Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty
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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 wordsIsolated premature thelarche Central precocious puberty Pelvic ultrasonography
follicle stimulating hormone
luteinizing hormone-releasing hormone
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- 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
- 3.Greulich WW, Pyle SI (1959) Radiographic atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, Stanford, CAGoogle Scholar
- 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
- 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
- 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
- 18.Wilkins L (1965) Diagnosis and treatment of endocrine disorders in childhood and adolescence, 3rd edn. Thomas, SpringfieldGoogle Scholar