Background: Pelvic ultrasound is used for the diagnosis and follow-up of girls with precocious puberty (PP). This tool may be somewhat misleading, because during treatment some patients may persist with pubertal uterine and ovarian anatomy. Oestrogens decrease the resistance of the uterine arteries, so Doppler evaluation of these vessels might be a useful complementary exam to determine the effects of treatment in these patients.
Objective and hypotheses: To evaluate the usefulness of uterine artery Doppler analysis in the diagnosis and follow-up of girls with PP.
Method: 14 girls with central PP (breast Tanner stage II-V, <8 years, LH >6.0 IU/L after leuprolide stimulation, >3,5 cm uterus length) were treated with long acting triptorelin pamoate 22.5 mg, which lasts 6 months. A single operator performed a pelvic ultrasound at the time of diagnosis, and after 6 and 12 months of analogue therapy, by measuring uterine size, ovarian volume and a Doppler analysis of the uterine arteries was performed. The blood flow velocity waveform was characterized as either high resistance, which represents lack of pubertal development, or low and/or intermediate resistance, which indicates active puberty. These parameters were correlated with the LH levels observed in these patients at the time of diagnosis and during treatment with triptorelin pamoate 22.5 mg.
Results: All patients received 1 dose of triptorelin at times 0 and 6 months, and completed 1 year of treatment. Mean age at the beginning of treatment was 7.9 years +1.3(48), and LH peak before treatment was 34.0 IU/L+23.0(8.691.0). At baseline, ten out of 12 patients (83%) had low or intermediate resistance with Doppler analysis, whereas two patients (17%) had high resistance. Mean peak LH at 6 months of treatment was 2.2 IU/L+0.8(0.73.7), and 13 patients (93%) showed high resistance, whereas 1 patient showed an intermediate pattern. All 14 patients (100%) showed high resistance blood flow velocity waveform at 12 months, which was associated with a mean peak LH of 1.8 IU/L+1.0(0.34.0).
Conclusion: Uterine artery Doppler colour analysis is a valuable complementary tool for the diagnosis and management of girls with central PP. This technique shows a good correlation with LH levels, and may be useful for patients with this condition during LHRH analogue treatment. Supported by Debiopharm, Switzerland.
Conflict of interest: This study was supported by Debiopharm, Switzerland.
Funding information: This study was supported by Debiopharm, Switzerland.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology