Menstruation in an infant: a case report of exacerbated mini-puberty

There are three periods throughout life in which an activation of the hypothalamus-pituitary-gonads axis takes place: prenatal, immediate postnatal period and puberty. The period that occurs after the first week of life and in which there are high levels of gonadotropins, is called mini-puberty. The possibility of premature girls presenting vaginal bleeding in the context of exacerbated mini puberty is poorly described. We report a case of a 5-month-old infant (2 months of corrected age), born premature (26 weeks), who presented spontaneous vaginal bleeding associated with premature thelarche and augmented clitoral hood. Laboratory analysis and pelvic ultrasound supported the diagnosis of precocious puberty of central origin. Clinical findings resolved spontaneously without any intervention due to gradual return of gonadotropins levels to the prepubertal range. This case highlights this benign and self-limited situation that can occur later in premature children and that should be recognized to avoid unnecessary investigations and therapeutics.