ESPE2015 Poster Category 3 Puberty (39 abstracts)
Gaziantep University, Gaziantep, Turkey
Background: Accurate and differential diagnosis of preococious puberty (PP) have some important challenges. Many parameters have used to diagnose pubertal diseases so far. However LH-RH stimulation test is considered as a gold standard procedure, ıt has some difficulties in practise.
Objective: We aimed to set a newly proposed clinical and laboratory finding-based diagnostic scoring in the differential diagnosis of preoccious puberty and premature telarch (PT).
Method: In this study, a total of 267 patients (164 PP; 103 PT) were enrolled in Paediatric Endocrinology Department of Medical Faculty of Gaziantep University. We accepted following including criteria: At least one of secondary sex characteristics is T2 or P2 according to Tanner scoring. We used basal LH 0.31 or peak LH of at least 5 IU/l and/or stimulated LH/FSH ratio of at least 0.31 as cutoff criteria for pubertal response during GnRH testing. We accepted following findings as pubertal signs: i) uterine length is 35 mm or longer; ii) ovarian volume is 1 ml or larger size; iii) bone age is more advanced than chronological age by 1 years or older; iv) oestradiol level is higher than 10 pg/ml.
Findings: We determined among all parameters what we can use in clinical scoring. (Nagelkerke) These parameters: i) age at diagnosis ii) BA-CA(year) iii) Estradiol level iv) uterine length (mm) v) Ovarian volume(cm3) vi) peak LH level. We determined scoring every single parameters and established two different scoring model: i) Model 1 (without LH-RH stimulation test); ii) Model 2 (including peak LH level). We have designed the total score respectively as 12 and 15 points in Models 1 and 2. For diagnosis of precocious puberty, we accepted above five points (>5 points) in Model 1 and above seven points (>7 points) in Model 2 (Table 2). The specificity of both models were statistically significant. Model 1(%88.4); model 2(%91.4).
Variables (%) | Cut off | PP (n:164) | PT (n:103) |
Age at diagnosis (year) | >6.5 | 142 (86.6) | 44 (42.7) |
≤6.5 | 22 (13.4) | 59 (57.3) | |
BA-CA (year) | >1.1 | 116 (70.7) | 14 (13.6) |
≤1.1 | 48 (29.3) | 89 (86.4) | |
Estrogen | >12 | 87 (53.0) | 6 (5.8) |
≤12 | 77 (47) | 97 (94.2) | |
Uterine length (mm) | >32 | 132 (80.5) | 28 (27.2) |
≤32 | 32 (19.5) | 75 (72.8) | |
Ovarian volume (cm3) | >1.09 | 126 (76.8) | 27 (26.2) |
≤1.09 | 38 (23.2) | 76 (73.8) | |
PLH | >4.37 | 109 (79.6) | 19 (26) |
≤4.37 | 28 (20.4) | ||
Significant at P<0.05. Nagelkerke R 2=0.77. Cox & Snell R 2=0.56. |
Model 1: Nagelkerke R2=0.77 | Model 2: Nagelkerke: R2=0.81 | |||||||
Variables n (%) | β | Rounded score | Adjusted OR (95% Cl) | P | β | Adjusted OR lower | P | |
Age at diagnosis | 3.02 | 3 | 20.4 (5.87-70.90) | 0.001* | 3.32 | 3 | 27.68 (5.87141.93) | 0.001* |
BA-CA | 2.15 | 2 | 8.61 (3.34-22.22) | 0.001* | 2.68 | 2.5 | 14.63 (95.8770.90) | 0.001* |
Estrogen | 3.63 | 3.5 | 37.64 (9.33-151.90) | 0.001* | 2.74 | 2.5 | 15.60 (2.83-85.800) | 0.002* |
Uterine length | 1.89 | 2 | 6.65 (2.7516.12) | 0.001* | 1.60 | 1.5 | 4.95 (1.6113.17) | 0.005* |
Overian volume | 1.54 | 1.5 | 4.64 (1.8911.35) | 0.001* | 2.35 | 2 | 10.52 (2.9737.27) | 0.001* |
pLH | | | | 3.51 | 3.5 | 33.52 (8.20136.89) | 0.001* | |
Total=12 | Total =15 |
Conclusion: Clinical and laboratory finding-based practical and integrative diagnostic scoring in the differential diagnosis of preoccious puberty) and premature telarch can be more logical and reasonable approach. We propose a newly scoring system which is used onset age, bone age-choronological age,uterine length, ovarian volume, estradiol in differential diagnosis of PP and PT. The newly proposed scoring system which allows to diagnose PP and PT without LH-RH stimulation test. This scoring model both eliminates disadvantages and provides applicaple to every society, standard and measurable approach.