{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:09:16Z","timestamp":1793394556902,"version":"4.5.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Girls with early thelarche may show an intermediate clinical picture between isolated premature thelarche (PT) and central precocious puberty (CPP), defined as \u201cthelarche variant\u201d (TV), characterized by an FSH-predominant response, although a univocal definition is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis on 91 girls with early thelarche (&amp;lt;8 years) and advanced bone age and\/or accelerated growth who underwent 104 LHRH tests. Patients were classified into CPP (LH peak \u22655 IU\/L; n = 28, 31%), TV (FSH peak \u226520 IU\/L, LH peak &amp;lt;5 IU\/L; n = 15, 16%), or PT (FSH peak &amp;lt;20 IU\/L and LH peak &amp;lt;5 IU\/L; n = 48, 53%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>TV patients were younger (5.51 years) and with less advanced bone age (+0.8 years). They had higher basal and peak FSH (2.5 and 26.6 IU\/L) and lower basal and peak LH\/FSH ratios (0.08 and 0.11). The prevalence of presence of ovarian follicles &amp;gt;5 mm in TV (42%) was similar to CPP but significantly higher than PT, whereas maximum ovarian volume was smaller in TV (1.0 cm<jats:sup>3<\/jats:sup>). At the last follow-up visit (available in 60% of the cases), 44% of TV developed CPP compared with 14% of PT (p = 0.04). At first evaluation, those who progressed to CPP had a higher basal FSH (3.2 IU\/L), lower LH\/FSH ratio (0.07), and a higher peak LH (4.1 IU\/L) compared with those who did not progress to CPP (basal FSH 1.9 IU\/L, p &amp;lt; 0.01; basal LH\/FSH ratio 0.12, p &amp;lt; 0.01; peak LH 2.8 IU\/L, p = 0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using laboratory parameters only as a definition, we identified the clinical, laboratory, and imaging features of TV: these girls showed less advanced bone age and FSH predominance also at baseline, with smaller ovaries but with follicles &amp;gt;5 mm. Almost half of girls initially diagnosed as TV developed CPP at last follow-up visit, and these girls had higher baseline FSH, lower baseline LH\/FSH ratio, and higher peak LH at first evaluation. Therefore, TV may represent a \u201cprecocious prepuberty\u201d in which the FSH predominance may initially limit the progression into proper puberty, but it may eventually trigger full puberty (even CPP, depending on the girls\u2019 age).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1303989","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T16:27:55Z","timestamp":1701448075000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Prevalence and characteristics of thelarche variant"],"prefix":"10.3389","volume":"14","author":[{"given":"Francesca","family":"Burlo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Lorenzon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tamaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Fabretto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Buonomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Peinkhofer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Vidonis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Vittori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Faleschini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egidio","family":"Barbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tornese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0800459","article-title":"Clinical practice. 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