Diagnostic value of pituitary volume in girls with precocious puberty
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RESEARCH ARTICLE
Open Access
Diagnostic value of pituitary volume in girls with precocious puberty Su Wu1†, Yan Yang2†, Yujiao Wang1, Qianqi Liu1, Ziyang Zhu1*
and Wei Gu1*
Abstract Background: To date, the gonadotropin-releasing hormone (GnRH) stimulation test is still the gold standard for precocious puberty (PP) diagnosis. However, it has many disadvantages, including low sensitivity, high cost, and invasive operation. This study aims to evaluate whether magnetic resonance imaging (MRI)-derived variables, including pituitary volume (PV), could be used as diagnostic factors for PP in girls, providing a non-invasive diagnostic approach for PP. Methods: A total of 288 young female patients who presented to the Clinic of Pediatric Endocrinology for evaluation of PP from January 2015 to December 2017 were enrolled. The sample included 90 girls diagnosed with premature thelarche (PT), 133 girls determined as idiopathic central precocious puberty (ICPP), 35 early pubertal girls, and 30 normal girls. All patients received pituitary MRI examinations. Results: The largest PV and pituitary height were shown in the ICPP and pubertal groups, followed by the PT group. The receiver operating characteristic (ROC) curve analysis showed that PV is a predictive marker for ICPP, with a sensitivity of 54.10% and a specificity of 72.20% at the cutoff value of 196.01 mm3. By univariate analysis, PV was positively associated with peak luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), age, bone age, and body mass index (BMI) (all P < 0.05). However, bone age and peak LH were the only significant predictors of PV as demonstrated by the stepwise multivariate regression analysis (Model: PV = 9.431 * bone age + 1.230 * peak LH + 92.625 [P = 0.000, R2 = 0.159]). Conclusions: The PV in the ICPP group was significantly higher than in PT and control groups, but there was no reliable cutoff value to distinguish ICPP from PT. Pituitary MRI should be combined with clinical and laboratory tests to improve the diagnostic value of PV for PP. Keywords: Diagnosis, Precocious puberty, Puberty, Pituitary, MRI, Pituitary volume
Background Precocious puberty (PP) is defined as the development of secondary sexual characteristics before the age of 9 years for boys and 8 years for girls [1, 2]. The prevalence of PP in girls is approximately ten times higher than in boys, with the estimated register-based population
* Correspondence: [email protected]; [email protected] † Su Wu and Yan Yang contributed equally to this work. 1 Department of Endocrinology, Children’s Hospital of Nanjing Medical University, Nanjing 210000, China Full list of author information is available at the end of the article
prevalence of below 0.05% in boys and approximately 0.2% in girls [3]. Central precocious puberty (CPP) or gonadotropindependent precocious puberty results from early activation of the hypothalamic-pituitary-gonadal axis (HPGA). Mutations in the kisspeptin system, including makorin RING finger protein 3 (MKRN3) and delta-like1homologue (DLK1), h
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