ESPE Abstracts (2018) 89 P-P3-004

Basal Levels of 17-hydroxyprogesterone can Distinguish Isolated Precocious Pubarche from Non-Classical Congenital Adrenal Hyperplasia in Children: A Prospective Observational study

Anna Grandone, Adalgisa Festa, Michela Mariani, Caterina Luongo & Emanuele Miraglia del Giudice


Università della Campania Vanvitelli, Naples, Italy


Background: Basal levels of androgens, in particular 17-OHprogesterone (17OHP), are widely debated as predictors of non-classical congenital adrenal hyperplasia (NCCAH) among patients with precocious pubarche (PP). So many authors suggested the execution of ACTH stimulation test in all children with PP. The aim of our study was to identify clinical and biochemical predictors of NCCAH in children with PP.

Methods: We conducted a prospective study of 92 patients with PP undergoing an ACTH stimulation test. We tested the association of basal clinical and biochemical factors with NCCAH diagnosis. Patients were suspected to have NCCAH if their stimulated 17-OHP plasma levels were >10 ng/ml and then genotyped to confirm the diagnosis.

Results: Seven (7.6%) patients resulted having NCCAH. The best basal biochemical predictor for NCCAH was 17OHP level >2 ng/ml. In fact a basal 17OHP level >2 ng/ml had 100% (95%CI, 59.04–100) sensitivity, and 93% (95%CI, 85.3–97.37) specificity. The area under the ROC curve for 17OHP was 0.99 (95% CI, 0.98–1.007).

Conclusions: Basal 17-OHP cut-off of 2 ng/mL was very effective in predicting NCCAH among our patients with PP. Assay specific cut-off would probably be the best strategy to avoid unnecessary ACTH test.

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