Selecting girls with precocious puberty for brain imaging: validation of European evidence-based diagnosis rule

Chalumeau, Martin; Hadjiathanasiou, Charalambos; Ng, Sze May; Cassio, Alessandra; Mul, Dick; Cisternino, Mariangela; Partsch, C. J.; Theodoridis, Charalambos; Didi, Mohammed; Cacciari, E; Oostdijk, Wilma; Borghesi, A.; Sippell, Wolfgang G.; Breart, Gérard; Brauner, Raja

doi:10.1067/s0022-3476(03)00328-7

Cited by 111 publications

(64 citation statements)

References 31 publications

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“…Both sensitivity and specificity perhaps could be improved by combining a high PCT with other VUR predictors in clinical decision rule, as has been proposed in other situations to avoid unnecessary imaging in children. 29 …”

Section: Discussionmentioning

confidence: 99%

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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ABSTRACT. Objective. A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, it is irradiating, painful, and expensive. Thus, selective approaches are needed. Because procalcitonin has been shown to be associated with severe pyelonephritis and renal scars, which are correlated to vesicoureteral reflux, we analyzed its relationship with vesicoureteral reflux.Methods. A retrospective hospital-based cohort study included all children who were 1 month to 4 years of age and had a first febrile urinary tract infection. Univariate and multivariate analyses were performed.Results. Among 136 patients included, 25% had vesicoureteral reflux. The median procalcitonin concentration was significantly higher in children with reflux than in those without (1.2 vs 0.6 ng/mL). High procalcitonin (>0.5 ng/mL) was associated with reflux (odds ratio [OR]: 4.6; 95% confidence interval [CI]: 1.6 -16.2). After logisticregression adjustment for all potential confounders, the association remained significant (OR: 4.9; 95% CI: 1.7-14.0). The relationship was stronger for high-grade (>3) reflux (OR: 8.7; 95% CI: 1.2-382) than low-grade reflux (OR: 3.6; 95% CI: 1.1-15.3). High procalcitonin sensitivities were 85% (95% CI: 70 -94) and 92% (95% CI: 65-99) for all-grade and high-grade reflux, respectively, with 44% specificity (95% CI: 35-54).Conclusion. High procalcitonin is a strong and independent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography. U rinary tract infection (UTI) is one of the most frequent bacterial infections in children. 1 It has been estimated that 7% of girls and 2% of boys will have a UTI before 6 years of age. 2 Vesicoureteral reflux (VUR) is diagnosed at the time of the first febrile UTI in 20% to 40% of children. 3 VUR is a risk factor for relapsing UTI, renal scarring, hypertension, and renal failure. 3 Thus, pediatric societies 4-6 have recommended systematic voiding cystourethrography after the first febrile UTI in children. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, this procedure has been associated with a risk for iatrogenic UTI 7 and is irradiating, particularly for gonads, 8 painful, 9 and expensive. 10 Therefore, it would be useful to be able to predict the absence of VUR so as to avoid unnecessary voiding cystourethrography. 8 Two predictive tools have been proposed to define selective approaches for voiding cystourethrography. Renal ultrasonography alone, regardless of the criteria chosen, was shown to be poorly sensitive for VUR prediction. 11-14 A highly sensitive VUR risk score, combining clinical, biological, and radiologic variables, was also proposed, 15 but we have shown that this score was poorly reproducible. 16 Thus, new predictors of VUR afte...

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Section: Discussionmentioning

confidence: 99%

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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“…(vi) Magnetic resonance imaging of the brain is indicated in all boys with CPP, given the high prevalence of organic causes in this group. Most centres would probably also routinely perform this imaging in all girls with precocious puberty, although the prevalence of an organic lesion is much lower when early puberty presents after 6 years of age (18).…”

Section: Precocious Puberty: Assessmentmentioning

confidence: 99%

The use of GnRH agonists in precocious puberty

Mul¹,

Hughes

2008

European Journal of Endocrinology

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In this review several aspects of gonadotrophin releasing hormone agonists (GnRHa) treatment in central precocious puberty (CPP) are highlighed. These include issues of the definition of precocity, assessment of CPP and thelarche variants. Indications for treatment with GnRH agonists are discussed, not only in CPP but also in children with other reasons to suppress central activation, e.g. adopted or developmental retardation. Finally, outcome data are summarized, both on growth and psychosocial parameters.European Journal of Endocrinology 159 S3-S8

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“…Sin embargo, no se han descrito variables predictoras lo suficientemente seguras como para seleccionar a qué tipo de niñas se les debe realizar. [8][9][10] En nuestro Servicio de Endocrinología Pediátrica, del total de pacientes con PP en 10 años (n= 136), el 13,2% presentan algún hallazgo en la RM (HH en 27,7% de ellos).…”

Section: Discussionunclassified

Hamartomas hipotalámicos: distintas formas de debut. Casos clínicos

et al. 2015

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Presentación de casos clínicos RESUMENLos hamartomas hipotalámicos son malformaciones no neoplásicas de sustancia gris compuestas por neuronas hiperplásicas. Suelen ser lesiones pequeñas localizadas en la base del cerebro, en el piso del tercer ventrículo y, generalmente, asintomáticas. Sin embargo, pueden ocurrir con alteraciones conductuales-cognitivas, crisis epilépticas y/o signos de pubertad precoz central en función de la localización en la que se encuentren. Se presentan dos pacientes de 2 años 8 meses y 7 años, con presencia de hamartomas hipotalámicos diagnosticados tras el estudio de pubertad precoz central. La paciente de menor edad presenta, además, crisis gelásticas, típicamente asociadas a hamartomas hipotalámicos. Tras los hallazgos clínicos y radiológicos, se trataron con análogos de gonadotropinas, y se observó una regresión de los signos puberales y una no progresión del tamaño de los hamartomas. Palabras clave: hamartoma hipotalámico, pubertad precoz central, epilepsia gelástica. ABSTRACTHypothalamic hamartomas are benign tumors of gray substance composed by hyperplasic neurons. They are usually asymptomatic small masses with extensions into the third ventricular cavity. In some instances they can cause cognitive behavioral alterations, seizures and/or central precocious puberty depending on the location. Here we present two cases of central precocious puberty due to hypothalamic hamartomas at 2 8/12 and 7 years of age. The younger patient also presents gelastic seizures, typically associated with hypothalamic hamartomas. After the clinical and radiological findings, they started treatment with GnRH analogues and a regression of the puberty signs without progression in the hamartomas size was observed.

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Selecting girls with precocious puberty for brain imaging: validation of European evidence-based diagnosis rule

Cited by 111 publications

References 31 publications

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

The use of GnRH agonists in precocious puberty

Hamartomas hipotalámicos: distintas formas de debut. Casos clínicos

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