Sir.—We were appalled to read the article by Kosloske et al,1 which described single 9- and 11-mm follicular cysts in the ovaries of two girls with isolated breast development. Both girls had many of the clinical and biochemical features of isolated premature thelarche. The authors did not mention the time of day of their samples but basal gonadotropin levels in early sexual maturation would be expected to be low if they were measured during the day, 2 and girls with isolated premature thelarche have nocturnal secretion of gonadotropins.3 We agree with the associated editorial4 that the physical signs need to be observed over a period of time and that appropriate endocrine investigations need to be performed before a diagnosis can be made.
Postmortem evidence has demonstrated that the prepubertal ovary contains numerous follicular cysts5 that have a continuous turnover.6 We have unpublished ultrasonic data
STANHOPE R, BROOK CGD. Precocious Pseudopuberty and Ovarian Follicular Cysts. Am J Dis Child. 1985;139(3):222. doi:10.1001/archpedi.1985.02140050016008