ESPE Abstracts

Context: Premature breast enlargement before the age of 8 in girls is caused by a broad spectrum from premature thelarche to central precocious puberty. Treatment with GnRH analogues aim to delay either early onset of menstruation with its psychological consequences and/or early epiphyseal fusion. The Indication of treatment is a challenge classically based on the result of the luteinizing hormone (LH)-releasing hormone (LHRH) stimulation test.

Objective: To examine the potential usefulness of unstimulated LH levels, in addition to age of onset of breast development and uterine length on pelvic ultrasound in treatment decision.

Method: Clinical, imaging and biological data were retrospectively analyzed in 115 girls with early breast development between 6 and 8 years of age, referred to our pediatric hospital between 2012 and 2021. 26 of them had breast development before the age of 7 (group 1: 22.6%), 24 between 7 and 7.5 years (group 2: 20.8%) and 65 between 7.5 and 8 years (group 3: 56.6%). LH was measured using an electrochemiluminescent immunoassay. Follow-up information was available for 85 patients.

Results: LHRH stimulation test showed LH response levels > 5 U/l in 63 girls (54.7%): 10 in group 1 (38%), 11 in group 2 (45.8%) and 42 in group 3 (64.6%). Only 73.3% of girls demonstrated LH peak > 5 U/l received GnRHa treatment and 20% received treatment while the simulated LH peak was <5 U/l. The analysis of age at breast development, unstimulated LH levels and uterine length in our cohort allowed us to determine a predictive score in 104 of the 115 girls, that was correlated to the LHRH stimulation test results in 83.6% of cases (n=82). Discrepancies were noted for 16 girls, 10 showing stimulated LH peak >5 U/l and negative score and 6 showing LH peak <5 U/l and positive score. For them, predictive score results fit better with the treatment decision than the LHRH stimulation test result.

Conclusion: LHRH stimulation test showed activation of the gonadotropic axis in only half of the girls with premature breast enlargement between 6 and 8 years of age. A score based on unstimulated LH levels, age of onset of breast development and uterine length could be sufficient for treatment decision. Our new score could thus make it possible to dispense with the LHRH stimulation test. However, others studies including growth velocity and bone age may be relevant to support the predictive score.