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[Complete isosexual precocious puberty: clinical, pelvic ultrasound and laboratory features]
O Moreno-Pérez1, C Carles Genovés, F Moreno Macián
1Departamento de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Alicante, Spain. moreno_osc@gva.es
Insights
Clinical presentation and ultrasound findings overlap between idiopathic and organic central precocious puberty (CPP). Central nervous system imaging is essential for all CPP diagnoses, as ultrasound data alone is insufficient for differentiation.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Reproductive Medicine
Background:
- Central precocious puberty (CPP) is a condition where puberty begins abnormally early.
- Differentiating between idiopathic CPP and organic CPP is crucial for appropriate management.
- The role of clinical presentation and imaging in diagnosis requires further elucidation.
Purpose of the Study:
- To investigate variations in initial presentation based on the etiology of CPP.
- To assess if clinical differences aid in distinguishing idiopathic from organic CPP.
- To determine if central nervous system (CNS) imaging can be omitted in certain CPP cases.
Main Methods:
- A prospective observational study enrolled 62 children diagnosed with CPP.
- Clinical, laboratory, and ultrasound features were systematically recorded.
- Characteristics of idiopathic CPP (n=52) and organic CPP (n=10) were compared.
Main Results:
- No significant differences were observed in pubertal staging, age at onset, or bone age/chronological age ratio between idiopathic and organic CPP.
- Patients with organic CPP exhibited poorer height SD, predicted adult height, and growth rate SD.
- Girls with organic CPP had significantly higher estradiol levels and a higher prevalence of pubertal changes in internal genitalia on pelvic ultrasound.
Conclusions:
- A clinical and ultrasound overlap exists between idiopathic and organic CPP, making differentiation challenging.
- Central nervous system imaging remains indispensable for diagnosing all cases of central precocious puberty.
- Ultrasound findings alone are not sufficient to replace other diagnostic investigations, including CNS imaging.
Objective:
To determine whether initial presentation varies according to aetiology, whether such differences allow differential diagnosis between idiopathic and organic forms, and whether CNS imaging can be avoided in some patients with central precocious puberty (CPP).
Patients And Methods:
Children referred for evaluation of precocious puberty were evaluated, and the subpopulation of children with CPP was enrolled in this prospective observational study. Clinical, laboratory and ultrasound features of 62 consecutive patients with CPP (5 boys and 57 girls) were recorded. We compared the characteristics of idiopathic (3 boys, 49 girls) and organic (2 boys, 8 girls) CPP.
Results:
There were no differences in pubertal staging, age at puberty onset (7.0 [5.8-7.5] vs. 7.3 [5.1-8.3] years), bone age/chronological age ratio (1.26 [1.2-1.3] vs. 1.23 [1.1-1.3]), maternal menarche (11.7+/-0.2 vs. 11.7+/-0.6 years) between idiopathic and organic CPP, respectively. Organic CPP patients had a poorer height SD (0.35+/-0.4 vs. 1.6+/-0.1; p<0.01), predicted adult height, growth rate and growth rate SD (0.8+/-0.9 vs. 3.7+/-0.7). Girls with organic CPP had significantly higher oestradiol levels (47.5 [25-68] vs. 27 [14-43] pg/ml) than girls with idiopathic CPP. Pelvic ultrasound at the time of diagnosis revealed the presence of pubertal changes in internal genitalia in 43.9% of girls (37.2% idiopathic versus 62.5% organic CPP subpopulation; p=0.18).
Conclusions:
There is a clinical-ultrasound overlap between idiopathic and organic CPP. Imaging remains necessary in all cases of central precocious puberty, and ultrasound data should not be replaced by other diagnostic investigations.
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