ESPE Abstracts (2015) 84 P-3-1161

Puberty

A Practical and Integrative Approach to Differential Diagnosis Between Precocious Puberty and Premature Telarch: Newly Proposed Clinical and Laboratory Finding-Based Diagnostic Scoring in Precocious Puberty and Premature Telarch

Murat Karaoglan, Mehmet Keskin, Ayhan Ozkur & Ozlem Keskin

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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).

Table 1 Cut off levels for PP and PT.
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.
Table 2 Scores for every single parameters (for abstract P3-1161).
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 (5.87–141.93) 0.001*
BA-CA 2.15 2 8.61 (3.34-22.22) 0.001* 2.68 2.5 14.63 (95.87–70.90) 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 (2.75–16.12) 0.001* 1.60 1.5 4.95 (1.61–13.17) 0.005*
Overian volume 1.54 1.5 4.64 (1.89–11.35) 0.001* 2.35 2 10.52 (2.97–37.27) 0.001*
pLH 3.51 3.5 33.52 (8.20–136.89) 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.

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