Premature thelarche (bilateral and asymmetrical)
Painless swelling of the breasts
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Bilateral retroareolar heterogeneously hypoechoic area more prominent on the right side (thickness 0.84 cm on the right versus 0.40 cm on the left).
The majority of cases of idiopathic premature thelarche (i.e. breast development) are related to a slight hyperfunction of the pituitary-ovarian axis. A pelvic ultrasound is required to differentiate an isolated premature thelarche from central precocious puberty by analyzing the size and shape of the uterus and ovaries and rule out an ovarian tumor. It is also important to determine bone age to see whether there is advanced bone maturation.
In most cases, premature thelarche regresses before puberty.