Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche

Abstract

Objective: To determine if uterine and ovarian measurements can significantly distinguish between precocious puberty (PP) and premature thelarche (PT) and whether ultrasound has any advantage over the gonadotropin-releasing hormone (GnRH) stimulation test. Design: Prospective. Methods: One hundred and three girls referred consecutively for evaluation of breast budding before age 8 years underwent physical examination, GnRH stimulation test, bone age assessment, and transabdominal pelvic ultrasound. The diagnosis of PP or PT was based on clinical judgment. The clinical, laboratory, and ultrasound data of the PP and PT groups were compared. Results: Eighty-one girls were diagnosed with PP and 22 with PT. Significant differences in most of the uterine and ovarian measurements were found between the groups. On logistic regression analysis, bone age standard deviation score, uterine transverse diameter, and uterine volume were the most significant variables predicting PP. Comparison of 30 girls with PP and 21 with PT in whom peak luteinizing hormone was !5 mIU/ml on the GnRH stimulation test, using analysis of variance, yielded significant differences in uterine width (P!0.001), fundus diameter (P !0.04), uterine volume (PZ 0.006), and ovarian circumference (P !0.02). Conclusions: Increased uterine and ovarian measurements may be an early and sensitive sign of PP. Pelvic ultrasound, a noninvasive, inexpensive, and reliable tool, may give the clinician a complementary indication to the GnRH test in distinguishing isolated PT from early-stage PP in girls with early breast budding.European Journal of Endocrinology 154 891-898

The diagnostic value of first-voided urinary LH compared with GNRH-stimulated gonadotropins in differentiating slowly progressive from rapidly progressive precocious puberty in girls

“…above the mean in the same reference group. Many authors adopted the O5 IU/l threshold (7,10,32,33,34). While applying this cutoff of peak LH in our study, 13 out of 18 girls (72%) in the RP group and two out of 29 girls (7%) in the SP group were wrongly assigned to the opposite group.…”

“…There is however an overlap between prepubertal and early pubertal values (1,9) and between girls with premature thelarche and progressive PP (6,10). It was suggested therefore that pubertal progression and growth acceleration should be documented over a 3-to 6-month period before GNRHa therapy is initiated.…”

Role of Pelvic Ultrasound in Girls with Precocious Puberty

“…Almost all studies have shown that girls with true PP have enlarged ovaries, an increased uterine volume, and a midline endometrial echo on ultrasound scans compared to prepubertal age-matched controls and to girls with isolated premature thelarche [11,12,15,21,22]. However, on statistical analysis of the diagnostic value of these sonographic findings, most studies found that despite their good specificity, their sensitivity was low owing either to the transabdominal approach or the great overlap between normal prepubertal and pathological values (fig.…”

“…Measurement of luteinizing hormone (LH) after GnRH stimulation test is an important component of the evaluation, but its interpretation suffers from lack of uniformity and clear diagnostic cutoffs [9,10]. Studies have shown that girls with CPP have larger ovarian and uterine dimensions than age-matched controls and girls with premature thelarche [11,12]. Therefore, pelvic ultrasound might serve as a helpful and accurate diagnostic adjunct when PP needs to be differentiated from premature thelarche or obesity.…”

An Evidence-Based Model of Multidisciplinary Care for Patients and Families Affected by Classical Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

“…The diagnosis of central precocious puberty is confirmed when GnRH stimulation testing shows a robust LH response that exceeds that of FSH and when accompanied by additional clinical and laboratory features of puberty. Girls may receive a baseline pelvic ultrasound to obtain uterine measurements and assess the presence or absence of an endometrial stripe prior to the initiation of treatment [42, 43]. GnRH agonists (GnRHa) are effective at preventing further progression of the clinical signs of central precocious puberty when coupled with appropriate glucocorticoid and mineralocorticoid replacement [41].…”