DOI QR코드

DOI QR Code

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

  • Yu, Jung (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Shin, Ha Young (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Sun Hee (Department of Pediatrics, Gil Medical Center, Graduate School of Medicine, Gacheon University of Medicine and Science) ;
  • Kim, You Sung (Department of Radiology, Inje University Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Jae Hyun (Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine)
  • Received : 2014.08.21
  • Accepted : 2014.10.20
  • Published : 2015.08.10

Abstract

Purpose: It 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. Methods: This 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. Results: A 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, $2.45{\pm}0.50cm$ vs. $2.63{\pm}0.49cm$, P=0.015; uterine volume, $0.95{\pm}0.62cm^3$ vs. $1.35{\pm}0.76cm^3$, 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 $1.07cm^3$ was the most predictive parameter for CPP with an area under the curve of 0.670 (95% confidence interval, 0.593-0.747). Conclusion: Uterine 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.

Keywords

References

  1. Lee PA. Central precocious puberty. An overview of diagnosis, treatment, and outcome. Endocrinol Metab Clin North Am 1999;28:901-18, xi. https://doi.org/10.1016/S0889-8529(05)70108-0
  2. Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003;24:668-93. https://doi.org/10.1210/er.2002-0019
  3. Brauner R, Adan L, Malandry F, Zantleifer D. Adult height in girls with idiopathic true precocious puberty. J Clin Endocrinol Metab 1994;79:415-20.
  4. Yang JH, Han SW, Yeom CW, Park YJ, Choi WS, Seo JY, et al. Depression and self-concept in girls with perception of pubertal onset. Ann Pediatr Endocrinol Metab 2013;18:135-40. https://doi.org/10.6065/apem.2013.18.3.135
  5. Mrug S, Elliott M, Gilliland MJ, Grunbaum JA, Tortolero SR, Cuccaro P, et al. Positive parenting and early puberty in girls: protective effects against aggressive behavior. Arch Pediatr Adolesc Med 2008;162:781-6. https://doi.org/10.1001/archpedi.162.8.781
  6. Carel JC, Leger J. Clinical practice: precocious puberty. N Engl J Med 2008;358:2366-77. https://doi.org/10.1056/NEJMcp0800459
  7. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR; ESPELWPES GnRH Analogs Consensus Conference Group, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752-62. https://doi.org/10.1542/peds.2008-1783
  8. Salardi S, Cacciari E, Mainetti B, Mazzanti L, Pirazzoli P. Outcome of premature thelarche: relation to puberty and final height. Arch Dis Child 1998;79:173-4. https://doi.org/10.1136/adc.79.2.173
  9. Pescovitz OH, Hench KD, Barnes KM, Loriaux DL, Cutler GB Jr. Premature thelarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab 1988;67:474-9. https://doi.org/10.1210/jcem-67-3-474
  10. Shawker TH, Comite F, Rieth KG, Dwyer AJ, Cutler GB Jr, Loriaux DL. Ultrasound evaluation of female isosexual precocious puberty. J Ultrasound Med 1984;3:309-16. https://doi.org/10.7863/jum.1984.3.7.309
  11. de Vries L, Horev G, Schwartz M, Phillip M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol 2006;154:891-8. https://doi.org/10.1530/eje.1.02151
  12. Haber HP, Wollmann HA, Ranke MB. Pelvic ultrasonography: early differentiation between isolated premature thelarche and central precocious puberty. Eur J Pediatr 1995;154:182-6. https://doi.org/10.1007/BF01954267
  13. Kang HJ, Nam JS, Cho WK, Cho KS, Park SH, Jung MH, et al. Pelvic ultrasonography findings in girls with precocious puberty. J Korean Soc Pediatr Endocrinol 2010;15:126-32.
  14. Herter LD, Golendziner E, Flores JA, Moretto M, Di Domenico K, Becker E Jr, et al. Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty. J Ultrasound Med 2002;21:1237-46. https://doi.org/10.7863/jum.2002.21.11.1237
  15. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1-25. https://doi.org/10.3345/kjp.2008.51.1.1
  16. Greulich WW, Pyle SI. Radiologic atlas of skeletal development of the hand and wrist. 2nd ed. California: Stanford University Press, 1959.
  17. Akobeng AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 2007;96:644-7. https://doi.org/10.1111/j.1651-2227.2006.00178.x
  18. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-5. https://doi.org/10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3
  19. Garel L, Dubois J, Grignon A, Filiatrault D, Van Vliet G. US of the pediatric female pelvis: a clinical perspective. Radiographics 2001;21:1393-407. https://doi.org/10.1148/radiographics.21.6.g01nv041393
  20. Badouraki M, Christoforidis A, Economou I, Dimitriadis AS, Katzos G. Evaluation of pelvic ultrasonography in the diagnosis and differentiation of various forms of sexual precocity in girls. Ultrasound Obstet Gynecol 2008;32:819-27. https://doi.org/10.1002/uog.6148
  21. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47:458-72. https://doi.org/10.1002/bimj.200410135
  22. Haber HP, Mayer EI. Ultrasound evaluation of uterine and ovarian size from birth to puberty. Pediatr Radiol 1994;24:11-3. https://doi.org/10.1007/BF02017650
  23. Griffin IJ, Cole TJ, Duncan KA, Hollman AS, Donaldson MD. Pelvic ultrasound measurements in normal girls. Acta Paediatr 1995;84:536-43. https://doi.org/10.1111/j.1651-2227.1995.tb13689.x
  24. Buzi F, Pilotta A, Dordoni D, Lombardi A, Zaglio S, Adlard P. Pelvic ultrasonography in normal girls and in girls with pubertal precocity. Acta Paediatr 1998;87:1138-45. https://doi.org/10.1111/j.1651-2227.1998.tb00921.x
  25. Sathasivam A, Rosenberg HK, Shapiro S, Wang H, Rapaport R. Pelvic ultrasonography in the evaluation of central precocious puberty: comparison with leuprolide stimulation test. J Pediatr 2011;159:490-5. https://doi.org/10.1016/j.jpeds.2011.02.032
  26. de Vries L, Phillip M. Role of pelvic ultrasound in girls with precocious puberty. Horm Res Paediatr 2011;75:148-52. https://doi.org/10.1159/000323361
  27. Battaglia C, Mancini F, Regnani G, Persico N, Iughetti L, De Aloysio D. Pelvic ultrasound and color Doppler findings in different isosexual precocities. Ultrasound Obstet Gynecol 2003;22:277-83. https://doi.org/10.1002/uog.154

Cited by

  1. Basal serum luteinizing hormone value as the screening biomarker in female central precocious puberty vol.24, pp.3, 2019, https://doi.org/10.6065/apem.2019.24.3.164
  2. Rapid progressive central precocious puberty: diagnostic and predictive value of basal sex hormone levels and pelvic ultrasound vol.33, pp.6, 2020, https://doi.org/10.1515/jpem-2019-0577