ROYAL SOCIETY OF MEDICINE

20 May 1948. ^\ ^ Precocity in a Girl Aged 5 Due to Stilboestrol Inunction.—Dr. C. H. WHITTLE l^ and Dr. A. LYELL. il S. H—. This child had total alopecia from 1 year of age after chickenpox and ^ otitis media. î In December 1947 she was given stilboestrol ointment 0-5% to rub into the scalp, ^̂ and the mother continued to use this for thirteen Aveeks. After about ten Aveeks' ., treatment vaginal bleeding was noticed and was fairly heavy for a week. It con;,; tinued for about four Aveeks, for the last week of Avhich she was mider observation in hospital. For the last two or three months there has been deep pigmentation of the areolae •^ of the breasts, and the breasts have developed and become prominent. There is 1̂ deep pigmentation also of the trunk. Investigation in hospital showed a healthy Avell-groATO child, with rather a deep ^ voice. The scalp hair appears to be growing : eyebrows present, eyelashes present !*' but scanty on lower hds. No pubic or axillary hair. Dosage : 2 ounces of ointment (emulsifying hase) yield 240 mg. of stilboestrol, '̂ or approximately 2-7 mg. daily if all were aljsorbcd. ^ Special examinations.—(1) 17-ketosteroid output 1-7 mg. per day (normal) ; (2) Skiagram of the skull—sella tm-cica normal. Comment.—Dr. Laurence Martin saw tlie child and thought this was a pure ® stilboestrol efl'ect. He suggested as an alternative diagnosis a true constitutional ^ precocious puberty. If the first alternative is rejected, the second mâ ^ be correct, 'the stilboestrol either drawuig attention to or accentuating the condition ; but the ^ bleeding has ceased and the breasts are getting smaller since stilboestrol was stopped. Postscript.—(3.vii.48).—Dr. H. W. Barber writes (personal communication) : ' '*As compared with the effects of oral administration of tablets in usual dosage, there is no doubt that inunctions are far more active, and must be used with the ' gre'atest care. The explanation, no doubt, is that some of the oestrogen, when rubbed into the skin, is absorbed into the blood-stream and exerts its effects l.iefore 'being altered by the liver, whereas Avhen given by mouth all of it, of course, has to pass through the liver before reaching the main l^Iood-stream. I ha e had man}^ t cases in which uterine bleeding and pigmentation of the nipples have followed in a short time the inunction of dienoestrol ointment into the scalp or face of women : long past the menopause, while it is extremely rare for pigmentation of the nipples 1 to result even from high doses of oestrogen by mouth after the menopause, the excess of pituitary gonadotropins being supposed in some way to check pigmentation. L Stilboestrol is many times more potent than dienoestrol, so I am not. sui-prised at the effects in this case."—C. H. W.