Role of Pelvic Ultrasound in Girls with Precocious Puberty

Vries, Liat de; Phillip, Moshe

doi:10.1159/000323361

Cited by 32 publications

(18 citation statements)

References 43 publications

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“…The uterine endometrial echogenicity may be of help in the diagnosis of CPP, although it was highly specific, but less sensitive 11 26) . In our study, endometrial echogenicity was observed in only one case with advanced CPP, suggesting that the evaluation in this study was performed in the early phase of puberty.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls

Shin

Lee

et al. 2015

Korean J Pediatr

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PurposeIt is difficult to differentiate between central precocious puberty (CPP) and premature thelarche (PT) in girls. The aim of this study was to investigate the diagnostic usefulness of pelvic ultrasonography to distinguish between CPP and PT in girls with early breast development.MethodsThis study included girls with early breast development who visited the clinic between January 2012 and December 2013. Clinical, laboratory, and pelvic ultrasonographic data were evaluated. CPP and PT were confirmed using the gonadotropin-releasing hormone stimulation test.ResultsA total of 248 girls aged 7-8 years were included, among whom 186 (75.0%) had CPP and 62 (25.0%) had PT. The uterine length, transverse diameter, fundus, volume, and cross-sectional area were significantly larger in the CPP group (uterine length, 2.45±0.50 cm vs. 2.63±0.49 cm, P=0.015; uterine volume, 0.95±0.62 cm3 vs. 1.35±0.76 cm3, P<0.001). However, there were no differences in the fundus/cervix ratio and ovarian measurements. In receiver operating characteristic analysis, a uterine volume of at least 1.07 cm3 was the most predictive parameter for CPP with an area under the curve of 0.670 (95% confidence interval, 0.593-0.747).ConclusionUterine measurements by pelvic ultrasonography in girls with early pubertal development were significantly larger in the CPP group. However, the diagnostic value of ultrasonographic parameters was not high because of a considerable overlap of values between the two groups. Therefore, pelvic ultrasonography in combination with clinical and laboratory tests may be useful to distinguish between CPP and PT in girls.

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Section: Discussionmentioning

confidence: 99%

Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls

Shin

Lee

et al. 2015

Korean J Pediatr

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“…However, at the endocrine follow-up, when the patient was 4.8 year-old, she exhibited a progression of the pubertal staging (Ph3 B2-3, no axillary hair), according to Marshall and Tanner criteria ( 7 ). Ultrasonography showed a slight increase of the uterine longitudinal diameter (42 mm, normal values <40 mm) ( 8 ). She weighted 15.6 Kg [−1.31 SDS, 10th percentile according to Cacciari et al ( 9 )] and was 107 cm tall [−0.37 SDS, 25–50th percentile according to Cacciari et al ( 9 )].…”

Section: Case Presentationmentioning

confidence: 99%

Central Precocious Puberty in a Child With Metachromatic Leukodystrophy

et al. 2018

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Metachromatic leucodystrophy (MLD) is a rare inherited lysosomal disorder caused by reduced activity of the enzyme arylsulfatase A with accumulation of sulfatides in the nervous system. We report a female child affected by MLD who developed central precocious puberty (CPP). This association has not been described so far. The proposita, after normal growth and psychomotor development, at age of 30 months presented with a rapidly progressive gait disturbance with frequent falls and with loss of acquired language skills. Magnetic resonance imaging showed leukoencephalopathy. Biochemical blood essays showed a 91% reduction in the arylsulfatase A activity and genetic analysis revealed compound heterozygous mutations of the Arylsulfatase A gene, enabling diagnosis of MLD. Subsequently, the patient had further rapid deterioration of motor and cognitive functions and developed drug-resistant epilepsy. At 4 years and 7 months of age bilateral thelarche occurred. Magnetic resonance imaging showed a small pituitary gland, extensive signal changes of the brain white matter, increased choline, decreased N-acetyl-aspartate and presence of lactate on 1HMR spectroscopy. Pelvic ultrasound demonstrated a slightly augmented uterine longitudinal diameter (42 mm). The gonadotropin-releasing hormone stimulation test revealed a pubertal LH peak of 12.9 UI/l. A diagnosis of CPP was made and treatment with gonadotropin-releasing hormone agonists was initiated, with good response. In conclusion, a CPP may occur in MLD as in other metabolic diseases with white matter involvement. We hypothesize that brain accumulation of sulfatides could have interfered with the complex network regulating with the hypothalamic-pituitary axis and thus triggering CPP in our patient.

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“…Peak LH levels of 5-8 IU/l have been considered as indicative of progressive CPP, but an overlap between prepubertal and early pubertal values does exist [6]. Therefore, a variety of other physiological tests and diagnostic tools to assess CPP have been proposed, such as the measurement of basal gonadotropins [7] or ultrasonography measurements of internal genitalia [8,9], but these proposed methods do not adequately differentiate between the progressive form (PF) and the non-progressive form (NPF) with a sufficient degree of sensitivity and specificity, especially in the first phase of puberty (Tanner stage II). In light of this, unless levels of LH are clearly elevated, the presence of a persistent hypothalamic-pituitary-ovarian axis activation leading to PF should be confirmed via a stimulation test before initiating treatment [10].…”

Section: Introductionmentioning

confidence: 99%

Baseline Inhibin B Levels for Diagnosis of Central Precocious Puberty in Girls

Filippo

Rendina²,

Nazzaro³

et al. 2013

Horm Res Paediatr

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Aim: To evaluate the use of baseline inhibin B (INHB) levels to differentiate the progressive form (PF) from the non-progressive form (NPF) of central precocious puberty (CPP). Methods: A total of 62 girls were enrolled, 31 with PF and 31 with NPF. Using receiver operating characteristic (ROC) curves, we analysed the diagnostic performance of INHB in addition to other diagnostic tools used to differentiate the 2 forms of CPP. Results: INHB levels were higher in PF versus NPF (29.1 vs. 13.1 pg/ml; p < 0.001). The ROC area under the curve (AUC) was greatest for luteinizing hormone [LH; 0.807, standard error (SE) 0.069], followed by INHB (0.800, SE 0.067), ovarian volume (OV; 0.782, SE 0.070) and uterine volume (0.723, SE 0.076). In ROCs relative to a combination of such parameters, the AUC was greater for LH + INHB (0.972, SE 0.010), followed by OV + LH (0.841, SE 0.084) and OV + INHB (0.836, SE 0.075). The combination of INHB and LH (with cut-offs of 20 pg/ml and 0.2 IU/l, respectively) results in 98% sensitivity and specificity. Conclusion: Our results suggest that the addition of basal INHB values to baseline LH levels provides a reliable method to identify PF. Further replication studies are needed to definitively prove or disprove the utility and advantages of INHB levels as part of the work-up of CPP.

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Role of Pelvic Ultrasound in Girls with Precocious Puberty

Cited by 32 publications

References 43 publications

Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls

Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls

Central Precocious Puberty in a Child With Metachromatic Leukodystrophy

Baseline Inhibin B Levels for Diagnosis of Central Precocious Puberty in Girls

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