Advertisement

European Journal of Pediatrics

, Volume 154, Issue 3, pp 182–186 | Cite as

Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty

  • H. P. Haber
  • H. A. Wollmann
  • M. B. Ranke
Endocrinology Original Paper

Abstract

We examined 55 girls with isolated premature thelarche between the ages of 0.3 and 7.3 years (group A), 20 children with central precocious puberty between 2.1 and 7.7 years of age and 101 age-matched controls. The children with precocious puberty were divided according to distribution of pubic hair into group B (Tanner stages PH1, B2–3;n=11), representing an early stage of the disorder, and group C (stages PH2–3, B3–4;n=9), representing an advanced stage. Uterine and ovarian volumes were measured sonographically, peak serum levels of luteinizing hormone and folliclestimulating hormone were determined after intravenous administration of luteinizing hormone-releasing hormone. The mean uterine and ovarian volumes were significantly greater in children with precocious puberty than in controls (group B: uterine volume: 3.8±2.0 ml vs 0.9±0.3 ml for controls,P<0.001; ovarian volume: 2.2±1.3 ml vs 0.6±0.2 ml for controls,P<0.01; group C: uterine volume: 8.0±4.4 ml vs 1.0±0.3 ml for controls,P<0.01; ovarian volume: 2.6±1.3 ml vs 0.4±0.1 ml,P<0.01). No significant differences were found between children with premature thelarche and the control group. As a diagnostic method for the early detection of central precocious puberty, ultrasound measurement of uterine volume had a sensitivity and specificity of 100% (cut-off value, 1.8 ml), while ultrasound determination of ovarian volume had a sensitivity of 82% and a specificity of 95% (cut-off value, 1.2 ml). In contrast, as a diagnostic criterion the ratio of levels of luteinizing hormone to follicle-stimulating hormone as determined following stimulation with luteinizing hormone releasing hormone had a sensitivity of 33% and a specificity of 100% (cut-off value, 1.0). Conclusion: ultrasonographic measurement of uterine and ovarian volume offers a reliable means of distinguishing between isolated premature thelarche and early stages of central precocious puberty.

Key words

Isolated premature thelarche Central precocious puberty Pelvic ultrasonography 

Abbreviations

FSH

follicle stimulating hormone

LH

luteinizing hormone

LHRH

luteinizing hormone-releasing hormone

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Escobar ME, Rivarola MA, Bergada C (1976) Plasma concentration of oestradiol-17β in premature thelarche and in different types of sexual precocity. Acta Endocrinol (Copenh) 81:351–361Google Scholar
  2. 2.
    Frejaville E, Pagni G, Cacciari E, Pifferi MC, Tramonti C, Santi V, Cesari C, Partesotti S, Orlandi C (1988) Breast contact thermography for differentiation between premature thelarche and true precocious puberty. Eur J Pediatr 147:389–391CrossRefPubMedGoogle Scholar
  3. 3.
    Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, Stanford, CAGoogle Scholar
  4. 4.
    Haber HP, Mayer EI (1994) Ultrasound evaluation of uterine and ovarian size from birth to puberty. Pediatr Radiol 24:11–13PubMedGoogle Scholar
  5. 5.
    Illicki A, Prager Lewin R, Kauli R, Kaufman H, Schachter A, Laron Z (1984) Premature thelarche-natural history and sex hormone secretion in 68 girls. Acta Paediatr Scand 73:756–762PubMedGoogle Scholar
  6. 6.
    Jenner MR, Kelch RP, Kaplan SL (1972) Hormonal changes in puberty: IV. Plasma estradiol, LH, and FSH in prepubertal children, pubertal females, and in precocious puberty, premature thelarche, hypogonadism, and in a child with a feminizing ovarian tumor. J Clin Endocrinol 34:521–530Google Scholar
  7. 7.
    Kaufman RH, Leeds LJ (1972) Cervical and vaginal cytology in the child and adolescent. Pediatr Clin North Am 19:547–557PubMedGoogle Scholar
  8. 8.
    Lucky AW, Rich BH, Rosenfield RL, Fang VS, Roche-Bender N (1980) Bioactive LH: a test to discriminate true precocious puberty from premature thelarche and adrenarche. J Pediatr 97:214–216PubMedGoogle Scholar
  9. 9.
    Partsch CJ, Hümmelink R, Lorenzen F, Sippell WG (1989) Bedeutung und Charakteristika des LHRH-Testes in der Diagnostik der vorzeitigen Pubertäsentwicklung bei Mädchen: Der stimulierte LH/FSH-Quotient differenziert zwischen zentraler Pubertas präcoux und prämaturer Thelarche. Monatsschr Kinderheilkd 137:284–288PubMedGoogle Scholar
  10. 10.
    Pasquino AM, Piccolo F, Scalamandre A, Malvaso M Orolani R, Boscherini B (1980) Hypothalamic-pituitary-gonadotropic function in grils with premature thelarche. Arch Dis Child 55:941–944PubMedGoogle Scholar
  11. 11.
    Pelzer V, Ditfurth M von, Wendel U (1990) Differentiadiagnostische Abgrenzung der Pubertas praecos gegen die prämature Thelarche mit Hilfe der Ultrasonographie und dem stimulierten LH/FSH-Quotienten. Geburtshilfe Frauenheilkd 50:964–968PubMedGoogle Scholar
  12. 12.
    Pescovitz OH, Hech KD, Barnes KM, Loriaux DL, Cutler GB (1988) Premature thelarche and central precocious puberty: The relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab 67:474–479PubMedGoogle Scholar
  13. 13.
    Reiter EO, Kaplan SL, Conte FA, Grumbach MM (1975) Responsivity of pituitary gonadotropes to luteinizing hormone-releasing factor in idiopathic precocious puberty, precocious thelarche, precocious adrenarche, and in patients treated with medroxyprogesterone acetate. Pediatr Res 9:111–116PubMedGoogle Scholar
  14. 14.
    Salrdi S, Orsni LF, Caciari E, Partesotti S, Brondelli L, Ciocognani A, Frejaville E, Pluchinotta V, Tonioli S, Bovicelli L (1988) Pelvic ultrasonography in girls with precocious puberty, congential adrenal hyperplasia, obesity or hirsutism. J Pediatr 112:880–887PubMedGoogle Scholar
  15. 15.
    Stanhope R, Abdulwahid NA, Adams J, Brook CGD (1986) Studies of gonadotrophin pulsatility and pelvic ultrasound examinations distinguish between isolated premature thelarche and central precocious puberty. Eur J Pediatr 145:190–194CrossRefPubMedGoogle Scholar
  16. 16.
    Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity and stages of puberty. Arch Dis Child 51:170–179PubMedGoogle Scholar
  17. 17.
    Tonore A, Franzese A, Quattrin T, Sandomenico ML, Aloi G, Gallo P, Mariano A, Di Maio S (1991) Prognostic signs in the evelution of premature thelarche by discriminant analysis. J Endocrinol Invest 14:375–381PubMedGoogle Scholar
  18. 18.
    Wilkins L (1965) Diagnosis and treatment of endocrine disorders in childhood and adolescence, 3rd edn. Thomas, SpringfieldGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • H. P. Haber
    • 1
  • H. A. Wollmann
    • 1
  • M. B. Ranke
    • 1
  1. 1.Children's Hospital of the University of TübingenTübingenGermany

Personalised recommendations