An 18-month-old girl presents with asymmetrical breast enlargement. There was no pubic hair growth or body odor and her height was in mid parental range. Her bone age was mildly ad... An 18-month-old girl presents with asymmetrical breast enlargement. There was no pubic hair growth or body odor and her height was in mid parental range. Her bone age was mildly advanced. Which of the following is the best next step in management?
Understand the Problem
The question describes a clinical scenario of an 18-month-old girl presenting with asymmetrical breast enlargement and asks for the most appropriate next step in management. We need to determine the most likely cause based on the given information (age, symptoms, lack of other signs of puberty, mildly advanced bone age) the question requires knowledge of pediatric endocrinology and diagnostic procedures.
Answer
Observation and follow-up are the most appropriate next steps, with further investigation if progression occurs.
Given the asymmetrical breast enlargement, lack of other pubertal signs, mid-parental height and mildly advanced bone age, the best next step is typically observation and follow-up. Further investigations would be considered if there is progression or other signs of puberty.
Answer for screen readers
Given the asymmetrical breast enlargement, lack of other pubertal signs, mid-parental height and mildly advanced bone age, the best next step is typically observation and follow-up. Further investigations would be considered if there is progression or other signs of puberty.
More Information
Asymmetrical breast enlargement in the absence of other pubertal signs is common and often benign in young girls. Mildly advanced bone age can be normal, investigations are typically reserved for cases with other signs of precocity.
Tips
A common mistake is to immediately order extensive testing without considering the clinical context and natural history of the condition.
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