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Uterine artery pulsatility index as a functional biomarker of central precocious puberty: a scoping review

Ignazio Cammisa1, Donato Rigante2,3, Clelia Cipolla2

  • 1Department of Pediatrics, San Giovanni Evangelista Hospital, Tivoli, Italy.

Clinical Pediatric Endocrinology : Case Reports and Clinical Investigations : Official Journal of the Japanese Society for Pediatric Endocrinology
|July 13, 2026
PubMed

Insights

The uterine artery pulsatility index (PI) shows promise in diagnosing central precocious puberty (CPP) by indicating hypothalamic-pituitary-gonadal (HPG) axis activation. This non-invasive measure may aid in evaluating and monitoring CPP, especially when combined with other diagnostic tools.

Area of Science:

  • Pediatric Endocrinology
  • Reproductive Medicine
  • Diagnostic Imaging

Background:

  • Central precocious puberty (CPP) involves early activation of the hypothalamic-pituitary-gonadal (HPG) axis.
  • The GnRH stimulation test is the standard diagnostic method for CPP.
  • Uterine artery pulsatility index (PI) is explored as a functional indicator of pubertal activation.

Purpose of the Study:

  • To review the diagnostic utility of uterine artery PI in evaluating CPP.
  • To summarize evidence on the relationship between uterine artery PI and pubertal progression.
  • To assess the potential of uterine artery PI as a marker for therapeutic response in CPP.

Main Methods:

  • Systematic review of 11 studies involving 1,151 patients.
  • Analysis of the relationship between uterine artery PI and pubertal status.
  • Evaluation of PI sensitivity, specificity, and accuracy in CPP diagnosis.
  • Assessment of PI changes during GnRH agonist therapy.

Main Results:

  • A consistent inverse relationship was found between uterine artery PI and pubertal progression.
  • PI sensitivity for pubertal onset ranged from 77% to 100%, with specificity from 48% to 100%.
  • Combining PI with uterine morphometrics improved diagnostic accuracy.
  • PI increased significantly during GnRH agonist therapy, indicating treatment response.

Conclusions:

  • Uterine artery PI is a physiologically relevant tool for assessing HPG axis activation in CPP.
  • PI can serve as an adjunctive diagnostic and monitoring tool for CPP.
  • While not a standalone test, PI integration enhances non-invasive CPP evaluation and management.

Keywords:
central precocious pubertypelvic ultrasoundprecision medicinepubertyuterine artery pulsatility index

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