Observational study pelvic ultrasound a useful tool in the diagnosis and differentiation of precocious puberty in Chinese girls

Abstract

Rapid and noninvasive diagnosis on and differentiation between normal, central precocious puberty (CPP), and isolated precocious puberty (IPP) is imperative before a decision can be made with gonadotropin-releasing hormone (GnRH) agonist treatment. Our study aims to evaluate such a role by pelvic ultrasound.We consecutively enrolled 84 cases of IPP (59 with premature thelarche/ pubarche and 25 with premature menarche), 47 CPP, and 177 age-matched normal controls. The IPP and CPP were diagnosed by clinical examination and GnRH-stimulation test and confirmed by over 2 years’ follow-up. All subjects underwent pelvic ultrasound examination for length, width, thickness, volume of uterine/cervix/ovaries, fundal/cervical thickness ratio, endometrial thickness, and averaged maximal diameter of largest follicles. Statistical comparisons of these sonographic parameters between disease groups were made according to age intervals.It was found that between CPP and normal girls, 10 and 12 ultrasound parameters differed significantly in the >6 to 8 and >8 to 10 years age interval, respectively. Cervical thickness and endometrial thickness was the best discriminating parameter in the 2 intervals by receiver operating characteristic (ROC) curve analysis, and the cutoff, sensitivity and specificity associated with was 0.73 cm, 93.30%, 85.70%, and 0.26 cm, 76.92%, 100%, respectively. Between CPP and IPP, 2 and 5 parameters differed significantly in the >6 to 8 and >8 to 10 years age interval. Cervical length was the best discriminating parameter in both age intervals. The cutoff, sensitivity, and specificity associated were 1.49 cm, 93.33%, 55.17%, and 1.88 cm, 100%, 71.43%, respectively; Finally between normal and IPP girls, 4, 7, and 5 parameters differed significantly in the 0 to 6, >6 to 8, and >8 to 10 years intervals, respectively. Ovarian thickness, ovarian width, and cervix thickness was the best parameter for the 3 age interval respectively, and the cutoff, sensitivity and specificity associated were 0.98 cm, 76.46%, 84.85%, 1.39 cm, 85.71%,73.81%, and 0.75 cm, 90.48%, 64.21%, respectively.Our results indicate that pelvic ultrasonography could serve as a complementary tool for differentiation between normal girls and girls with different forms of sexual precocity in China. The best discriminating parameter changes according to precocity forms and age intervals.

Pelvic Ultrasound in Diagnosing and Evaluating the Efficacy of Gonadotropin-Releasing Hormone Agonist Therapy in Girls With Idiopathic Central Precocious Puberty

“…The uterine and ovarian volume was calculated by the formula: Volume = length × anteroposterior diameter × transverse diameter × 0.5233. There was no significant difference in the size of the bilateral ovaries (Wen et al, 2018). Therefore, the average of the bilateral ovaries was calculated for statistical analysis.…”

“…According to our study, with a cutoff value of 1.01 cm 3 in the volume of uterine body to diagnose ICPP, the sensitivity and specificity are 91.6 and 68.7%, respectively. Wen et al reported endometrial thickness was the best parameter for distinguishing CPP from normal girls in the 8–10 year interval, where a cutoff of 0.26 cm had a sensitivity of 76.92% and specificity of 100% (Wen et al, 2018). The cutoff values have a certain reference value for the diagnosis of CPP.…”

“…Pelvic ultrasound can observe the size and structure of internal genitalia in girls, and can be used for the diagnosis and differential diagnosis of CPP, especially when the results of the GnRH stimulation test are ambiguous (de Vries et al, 2006; Badouraki et al, 2008; de Vries and Phillip, 2011a; Wen et al, 2018), and the operation is simple, non-invasive and easy to be accepted by children and their parents (Ziereisen et al, 2005). Up to now, a few literatures have reported the value of pelvic ultrasound in monitoring GnRHa therapy in girls with ICPP (Hall et al, 1986; Ambrosino et al, 1994; Jensen et al, 1998; de Vries and Phillip, 2011b), with limited cases (less than 30), and most of the literatures were published about a decade ago.…”

A diagnostic model of idiopathic central precocious puberty based on transrectal pelvic ultrasound and basal gonadotropin levels

“…Previous studies have shown that basal luteinizing hormone (LH) levels and pelvic ultrasound findings are important predictors of central precocious puberty. 6 – 8 …”

“…Previous studies have shown that basal luteinizing hormone (LH) levels and pelvic ultrasound findings are important predictors of central precocious puberty. [6][7][8] Therefore, we conducted this study to establish an ICPP diagnostic model with transrectal pelvic ultrasound and basal gonadotropin as variables, and to evaluate the diagnostic efficacy of this model.…”