The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty

Abstract

The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged <8 years) with signs of early puberty and advanced bone age. Ninety-three of 192 patients (48.4%) were diagnosed as having CPP and the others (51.6%) as having ET. The CPP group had higher uterine volumes (4.31±2.79 mL) than did the ET group (3.05±1.97 mL, p=0.03). No significant differences were found in other ultrasonographic parameters. By use of receiver operating characteristic curve analysis, the most predictive parameter for CPP was a uterine volume of least 3.30 mL, with an area under the curve of 0.659 (95% confidence interval: 0.576-0.736). The CPP group had significantly higher uterine volumes than did the ET group, but there were no reliable cutoff values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.

A Diagnostic Scoring System to Distinguish Precocious Puberty from Premature Thelarche based on Clinical and Laboratory Findings

“…We calculated that cut off value of ovarian volume is 1.09 cm 3 (sensitivity, 76.8% and specificity, 73.8%). There are different measurements for uterine length and ovarian volume as pubertal signs in the literature (30,31). These differences may result from different onset age, duration and stages of pubertal status.…”

Diagnostic Value of Pituitary Volume in Girls with Precocious Puberty

“…The gold standard for verifying HPG activity is the response of gonadotropin to a gonadotropin-releasing hormone (GnRH) stimulation. To date, the GnRH stimulation test is still the gold standard for PP diagnosis (6,8). Although this test is highly speci c, it has many disadvantages, such as low sensitivity, high cost, invasive operation, risk of local reaction, and unavailability of GnRH in some centers (9,10).…”

“…Representative types of IPP include isolated premature thelarche (PT), wherein the breasts develop, and premature adrenarche, wherein pubic and armpit hairs appear (4,5). CPP eventually affects the physical growth of the child with a number of adverse effects (6,7). Therefore, it is of great signi cance to distinguish CPP from common variants of…”

Diagnostic Value of Pituitary Volume in Girls with Precocious Puberty

“…Representative types of IPP include isolated premature thelarche (PT), wherein the breasts develop, and premature adrenarche, wherein pubic and armpit hairs appear or acne develops [4,5]. CPP eventually affects the physical growth of the child with a number of adverse effects, such as the increased occurrence of secondary diseases accompanying with polycystic cystic ovary syndrome, obesity, and metabolic syndrome [6,7]. Therefore, it is of importance to distinguish CPP from common variants of PP.…”

“…To date, GnRH stimulation test is still the pivotal guarantee of PP diagnosis [6,8]. Although this test is highly specific, it has many disadvantages, such as low sensitivity, high cost, invasive operation, risk of local reaction, and unavailability of GnRH in some centers [9,10].…”