Can uric acid levels be helpful for the diagnosis of CPP in girls?

Central precocious puberty (CPP) and premature thelarche (PT) are two common conditions in young girls that can present with overlapping clinical features, making differential diagnosis challenging. We aim to investigate whether serum uric acid (SUA) and urinary uric acid (UUA) parameters can help differentiate CPP from PT in girls.

This prospective case-control study included 40 girls diagnosed with CPP, 60 with PT, and 50 healthy controls, aged 6-8 years, evaluated between 2022 and 2024. SUA, UUA, serum creatinine (SCr), urinary creatinine (UCr) levels, urinary acid/creatinine ratios (UUA/UCr) and the fractional excretion of uric acid (FEua) were measured and compared among groups.

Age did not differ among groups. The CPP group had significantly higher SUA, UUA/UCr, and FEua levels than both PT and controls (all p<0.05), while no significant differences were observed between PT and controls. ROC analysis showed excellent discriminatory performance for SUA (AUC=0.969, p<0.001; cut-off 4.1 mg/dL: 90 % sensitivity, 95 % specificity), while UUA/UCr and FEua demonstrated fair-to-modest diagnostic utility (AUC=0.789 and 0.697, respectively).

Girls with CPP had significantly higher SUA, UUA/UCr, and FEua levels compared with PT and controls. SUA showed the strongest association with CPP and may support the differential diagnosis of pubertal disorders, but further studies are needed for clinical validation.