ABSTRACT
Isosexual precocity in girls is the development of secondary sexual characteristics in girls who are less than 8 years old and includes: isolated premature thelarche [PT], premature adrenarche and true precocious puberty [TPP]. True precocious puberty represents a serious developmental disorder necessitating immediate therapeutic measures, whereas premature thelarche is a harmless variation from the norm, necessitating only close follow up. However, many intermediate forms have been found with features intermediate between isolated PT and TPP and an open debate exists on treatment of these intermediate forms of puberty. The aim of the current study is to evaluate the role of the gray-scale ultrasound and color Doppler analyses in the differential diagnosis of true precocious puberty and premature thelarche and to correlate them with clinical, auxological and hormonal profile to determine their potential contribution to correctly diagnose girls with sexual precocity. Thirty-one girls were included in the study, of whom 20 girls had premature thelarche [PT] and 11 girls had true precocious puberty [TPP]. All cases were subjected to full clinical, auxological and pubertal assessment. The following hormonal profiles were done for all patients: basal leutinizing hormone [LH], basal follicle stimulating hormone [FSH], estradiol [E2] and stimulated peak LH/ peak FSH. Brain CT was done for all cases with central precocious puberty. Gray-scale ultrasound for uterine and ovarian evaluations was done for all patients and the following parameters were obtained: uterine and ovarian volumes by measuring length, depth and width, uterine morphology: fundocervical ratio, presence or absence of endometrial echo and ovarian morphology with the maximum diameter of the largest follicle was reported when present. Color Doppler analysis was done for uterine and ovarian arteries and these indices were measured: peak systolic velocity [PSV], end diastolic flow [ED], resistivity index [RI] and pulsatility index [PI]. The appearance of the wave was also reported [narrow systolic flow, absence or presence of diastolic flow].Our results proved that patients with TPP showed higher chronological age [CA] at the onset of the disease [p=0.000], more advanced height [p=0.000] and higher bone age [BA] [p=0.000]. The BA/CA, although higher in group II with TPP, yet it was non significant [p=0. 1]. According to Tanner scale, all patients presented a breast stage 2-3 except1/11 case in group II who presented a breast stage 4. Pubic hair stage 2-3 was present in 9/11 in group II [2/11 presented stage 1, 8/11 stage 2 and 1/11 stage 3] and 1/20 in group Ipresented stage 3 with significant difference between both groups [p=0. 000]. Regarding the hormonal prohle of the studied groups, our data showed a highly significant difference between both groups in their basal LH [1.3 vs 3.2, p=0.002], basal FSH [3.2 vs 4.5, p=0.045], E2 [12 vs 22, p=0. 000] and peak LH/peak FSH [0.4 vs 2.5, p=0.000]. The ultrasound examination and Doppler analysis of uterine and ovarian arteries blood flow data showed that girls with TPP had significantly higher uterine size [p=0.000], fundus/cervix ratio [p=0. 001], right and left ovarian size [p=0.002 and 0.016 respectively] together with the size of largest ovarian follicle measured when found [p=0.028]. Endometrial echo was found in 5/11 cases in group II and 3/20 cases in group I. All uterine and ovarian arteries Doppler indices showed significant difference between both groups except for ovarian artery RI that did not show significant difference between both groups. The uterine artery PI had high diagnostic value [sensitivity 90% and specificity 100]
Conclusion: Uterine and ovarian arteries Doppler indices can assist in the diagnosis of TPP and can be considered as a complementary tool to the clinical, laboratory and pelvic ultrasound parameters in diagnosing sexual precocity and further studies may be needed to assess their usefulness in following the cases after treatment