What is the telarca?
The telarca, popularly known as the mammary button, represents the unilateral or bilateral development of the mammary glands: it is a physiological condition when it occurs in girls aged between 10 and 11 years.
However, it has been shown that almost half of girls affected by early-onset telarca (around 45%) already have an appreciable breast hypertrophy at birth.
The telarca is generally not accompanied by any typical sign of early pubertal development, but 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 the 2 years; for other scholars, however, the early telarca appears around 2 years. While on the one hand there is no uniformity of thought on the exact period of onset of the early telarca, on the other there is a considerable congruence on the characterization of the disorder. In fact, all the authors agree on the absence of pubic hair and on the lack of structural and volumetric alterations of the large vaginal lips. Moreover, in the early telarca, the mammary areoles are not hyperpigmented (typical characteristic of puberty). Still, the growth of growth appears normal, as does the bone age, which turns out to be adequate for the child's age. From the ultrasound of the ovary of girls suffering from telarca, often small cysts appear that, as we will see later, stimulate the production of hormones.
Classification
The telarca is not a unique and standardized form , but presents itself with many nuances that vary from child to child:
- The term “ premature exaggerated telarca ” is defined as the telarca characterized not only by a premature enlargement of the breast, but also by a mentioned 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 isolated telarca " outlines a benign condition that provides for an enlargement of the mammary glands favored by an increase in estrogen and not accompanied by any typical sign of precocious puberty. This typology of telarca foresees a notable increase of the hormone FSH and the bone age coincides, practically, with the physiological age. The early isolated telarca tends to regress spontaneously in a few years, therefore it does not need some therapeutic strategies.
- " Thelarche variant ": some authors attribute to this term the clinical picture interposed between the premature telarca and the true precocious puberty. The girls affected by Thelarche variant (mixed form of telarca), show a thick breast enlargement often associated with pseudo-menstrual bleeding: vaginal blood loss occurs independently of a gonadotropin pulsatility, and the response to the GnRH test is negative. Even the mixed telarca is a benign form and, if an early pubertal development does not occur, no type of therapy is needed.
Early telegram regression
Statistics showed a tendency to spontaneous regression of the early fishing within 2-3 years from the time of the event; in any case, when the development of the breasts reaches 5 centimeters in diameter, the regression of the telarca could slow down (we speak of slow regression).
In other cases studied, the telarca does not spontaneously regress and lasts until puberty: consequently, the telarca is a lit spy of early pubertal development. It is not by chance that it is estimated that about 10% of girls with early-onset skin 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 most predisposes to the telarca: the level of the plasma gonadotropins increases notably, as well as the testosterone, the estradiol and the hormone FSH. FSH levels appear to be higher than "healthy" girls of the same age. Precisely the overproduction of the hormone FSH favors the formation of ovarian micro cysts that secrete estrogen. In the telarca an activation of the luteinizing hormone LH does not occur, since only in conjunction with the menarche (first menstruation), the plasma concentration of the hormone LH 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 check some parameters:
- Ultrasonography of the ovaries: useful for checking for cysts, which are responsible for stimulating the follicles (hormonal oscillations);
- Speed of development: it must not be altered;
- Determination of bone age: should coincide with physiological age;
- Hormonal dosage: the FSH hormone increases noticeably in girls with a telarca.
Periodic checking of these factors is indispensable, since the first warning bell of early pubertal development is the telarca.
