Distinguishing central precocious puberty from nonprogressive breast development: adiposity and DXA body composition

Area of Science:

• Pediatric Endocrinology
• Reproductive Health
• Childhood Obesity

Background:

• Distinguishing central precocious puberty (CPP/EP) from nonprogressive premature breast development (npPBD) is challenging.
• Increasing childhood adiposity can independently affect growth and skeletal maturation, complicating diagnosis.
• The hypothalamic-pituitary-ovarian (HPO) axis activation is a key factor in differentiating these conditions.

Purpose of the Study:

• To evaluate diagnostic markers differentiating CPP/EP from npPBD in girls.
• To assess the impact of adiposity on auxological and skeletal maturation parameters.
• To determine the role of hormonal and metabolic profiles in diagnosis.

Main Methods:

• Retrospective evaluation of 100 girls with CPP/EP or npPBD and 16 controls with obesity.
• Assessments included auxology, bone age, hormonal profiles (LH, FSH, estradiol, IGF-1 SDS), metabolic profiles, pelvic ultrasound, DXA body composition, and lifestyle factors.

Main Results:

• Hormonal markers (LH, FSH, estradiol, IGF-1 SDS) were significant discriminators between CPP/EP and npPBD.
• Overweight/obesity was associated with greater height relative to target height and higher IGF-1 SDS in both groups.
• In normal-weight girls, CPP/EP showed greater height and more advanced bone age than npPBD, but this difference vanished in overweight/obese girls.

Conclusions:

• Excess adiposity diminishes the diagnostic specificity of auxological and skeletal maturation parameters in early breast development.
• Biochemical assessments, particularly hormonal profiles and IGF-1 SDS, remain crucial for accurate diagnosis.
• IGF-1 SDS offers valuable supportive information in differentiating CPP/EP from npPBD.