What is the telarca?
The telarca, popularly known as breast button, represents the unilateral or bilateral development of the mammary glands: it is a condition physiological when it occurs in girls between the ages of 10 and 11.
In any case, it has been shown that almost half of the girls affected by early telarca (about 45%), already at birth present an "appreciable breast hypertrophy.
Telarca is generally not accompanied by any typical signs of precocious pubertal development, but it could be a possible indicator of precocious puberty.
Early Telarca
According to the studies of some authors, the early telarca occurs in the period between 10 months (in which the placental estrogenic effect is exhausted) and 2 years; for other scholars, however, the early telarca appears around 2 years. If on the one hand there is a lack of uniformity of thought on the "exact period of onset of early telarca, on the other hand there is a notable congruence on the characterization of the disorder. All the authors agree, in fact, on the absence of pubic hair and on the lack of structural and volumetric changes of the labia majora. Furthermore, in the early telarca, the mammary areolas are not hyperpigmented (typical characteristic of puberty). Still, growth development appears normal, as well as the bone age, which turns out to be adequate for the age of the girl. From the ultrasound of the ovary of girls affected by telarca, small cysts often appear which, as we will see later, stimulate the production of hormones.
Classification
The telarca is not a form unique and standardized, but it comes with many shades that vary from girl to girl:
- It defines itself as "premature telarca exaggerated"Telarca characterized not only by premature breast enlargement, but also by a marked increase in body growth, accompanied both by a marked response of the FSH hormone to the GnRh test, and by a modest advancement of the skeletal age (taken from Gynecology from the neonatal period to the developmental age, by Vincenzina Bruni, edited by Bruni-Dei, Metella Dei).
- The "early telarca isolated"Outlines a benign condition that involves an enlargement of the mammary glands favored by an increase in estrogen and not accompanied by any typical signs of precocious puberty. This type of telarca foresees a notable increase of the FSH hormone and the bone age practically coincides with the physiological age. The isolated early telarca tends to regress spontaneously in a few years, therefore it does not require any therapeutic strategies.
- “Thelarche variant": Some authors attribute to this term the clinical picture interposed between the premature telarca and the true precocious puberty. Girls suffering from Thelarche variant (mixed form of telarca), show breast enlargement often associated with pseudo-menstrual bleeding: blood loss vaginal occur regardless of gonadotropic pulsatility, and the response to the GnRH test is negative. Mixed telarca is also a benign form and, in the event that early pubertal development does not occur, no type of therapy is necessary.
Early telarca regression
The statistics showed a tendency to spontaneous regression of the early telarca within 2-3 years from the moment of the event; however, when the development of the breasts reaches 5 centimeters in diameter, the regression of the telarca may slow down (we speak of slow regression).
In other cases studied, the telarca does not regress spontaneously and lasts until puberty: consequently, the telarca is a bright indicator of early pubertal development. It is no coincidence that it is estimated that about 10% of girls with early telarca present a predisposition to early pubertal development (but once again there is no uniformity in the thinking of scholars).
Telarca and hormonal variations
Endogenous hormonal hypersecretion seems to be the cause that predisposes most to telarca: the level of plasma gonadotropins increases significantly, as does testosterone, estradiol and the FSH hormone. FSH levels seem to be higher than in "healthy" girls. the same age. The overproduction of the FSH hormone favors the formation of ovarian micro cysts that secrete estrogen. In the telarca there is no "activation of" the luteinizing hormone LH, since only in concomitance with the menarche (first menstruation), the plasma concentration of the LH hormone begins to oscillate, thus allowing the periodicity of the menstrual cycle.
Diagnosis
Although the premature telarca remains, in most cases, a benign condition, it is always essential to control some parameters:
- Ultrasound of the ovaries: useful to check for the presence of any cysts responsible for stimulating the follicles (hormonal fluctuations);
- Speed of development: it must not be altered;
- Determination of the bone age: it should coincide with the physiological age;
- Hormonal dosage: FSH hormone increases significantly in girls with telarca.
Periodic monitoring of these factors is essential, since the telarca is the first alarm bell of early pubertal development.
