Diagnostic value of basal sex hormone levels and pelvic B-mode ultrasound in central precocious puberty among female children

Valor diagnóstico de los niveles hormonales sexuales basales y la ecografía en modo B del pelvis en la pubertad precoz central en niñas

Background: This study aims to explore the diagnostic significance of basal sex hormone levels and pelvic B-mode ultrasound in the context of central precocious puberty (CPP) in female children. Methods: A cohort study was conducted at the Third Affiliated Hospital of Wenzhou Medical University from January 2014 to January 2024. The study enrolled female children exhibiting early breast development before the age of 8 and subjected them to gonadotropin-releasing hormone (GnRH) stimulation tests. Subsequently, the participants were categorized into a CPP cohort and a non-CPP cohort, each comprising 75 individuals. Comparative analysis was performed on the basal luteinizing hormone (LH) levels, uterine length and ovarian volume between the two cohorts. Results: The results show no significant differences were observed in age and body mass index (BMI) between the CPP and non-CPP groups (both p > 0.05). However, basal LH levels, uterine length, and ovarian volume were significantly higher in the CPP group compared to the non-CPP group (all p < 0.05). Binary logistic regression analysis revealed that basal LH levels, uterine length, and ovarian volume were independent risk factors for CPP in female children (all p < 0.05). Receiver Operating Characteristic (ROC) curve analysis showed that the area under the curve (AUC) for basal LH, ovarian volume, and uterine length were 0.823, 0.752 and 0.730, respectively. The combined diagnosis of these three factors significantly improved diagnostic performance, with an AUC of 0.931 (95% confidence interval (CI) : 0.891–0.972), a sensitivity of 88.00%, and a specificity of 86.70%. Conclusions: The integration of basal levels of sex hormones and pelvic B-mode ultrasound holds considerable importance in the diagnosis of CPP in young girls, offering a non-invasive, accessible and cost-effective method for clinical assessment. Therefore, its utilization is highly recommended.

Resumen

Antecedentes: Este estudio tiene como objetivo explorar la importancia del diagnóstico basado en los niveles de las hormonas sexuales basales y la ecografía en modo B del pelvis en el contexto de la pubertad precoz central (PPC) en niñas. Métodos: Se realizó un estudio de cohorta en el Tercer Hospital Afiliado a la Universidad de Medicina de Wenzhou desde enero de 2014 hasta enero de 2024. El estudio incluyó niñas que presentaron desarrollo precoz de los senos antes de los 8 años y se sometieron a pruebas de estimulación con la hormona liberadora de gonadotropina (GnRH). Posteriormente, las participantes fueron clasificadas en un cohorto PPC y un cohorto no PPC, cada uno con 75 individuos. Se realizó un análisis comparativo de los niveles de la hormona luteínizante (HL) basal, la longitud uterina y el volumen ovárico entre los dos cohortos. Resultados: Los resultados mostraron que no se observaron diferencias significativas en la edad y el índice de masa corporal (IMC) entre el grupo PPC y el grupo no PPC (ambos p > 0.05). Sin embargo, los niveles de hormona luteínizante basal, la longitud uterina y el volumen ovárico fueron significativamente más altos en el grupo PPC en comparación con el grupo no PPC (todos p < 0.05). El análisis de regresión logística binaria reveló que los niveles de hormona luteínizante basal, la longitud uterina y el volumen ovárico fueron factores de riesgo independientes para PPC en niñas (todos p < 0.05). El análisis de la curva Característica Operativa del Receptor (ROC) mostró que el área bajo la curva (AUC) para hormona luteínizante basal, volumen ovárico y longitud uterina fueron 0.823, 0.752 y 0.730, respectivamente. El diagnóstico combinado de estos tres factores mejoró significativamente el rendimiento diagnóstico, con un AUC de 0.931 (95% intervalo de confianza (IC) : 0.891–0.972), una sensibilidad del 88.00% y una especificidad del 86.70%. Conclusiones: La integración de los niveles basales de las hormonas sexuales y la ecografía en modo B del pelvis tiene una gran importancia en el diagnóstico de PPC en niñas, ofreciendo un método no invasivo, accesible y costoefectivo para la evaluación clínica. Por lo tanto, su utilización es muy recomendable.

Luteinizing hormone; Pelvic B-mode ultrasound; Female children; Central precocious puberty; Diagnosis

Palabras Clave

Hormona luteinizante; Ecografía en modo B del pelvis; Niñas; Pubertad precoz central; Diagnóstico

[1] Zevin EL, Eugster EA. Central precocious puberty: a review of diagnosis, treatment, and outcomes. The Lancet Child & Adolescent Health. 2023; 7: 886–896.

[2] Fan HY, Tsai WL, Chien KL, Hsu SY, Huang L, Hou JW, et al. Associations of central precocious puberty with blood pressure trajectories: prospective cohort study. Pediatric Research. 2024; 95: 1147–1152.

[3] Mason L, Daskas N. Central precocious puberty: assessment, diagnosis and decisions about treatment. Nursing Children and Young People. 2024; 36: 36–42.

[4] Liu Z, Song Q. Diagnostic model based on multiple factors for girls with central precocious puberty. Journal of Pediatric Endocrinology and Metabolism. 2024; 37: 150–155.

[5] Jiang M, Gao Y, Qu T, Ji Y, Niu Y, Zhang J, et al. Dose inhibin B or anti-Müllerian hormone relate to precocious puberty in girls? Result of a systematic review and meta-analysis. Journal of Ovarian Research. 2023; 16: 227.

[6] Briscoe A, Chen K, Klein KO. No pubertal growth spurt, rapid bone maturation, and menarche post GnRHa treatment in girls with precocious puberty. Journal of Pediatric Endocrinology and Metabolism. 2022; 35: 1401–1409.

[7] Tseng CH, Lee YJ, Huang CY, Wu YL, Wang LT, Lin CH, et al. The effects of gonadotropin-releasing hormone agonist on final adult height among girls with early and fast puberty. Frontiers in Endocrinology. 2023; 14: 1271395.

[8] Soliman AT, Alaaraj N, De Sanctis V, Hamed N, Alyafei F, Ahmed S. Long-term health consequences of central precocious/early puberty (CPP) and treatment with Gn-RH analogue: a short update. Acta Bio-Medica. 2023; 94: e2023222.

[9] Demir A, Büyükgebiz A, Aydin A, Hero M. Quantification of overnight urinary gonadotropin excretion predicts imminent puberty in girls: a semi-longitudinal study. Hormones. 2024; 23: 141–150.

[10] Zhang M, Sun J, Wang Y, Wu Y, Li X, Li R, et al. The value of luteinizing hormone basal values and sex hormone-binding globulin for early diagnosis of rapidly progressive central precocious puberty. Frontiers in Endocrinology. 2023; 14: 1273170.

[11] Wang W, Wang YF, Xiao Y, Zhang HR, Sun J, Shi WH, et al. Value of single-phase gonadotropin-releasing hormone stimulation test in diagnosis of central precocious puberty in girls with different levels of body mass index. Chinese Journal of Contemporary Pediatrics. 2024; 26: 592–598. (In Chinese)

[12] Chen YE, Gu XL, Shen LL, Xu M. Value of pelvic ultrasound combined with pituitary MRI in diagnosis of central precocious puberty in girls. European Review for Medical and Pharmacological Sciences. 2023; 27: 5973–5984.

[13] Latronico AC, Brito VN, Carel J. Causes, diagnosis, and treatment of central precocious puberty. The Lancet Diabetes & Endocrinology. 2016; 4: 265–274.

[14] Li M, Chen Y, Liao B, Tang J, Zhong J, Lan D. The role of kisspeptin and MKRN3 in the diagnosis of central precocious puberty in girls. Endocrine Connections. 2021; 10: 1147–1154.

[15] Huynh QTV, Ho BT, Le NQK, Trinh TH, Lam LHT, Nguyen NTK, et al. Pathological brain lesions in girls with central precocious puberty at initial diagnosis in Southern Vietnam. Annals of Pediatric Endocrinology & Metabolism. 2022; 72: 105–112.

[16] Talarico V, Rodio MB, Viscomi A, Galea E, Galati MC, Raiola G. The role of pelvic ultrasound for the diagnosis and management of central precocious puberty: an update. Acta Bio-Medica. 2021; 92: e2021480.

[17] Durá-Travé T, Gallinas-Victoriano F, Malumbres-Chacon M, Ahmed-Mohamed L, -Guindulain MJC, Berrade-Zubiri S. Clinical data and basal gonadotropins in the diagnosis of central precocious puberty in girls. Endocrine Connections. 2021; 10: 164–170.

[18] Calcaterra V, De Filippo G, Albertini R, Rendina D, Messini B, Monti CM, et al. Effectiveness of basal LH in monitoring central precocious puberty treatment in girls. Journal of Pediatric Endocrinology & Metabolism. 2020; 34: 45–50.

[19] He J, Kang Y, Zheng L. Correlation of serum levels of LH, IGF-1 and leptin in girls with the development of idiopathic central precocious puberty. Minerva Pediatrics. 2023; 75: 381–386.

[20] Wang W, Cao NN, Xiao Y, Wang Y, Wang YF, Sun J. Value of basal luteinizing hormone level combined with uterine volume measurement in the early diagnosis of central precocious puberty in girls with different Tanner stages. Chinese Journal of Contemporary Pediatrics. 2023; 25: 159–165. (In Chinese)

[21] Yeh SN, Ting WH, Huang CY, Huang SK, Lee YC, Chua WK, et al. Diagnostic evaluation of central precocious puberty in girls. Pediatrics and Neonatology. 2021; 62: 187–194.

[22] Vurallı D, Gönç EN, Özön ZA, Alikaşifoğlu A. Adequacy of basal luteinizing hormone levels in the diagnosis of central precocious puberty. Turkish Archives of Pediatrics. 2020; 55: 131–138.

[23] Cipolla C, Sodero G, Pane LC, Mariani F, Di Sarno L, Rigante D, et al. Auxological and metabolic parameters of children undergoing the gonadotropin-releasing hormone stimulation test: correlations with the final diagnosis of central precocious puberty in a single-center study. Biomedicines. 2023; 11: 1678.

[24] Cao R, Liu J, Fu P, Zhou Y, Li Z, Liu P. The diagnostic utility of the basal luteinizing hormone level and single 60-minute post GnRH agonist stimulation test for idiopathic central precocious puberty in girls. Frontiers in Endocrinology. 2021; 12: 713880.

[25] Yang K, Qi RF, Li RM, Zhang Y, Liu JX. Pelvic ultrasound parameters of long-acting depot formulation of leuprorelin in the treatment of idiopathic central precocious puberty in girls. Drug Design, Development and Therapy. 2021; 15: 1479–1484.

[26] Shi L, Jiang Z, Zhang L. Childhood obesity and central precocious puberty. Frontiers in Endocrinology. 2022; 13: 1056871.

[27] Calcaterra V, Klersy C, Vinci F, Regalbuto C, Dobbiani G, Montalbano C, et al. Rapid progressive central precocious puberty: diagnostic and predictive value of basal sex hormone levels and pelvic ultrasound. Journal of Pediatric Endocrinology & Metabolism. 2020; 33: 785–791.

[28] He Z, Yuan B. Retracted: Diagnostic value of combined detection of pelvic ultrasound and serum LH, FSH, and E2 levels in children with idiopathic central precocious puberty. Evidence-Based Complementary and Alternative Medicine. 2023; 2023: 9783570.

[29] Chen T, Zhang D. Basal gonadotropin levels combine with pelvic ultrasound and pituitary volume: a machine learning diagnostic model of idiopathic central precocious puberty. BMC Pediatrics. 2023; 23: 603.