In Reply.—

Drs Jacobson, Midyett, and Moore responded to our critique of their article largely by restating the very positions we felt were in error. Regarding the “traditional” definition of precocious puberty, although it is certainly common for girls with true precocious puberty to have both breast development and pubic hair, reflecting activation of both ovarian estrogen and adrenal androgen production at about the same time, this is not always the case. The best recent data come from the study of Chalumeau et al, in which 197 girls with hormonally proven central precocious puberty from a single center in Paris, France, were examined retrospectively. In all, 37 (19%) had stage 1 pubic hair and 159 (81%) had stage 2 or greater pubic hair. Interestingly, in the 11 patients with central nervous system abnormalities, 64% did not have pubic hair. Thus it is difficult to argue that the presence...

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