hamartoma and idiopathic central precocious puberty group,partial precocious puberty and idiopathic central precocious puberty group,ovarian cyst group and idiopathic central precocious puberty group.(2)The average age of diagnosis,serum estrogen,insulin-like growth hormone and bone age of partial precocious puberty are extreme lower than peripheral precocious puberty,however the LH?FSH?peak of LH and LH/FSH ratio are higher.(3)Luteinizing hormone,follicle stimulating hormone,estrogen,peak of Luteinizing hormone and the ratio of peak Luteinizing hormone to follicle stimulating hormone of hypothalamic hamartoma are significant high than partial precocious puberty.3.Follow-up results:we followed up these patient for 3 months to 7 years.The highest recurrence of vaginal bleeding is ovarian precocious puberty.Target height or normal rate of growth curve is 70 percent in group of idiopathic central precocious puberty group,partial precocious puberty group is 83percent and other groups are 100 percent.No sequelae or complications were found during follow-up.Conclusions:1.The etiologies of prepubertal vaginal bleeding are various,among them the precocious puberty is the main cause.2.Patients have a good prognosis after proper diagnosis and treatment.3.Hypothalamic hamartomas with precocious puberty can be adequately treated with GnRH analog therapy.