Sensitivity and specificity of using pelvic ultrasonographic parameters combined with basal gonadotropin levels to diagnose central precocious puberty in Thai girls
Creators: name: Kongmanas, ้Hataichanok
name: Trinavarat, Panruethai
name: wacharasindhu, suttipong
Publisher: name: figshare
Year: 2021
Subjects: subject: 111403 Paediatrics
subject: FOS: Clinical medicine
subject: 110306 Endocrinology

description: <b>Background:</b> The criterion standard gonadotropin-releasing hormone (GnRH) stimulation tests to diagnose central precocious puberty (CPP) are time-consuming, inconvenient, and expensive. <b>Objective:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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<sup>3</sup> and 1.5 cm<sup>3</sup> 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%. <b>Conclusion:</b> Combining uterine and ovarian ultrasonographic parameters with basal gonadotropin levels, especially uterine width and basal LH level, appears useful for diagnosis of CPP.<br><b>Figure 2.</b> Receiver operating characteristic curves for various ultrasonographic and hormonal parameters. <b>A.</b> Basal luteinizing hormone. <b>B.</b> Basal follicle stimulating hormone. <b>C.</b> Basal estradiol. <b>D.</b> Uterine volume. <b>E.</b> Uterine width. <b>F.</b> Uterine length. <b>G.</b> Uterine thickness. <b>H.</b> Bilateral ovarian volume. Solid lines indicate the variable parameter and dashed lines indicate a reference line. Diagonal segments are produced by ties.<br><br><b>Table 3</b>. Sensitivity, specificity, PPV, and NPV when combining uterine ultrasonographic and basal hormonal parameters<br><br>SPSS dataset (*.sav) to support <b>Figure 2</b> provided. SPSS Output files (*.spv) to support <b>Figure 2</b> and <b>Table 3</b> provided.