Kongmanas Hataichanok B, Trinavarat Panruethai, Wacharasindhu Suttipong
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Asian Biomed (Res Rev News). 2021 Feb 21;15(1):27-34. doi: 10.2478/abm-2021-0004. eCollection 2021 Feb.
The criterion standard gonadotropin-releasing hormone (GnRH) stimulation tests to diagnose central precocious puberty (CPP) are time-consuming, inconvenient, and expensive.
To determine predictive cut-off values codetermined by ultrasonographic parameters and basal gonadotropin levels in girls with premature sexual development and compare them results of criterion standard tests in a study of diagnostic accuracy.
Retrospective review of hormonal investigations and ultrasonographic uterine and ovarian parameters in a consecutive sample of girls at a single center, tertiary care hospital in Bangkok, Thailand.
We separated data from 68 girls (age range 2-12 years) into 2 groups based on their response to a GnRH analogue agonist stimulation test. A "prepubertal response" group included girls with premature thelarche and thelarche variants (n = 18, 6.37 ± 1.77 years) and a "pubertal response" group, including girls with CPP (n = 50, 8.46 ± 1.46 years); excluding patients with pathological causes (n = 0). The basal level of luteinizing hormone (LH) had the largest area under receiver operating characteristic curves (AUC) of 0.84; 95% confidence interval [CI] 0.74-0.93) compared with basal levels of follicle stimulating hormone (AUC 0.77; 95% CI 0.64-0.90) or estradiol (0.70; 95% CI 0.56-0.85). An optimal cut-off of 0.25 IU/L LH was related to a pubertal response to GnRH analogue agonist stimulation tests with 75.0% sensitivity, 88.9% specificity, 94.7% positive predictive value (PPV), and 57.1% negative predictive value. Uterine and ovarian cut-off volumes of 3.5 cm and 1.5 cm were related to a pubertal response with 88.6% and 76.2% PPV, respectively. A uterine width cut-off of 1.7 cm combined with a basal LH cut-off of 0.25 IU/L increased specificity and PPV to 100%.
Combining uterine and ovarian ultrasonographic parameters with basal gonadotropin levels, especially uterine width and basal LH level, appears useful for diagnosis of CPP.
用于诊断中枢性性早熟（CPP）的标准促性腺激素释放激素（GnRH）刺激试验耗时、不便且昂贵。
确定性早熟女童超声参数和基础促性腺激素水平共同决定的预测临界值，并在一项诊断准确性研究中与标准试验结果进行比较。
对泰国曼谷一家三级医疗中心连续样本中的女童进行激素检查以及子宫和卵巢超声参数的回顾性分析。
我们根据68名女童（年龄范围2至12岁）对GnRH类似物激动剂刺激试验的反应将数据分为两组。“青春期前反应”组包括乳房早发育和乳房早发育变异型女童（n = 18，6.37 ± 1.77岁），“青春期反应”组包括CPP女童（n = 50，8.46 ± 1.46岁）；排除有病理原因的患者（n = 0）。促黄体生成素（LH）基础水平在受试者工作特征曲线下的面积最大，为0.84；95%置信区间[CI]为0.74 - 0.93），而卵泡刺激素基础水平（AUC 0.77；95% CI 0.64 - 0.90）或雌二醇（0.70；95% CI 0.56 - 0.85）的相应面积较小。LH的最佳临界值为0.25 IU/L，与GnRH类似物激动剂刺激试验的青春期反应相关，敏感性为75.0%，特异性为88.9%，阳性预测值（PPV）为94.7%，阴性预测值为57.1%。子宫和卵巢的临界体积分别为3.5 cm和1.5 cm时，与青春期反应的PPV分别为88.6%和76.2%。子宫宽度临界值为1.7 cm与基础LH临界值为0.25 IU/L相结合，可使特异性和PPV提高到100%。
将子宫和卵巢超声参数与基础促性腺激素水平相结合，尤其是子宫宽度和基础LH水平，似乎对CPP的诊断有用。
