Exaggerated Mini-puberty in a Premature Female: Addressing the Treatment Dilemma in the Face of Vaginal Bleeding

Background Mini-puberty is an essential developmental phase that involves the maturation of the sexual organs following the activation of the hypothalamic-pituitary-gonadal (HPG) axis during infancy. Usually asymptomatic, but it may rarely manifest in an extreme form in premature infants and be associated with pubertal symptoms including breast development and vaginal bleeding. These unusual findings raise questions about the appropriate management approach. Case presentation: A premature female infant born at 27 weeks had vaginal bleeding episodes and breast development at the age of 3 months (corrected gestational age of 40 + 2 weeks), associated with increased levels of luteinizing and follicle-stimulating hormones and significantly high luteinizing hormone-releasing hormone (LHRH) test results. A brain magnetic resonance imaging (MRI) was normal. She was assessed to have exaggerated mini-puberty in preterm. Conclusion Few cases of exaggerated mini-puberty have been reported, underlining the importance of this study which highlights that mini-puberty should be considered in the differential diagnosis for preterm females with vaginal bleeding in the first 6 months of life. The presence of pubertal symptoms in premature infants alone does not warrant immediate treatment. Instead, important evaluation must first rule out serious conditions and cautious observation until complete resolution is recommended.