Fig. 4

Changes in the serum estradiol and testosterone levels and the breast Tanner stage at each age in the pediatric patient. The figure shows the changes in estradiol and testosterone levels from 9 years and 3 months of age to 15 years of age, including a drastic reduction in the estradiol level after changing tamoxifen with aromatase inhibitor at 13 years and 9 months of age. Following the operation at 13.5 years of age, the Tanner stage of the breast was improved from 5 to 3, followed by a decrease in estradiol at 14 and 15 years of age with symptomatic improvement and maintenance at Tanner stage I–II