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Distinguishing central precocious puberty from nonprogressive breast development: adiposity and DXA body composition
Daniela Fava1, Amanda Casirati1, Maria Grazia Calevo2
1Pediatric Endocrinology Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy.
Insights
Distinguishing central precocious puberty (CPP/EP) from nonprogressive premature breast development (npPBD) is difficult due to childhood adiposity. Hormonal tests, especially IGF-1 SDS, are key for diagnosis.
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.
Objective:
Distinguishing central precocious or early puberty (CPP/EP) from nonprogressive premature breast development (npPBD) is challenging, particularly in the context of increasing childhood adiposity, which may affect growth and skeletal maturation independently of hypothalamic-pituitary-ovarian (HPO) axis activation.
Methods:
We retrospectively evaluated 100 girls (69 CPP/EP, 31 npPBD) and 16 age-matched prepubertal girls with obesity as controls. Assessments included auxology, bone age, hormonal and metabolic profiles, pelvic ultrasound, DXA-derived body composition, and lifestyle factors.
Results:
Anthropometric parameters and bone age were similar between CPP/EP and npPBD, whereas LH, FSH, estradiol, and IGF-1 SDS (all P < .001) remained the main discriminators between groups. Overall body composition was comparable, except for a higher android-to-gynoid fat ratio in npPBD (P = .03). In both diagnostic groups, overweight/obesity was associated with greater height relative to target height (P = .004 in CPP/EP; P = .03 in npPBD) and higher IGF-1 SDS (P < .001 and P = .02, respectively) compared with controls. Among normal-weight girls, those with CPP/EP showed greater height relative to target height (P = .009) and more advanced bone age (P = .02) than those with npPBD, whereas these differences were not observed in girls with overweight/obesity.
Conclusion:
Excess adiposity reduces the diagnostic specificity of auxological and skeletal maturation parameters in girls with early breast development. Biochemical assessment remains central, with IGF-1 SDS providing additional supportive information.
