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Central nervous system imaging in girls with central precocious puberty: when is necessary?
OBJECTIVES: The determinants of an increased risk of an organic pathology underlying central precocious puberty (CPP) in girls remain contentious. The present study aimed to determine the clinical and hormonal findings that can be used to differentiate organic and idiopathic CPP in girls as a screen...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Endocrinologia e Metabologia
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10118962/ https://www.ncbi.nlm.nih.gov/pubmed/34033300 http://dx.doi.org/10.20945/2359-3997000000259 |
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author | Vuralli, Dogus Gonc, E. Nazli Alikasifoglu, Ayfer Kandemir, Nurgun Ozon, Z. Alev |
author_facet | Vuralli, Dogus Gonc, E. Nazli Alikasifoglu, Ayfer Kandemir, Nurgun Ozon, Z. Alev |
author_sort | Vuralli, Dogus |
collection | PubMed |
description | OBJECTIVES: The determinants of an increased risk of an organic pathology underlying central precocious puberty (CPP) in girls remain contentious. The present study aimed to determine the clinical and hormonal findings that can be used to differentiate organic and idiopathic CPP in girls as a screening method so that only those considered likely to have organic CPP undergo cranial magnetic resonance imaging (MRI). SUBJECTS AND METHODS: The medical records of 286 girls that received GnRH agonist (GnRHa) therapy for CPP were retrospectively evaluated. Chronological and bone age, height, pubertal stage, and basal/stimulated gonadotropin and estradiol (E(2)) levels, as well as cranial MRI findings at the time CPP was diagnosed were recorded. Clinical and hormonal parameters that can be used to differentiate between girls with organic and idiopathic CPP were identified using ROC curves. RESULTS: Organic CPP was noted in 6.3% of the participants. Puberty started before age 6 years in 88.9% of the girls with organic CPP. Mean E(2) and peak luteinizing hormone (LH) levels were higher in the girls with organic CPP than in those with idiopathic CPP that were matched for pubertal stage, as follows: early stage puberty (Tanner 2 and 3): E(2): 62.4 ± 19.8 pg/mL vs. 29.1 ± 9.5 pg/mL; peak LH: 16.8 ± 3.2 IU/L vs. 12.2 ± 3.7 IU/L; advanced stage puberty (Tanner 4): mean E(2): 87.6 ± 3.4 pg/mL vs. 64.6 ± 21.2 pg/mL; peak LH: 20.8 ± 0.4 IU/L vs. 16.6 ± 5.8 IU/L (P < 0.001 for all). Thresholds for differentiating organic and idiopathic CPP in girls with early-stage puberty were 38.1 pg/mL for E(2) (100% sensitivity and 80.4% specificity) and 13.6 IU/L for peak LH (100% sensitivity and 66.4% specificity). CONCLUSION: Pubertal symptoms and signs generally begin before age 6 years and hormone levels are much higher than expected for pubertal stage in girls with organic CPP. Based on the present findings, cranial MRI is recommended for girls aged < 6 years, as the risk of diagnosing an organic pathology is highest in this age group. Hormone levels higher than expected for pubertal stage might be another indication for cranial MRI, regardless of patient age. Cranial MRI should be performed in girls with early-stage puberty, and an E(2) level > 38 pg/mL and/or a peak LH level > 13.6 IU/L. |
format | Online Article Text |
id | pubmed-10118962 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Sociedade Brasileira de Endocrinologia e Metabologia |
record_format | MEDLINE/PubMed |
spelling | pubmed-101189622023-04-21 Central nervous system imaging in girls with central precocious puberty: when is necessary? Vuralli, Dogus Gonc, E. Nazli Alikasifoglu, Ayfer Kandemir, Nurgun Ozon, Z. Alev Arch Endocrinol Metab Original Article OBJECTIVES: The determinants of an increased risk of an organic pathology underlying central precocious puberty (CPP) in girls remain contentious. The present study aimed to determine the clinical and hormonal findings that can be used to differentiate organic and idiopathic CPP in girls as a screening method so that only those considered likely to have organic CPP undergo cranial magnetic resonance imaging (MRI). SUBJECTS AND METHODS: The medical records of 286 girls that received GnRH agonist (GnRHa) therapy for CPP were retrospectively evaluated. Chronological and bone age, height, pubertal stage, and basal/stimulated gonadotropin and estradiol (E(2)) levels, as well as cranial MRI findings at the time CPP was diagnosed were recorded. Clinical and hormonal parameters that can be used to differentiate between girls with organic and idiopathic CPP were identified using ROC curves. RESULTS: Organic CPP was noted in 6.3% of the participants. Puberty started before age 6 years in 88.9% of the girls with organic CPP. Mean E(2) and peak luteinizing hormone (LH) levels were higher in the girls with organic CPP than in those with idiopathic CPP that were matched for pubertal stage, as follows: early stage puberty (Tanner 2 and 3): E(2): 62.4 ± 19.8 pg/mL vs. 29.1 ± 9.5 pg/mL; peak LH: 16.8 ± 3.2 IU/L vs. 12.2 ± 3.7 IU/L; advanced stage puberty (Tanner 4): mean E(2): 87.6 ± 3.4 pg/mL vs. 64.6 ± 21.2 pg/mL; peak LH: 20.8 ± 0.4 IU/L vs. 16.6 ± 5.8 IU/L (P < 0.001 for all). Thresholds for differentiating organic and idiopathic CPP in girls with early-stage puberty were 38.1 pg/mL for E(2) (100% sensitivity and 80.4% specificity) and 13.6 IU/L for peak LH (100% sensitivity and 66.4% specificity). CONCLUSION: Pubertal symptoms and signs generally begin before age 6 years and hormone levels are much higher than expected for pubertal stage in girls with organic CPP. Based on the present findings, cranial MRI is recommended for girls aged < 6 years, as the risk of diagnosing an organic pathology is highest in this age group. Hormone levels higher than expected for pubertal stage might be another indication for cranial MRI, regardless of patient age. Cranial MRI should be performed in girls with early-stage puberty, and an E(2) level > 38 pg/mL and/or a peak LH level > 13.6 IU/L. Sociedade Brasileira de Endocrinologia e Metabologia 2020-05-27 /pmc/articles/PMC10118962/ /pubmed/34033300 http://dx.doi.org/10.20945/2359-3997000000259 Text en https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Vuralli, Dogus Gonc, E. Nazli Alikasifoglu, Ayfer Kandemir, Nurgun Ozon, Z. Alev Central nervous system imaging in girls with central precocious puberty: when is necessary? |
title | Central nervous system imaging in girls with central precocious puberty: when is necessary? |
title_full | Central nervous system imaging in girls with central precocious puberty: when is necessary? |
title_fullStr | Central nervous system imaging in girls with central precocious puberty: when is necessary? |
title_full_unstemmed | Central nervous system imaging in girls with central precocious puberty: when is necessary? |
title_short | Central nervous system imaging in girls with central precocious puberty: when is necessary? |
title_sort | central nervous system imaging in girls with central precocious puberty: when is necessary? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10118962/ https://www.ncbi.nlm.nih.gov/pubmed/34033300 http://dx.doi.org/10.20945/2359-3997000000259 |
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