Patient: My daughter was born in June 1999. She has always been tall, and in May 2007, she had breast swelling. In February 2009 (9 weeks and 8 months), her height was 147.5 (pm). The bone age was checked to be about 11 years old. The doctor said that if we don’t control it, we will have menarche in about 6 months and we will not reach our ideal height. We were very anxious. In May 2007, we then had a checkup locally (Xiamen) to check the bone age, and the result was that there was an overshoot (about 3 months or so). Since then, we have been taking Chinese herbal medicine, mainly Zhi Bai and Da Yin Pills, and going to the hospital for check-ups once every 3 months or so. Now the bone age seems to be accelerated. In this case, does my daughter need to be injected with drugs like Daphylline? What will be the effect? Does it have to be two years for the Dafilin injection? Since my daughter has problems such as sweaty hands and swollen tonsils that make her cough easily, if the treatment process requires stopping the medication, will the process of bone age be accelerated after stopping the medication? Pan Jiayan, Department of Pediatrics, Wuhu First People’s Hospital: Girls usually have their menarche when their bone age (TW3 method) reaches about 12.7 years old. If the bone age is indeed 11 years old at that time (however, from the obvious growth acceleration of your daughter in the past year or so, it is likely that the bone age is greater than 11 years old), then the menarche should be more than one year away (however, the accuracy of predicting menarche by bone age alone is not high, because menarche is not only affected by the size of bone age, but also by (However, predicting menarche by bone age alone is not very accurate because menarche is affected not only by bone size, but also by endometrial thickness, follicle size, and the season, with about half of girls having menarche in the summer). For the need of medication, in fact, it depends mainly on the adult height prediction. Because of the detailed scoring of bone age films required for adult height prediction and the complexity of the method, most hospitals are currently unable or unwilling to predict adult height for their patients. From the fact that your child has 147.5CM at present and the menarche has not yet appeared, the adult height is not too pessimistic, and girls usually grow 4~8CM after the menarche, so if you are not demanding, you can consider not using medication. Of course, your daughter is less than 8 weeks old to show signs of development, and the last year or so growth acceleration is obvious, the diagnosis of precocious puberty should not be a problem, appropriate intervention also has some benefits, but Dafirin and other higher prices, medication time is generally longer, but better safety, no need to stop the drug when you are sick. Personally, I don’t think it makes much sense to take Chinese medicine, and you should be able to see roughly from the effect of your daughter taking Chinese medicine. In addition to detailed assessment of bone age and height prediction, sex hormones and ultrasound of the uterus and ovaries (breast ultrasound is best for those undergoing treatment), thyroid function and adrenal function or ultrasound of the adrenal glands are required because hypothyroidism and adrenal cortical hyperplasia are also common causes of precocious puberty. The standard tests also include MRI or CT of the pituitary gland. Tests related to the presence of tumors that can secrete sex hormones such as chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) are often needed as well. The most reliable criterion for determining whether a tumor is true gonadotropic or not is the gonadotropin provocation test. Only if the diagnostic criteria for true gonadotropic development are met should GnRHa treatment be applied. For more information, please refer to the related articles and classic consultations on my webpage, such as the guidelines for the diagnosis and treatment of precocious puberty and pubertal development and precocious puberty. Patient: We are mainly afraid that the development will be inhibited after Dafylline injection, and we will miss the current growth period, and then we will end up using growth hormone to promote growth. I don’t know if there are cases where only Dafylline is used and no growth hormone is used, but the height is affected instead. Because we don’t want to use growth hormone. Pan Jiayan, Department of Pediatrics, Wuhu First People’s Hospital: You have misunderstood. The purpose of applying Dafilin is to inhibit pubertal development and prolong the growth period in order to improve lifetime height. If other children start to grow at 140CM and your child starts to grow at 130CM, then your child will be 10CM shorter than other children in terms of lifetime height. However, if we apply Dafylline to stop her puberty when she starts to develop at 130CM, and then let her continue to develop at 140CM, theoretically we can improve her lifelong height by 10CM (in fact, we can’t reach this range because when she reaches 140, her bone age will not remain the same). For true precocious puberty in general, and especially for those who develop precocious puberty at a young age, GnRHa injections are currently the only treatment with definite efficacy and relatively good safety. Although there may be other methods for boys, the safety aspect remains to be seen and the FDA has not officially approved its use. True sexual development is a prerequisite for the application of GnRHa, although not all individuals with true precocious puberty require immediate GnRHa injections (indications for this are included in the precocious puberty guidelines), and generally also require one of (1), an advanced age of 2 years or more for bone age, (2), excessive progression of bone age (usually more than 1 year for bone age as well), and (3), low predicted adult height. Sometimes, (4), when ultrasound suggests oversized follicles, or large endometrial thickness, with the possibility of early appearance of menarche, the indications for GnRHa application can be relaxed appropriately.