{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:46:24Z","timestamp":1792255584002,"version":"4.4.0"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Precocious puberty (PP) refers to pubertal onset before 8\u00a0years in females and 9\u00a0years in males. We present a rare case of a 6-year and 7-month-old Jordanian girl with peripheral PP onset at 4\u00a0months of age. Clinical evaluation revealed vaginal spotting, premature thelarche, advanced bone age, and recurrent uterine bleeding requiring multiple transfusions. Imaging demonstrated a progressive cervicovaginal mass and endometrial polyps. Histopathology identified atypical hyperplasia\/endometrioid intraepithelial neoplasia. Gonadotropins remained persistently suppressed, excluding central PP. Whole-exome sequencing (WES) identified a heterozygous likely-pathogenic ESR1 missense variant (NM_000125.3; c.1610A\u2009&amp;gt;\u2009C; p.Tyr537Ser), previously linked to estrogen-independent receptor activation in breast cancer. Tamoxifen produced partial clinical response with subsequent recurrence; the patient is now on combined letrozole\u2013tamoxifen therapy. This case highlights the value of WES in unexplained PP and suggests that gain-of-function ESR1 variants may drive peripheral PP through receptor hypersensitivity.<\/jats:p>","DOI":"10.1093\/omcr\/omag194","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:43:54Z","timestamp":1791459834000},"source":"Crossref","is-referenced-by-count":0,"title":["Peripheral precocious puberty in a 4-month-old infant associated with an ESR1 variant: a case report"],"prefix":"10.1093","volume":"2026","author":[{"given":"Fadi","family":"Ayyash","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Queen Rania Al Abdullah Hospital for Children, King Hussein Medical City , King Abdullah II Street 226, Amman 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3158-5898","authenticated-orcid":false,"given":"Noor","family":"alrawajfeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Prince Hamza Hospital , Habis Al-Majali Street, Al-Hashmi Al-Shamali, Amman, Amman Governorate 11947,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa Monther","family":"Al Quraan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Queen Rania Al Abdullah Hospital for Children, King Hussein Medical City , King Abdullah II Street 226, Amman 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel Othman","family":"Alqurieny","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Queen Rania Al Abdullah Hospital for Children, King Hussein Medical City , King Abdullah II Street 226, Amman 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6069-8055","authenticated-orcid":false,"given":"Abdelrazaq Ahmad","family":"Alyasin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Queen Rania Al Abdullah Hospital for Children, King Hussein Medical City , King Abdullah II Street 226, Amman 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juana Hani","family":"AbuRahmeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Prince Hamza Hospital , Habis Al-Majali Street, Al-Hashmi Al-Shamali, Amman, Amman Governorate 11947,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nama' Abdullah Bany","family":"Amer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Prince Hamza Hospital, Habis Al-Majali Street , Al-Hashmi Al-Shamali, Amman 11947,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sura","family":"Al-Rawabdeh","sequence":"additional","affiliation":[{"name":"Department of Pathology, King Hussein Medical Center, Royal Medical Services , Amman, Amman Governorate 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waseem","family":"Al Mefleh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Queen Rania Al Abdullah Hospital for Children, King Hussein Medical City , King Abdullah II Street 226, Amman 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sondos","family":"Harahshih","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Queen Rania Al Abdullah Hospital for Children, King Hussein Medical City , King Abdullah II Street 226, Amman 11855,","place":["Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"key":"2026101712301948000_ref1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1542\/pir.27.10.373","article-title":"Precocious puberty","volume":"27","author":"Muir","year":"2006","journal-title":"Pediatr Rev"},{"key":"2026101712301948000_ref2","volume-title":"StatPearls [Internet]","author":"Qudsiya","year":"2023"},{"key":"2026101712301948000_ref3","volume-title":"ClinVar [Internet]","year":"2024"},{"key":"2026101712301948000_ref4","doi-asserted-by":"publisher","first-page":"491","DOI":"10.23736\/S0026-4946.20.05970-8","article-title":"Precocious puberty","volume":"72","author":"Gangat","year":"2020","journal-title":"Minerva Pediatr"},{"key":"2026101712301948000_ref5","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-243401","article-title":"McCune\u2013Albright syndrome onset with vaginal 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