6-Year-Old Girl Experiences Breast Enlargement and Pain—Diagnosed with Peripheral Precocious Puberty

Peripheral precocious puberty is a growing concern in pediatric endocrinology, often linked to environmental, dietary, or hormonal imbalances. This case highlights a 6-year-old girl who presented with unilateral breast enlargement and tenderness—a rare but significant sign of early sexual development. After thorough evaluation, she was diagnosed with peripheral precocious puberty. With timely intervention using traditional Chinese medicine and lifestyle adjustments, her symptoms significantly improved within one month. This article explores the clinical journey, treatment approach, and key takeaways for parents and caregivers.

Case Overview

Patient: Female, 6 years oldDiagnosis: Peripheral precocious pubertyHospital: Nanjing Hospital of Traditional Chinese MedicineDate of Consultation: February 2022Treatment Plan: Herbal therapy with Zhibai Dihuang Pills (a traditional Chinese formula)Duration of Treatment: 1 monthOutcome: Complete regression of breast enlargement and resolution of pain; improved sleep and dietary habits

Initial Clinical Assessment

During the first consultation, the child was brought in due to noticeable swelling and discomfort in one breast. Physical examination revealed palpable breast tissue with developed areolae, consistent with early secondary sexual characteristics. There was mild tenderness upon palpation, but no signs of pubic or axillary hair growth—indicating isolated breast development.

A detailed medical history uncovered a diet high in sugary snacks and fried foods, which may contribute to hormonal disruptions. Family history showed no known genetic or metabolic disorders. Given that the onset of secondary sexual traits occurred well before the age of 8, clinicians concluded this was a case of peripheral precocious puberty—a condition driven by estrogen exposure independent of the central hypothalamic-pituitary-gonadal axis.

Diagnostic Evaluation

Key Laboratory and Imaging Tests

To confirm the diagnosis and rule out central precocious puberty or tumors, several tests were performed:

Hormone Panel: Elevated free triiodothyronine (FT3), low estradiol, and suppressed luteinizing hormone (LH) levels pointed toward an extracentral cause.
Bone Age X-ray: Advanced bone age compared to chronological age—an important indicator of accelerated growth and potential future height compromise if untreated.
Abdominal and Breast Ultrasound: No ovarian or uterine enlargement was observed, further supporting a peripheral rather than central etiology.

These findings collectively confirmed peripheral precocious puberty, likely influenced by external factors such as diet or environmental hormone disruptors.

Treatment Strategy and Progress

Herbal Intervention and Lifestyle Modifications

The treatment focused on nourishing kidney yin and clearing internal heat—a principle rooted in Traditional Chinese Medicine (TCM) for managing hormonal imbalances. The patient was prescribed Zhibai Dihuang Pills, a time-tested herbal formulation known for its regulatory effects on endocrine function.

In parallel, the family received comprehensive guidance on nutrition and daily routines:

Eliminate processed sweets, fried foods, and packaged snacks from the child's diet.
Prioritize seasonal vegetables, whole grains, lean proteins, and fresh fruits.
Maintain regular meal times and ensure adequate hydration.
Establish a consistent bedtime routine to prevent late-night sleeping patterns.
Encourage moderate physical activity such as outdoor play, swimming, or dance.

The child returned for follow-up after four weeks, showing remarkable improvement.

Observed Outcomes After One Month

At the follow-up visit, the breast tissue had regressed significantly, and the child reported no further discomfort. Parents noted enhanced appetite regulation, better concentration, and deeper, more restful sleep. Importantly, there was no progression of other secondary sexual characteristics.

Given the absence of ovarian stimulation or central nervous system involvement, additional invasive testing was deemed unnecessary. The parents expressed high satisfaction with the non-pharmaceutical, holistic approach and reported a positive shift in the child's emotional well-being.

Important Considerations for Parents

Recognizing Early Signs and Acting Promptly

This case underscores the importance of vigilance. Any sign of early puberty—such as breast development, pubic hair, rapid height growth, or mood changes—in children under 8 (girls) or 9 (boys) warrants prompt medical evaluation.

Diet plays a critical role. Many commercially available snacks contain additives, preservatives, and hidden sources of phytoestrogens or xenoestrogens—synthetic compounds that mimic natural hormones. Even certain non-organic produce treated with growth enhancers can contribute to hormonal imbalance.

Recommended Preventive Measures:

Avoid out-of-season fruits and vegetables that may be treated with ripening agents.
Limit consumption of fast food, instant noodles, and deep-fried items.
Choose organic dairy and meat products when possible to reduce exposure to exogenous hormones.
Promote screen-free evenings and consistent sleep schedules to support healthy circadian rhythms.

Equally important is emotional support. Children experiencing early physical changes may feel confused or self-conscious. Open communication, reassurance, and age-appropriate education about body development can ease anxiety and foster resilience.

Clinical Insights and Final Thoughts

As pediatric endocrinologists and integrative practitioners observe rising cases of precocious puberty, early detection remains crucial. While some cases stem from brain abnormalities or tumors (central precocious puberty), many are triggered by modifiable lifestyle factors—especially diet and environmental exposures.

Untreated central precocious puberty can lead to premature closure of growth plates, resulting in shorter adult height. Therefore, differentiating between central and peripheral forms through proper diagnostics—including hormone assays, imaging, and ultrasounds—is essential for appropriate management.

This case illustrates how a combination of evidence-based diagnostics and traditional therapeutic approaches can yield excellent outcomes without aggressive pharmaceutical intervention. It also serves as a powerful reminder: small changes in daily habits can have profound impacts on long-term health.

For parents, educators, and healthcare providers alike, awareness, prevention, and compassionate care are key to supporting children through these sensitive developmental stages.