ESPE2024 Poster Category 1 Pituitary, Neuroendocrinology and Puberty 2 (9 abstracts)
Pelvic ultrasound and pubertal attainment in girls with sexual precocity: the pivotal role of uterine volume in predicting the timing of menarche
Alessandro Cattoni 1 , Gianni Russo 2 , Giulia Capitoli 3 , Giulia Rodari 4 , Maria Laura Nicolosi 1 , Silvia Molinari 1 , Daniele Tondelli 3 , Ciretta Pelliccia 5 , Silvia Radaelli 5 , Andrea Arosio 1 , Katia Fondata 2 , Giulia Tattesi 1 , Paolo Passoni 6 , Annalisa Boneschi 6 , Claudi Giavoli 4 , Silvia Laura Carla Meroni 2 , Marianna Rita Stancampiano 2 , Elda Garuti 7 , Andrea Biondi 1 , Adriana Balduzzi 1 & Carla Bizzarri 8
1Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. 2Department of Pediatrics, Endocrine Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3Bicocca Bioinformatics, Biostatistics and Bioimaging B4 Centre, Milano-Bicocca University, Monza, Italy. 4Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy. 5Department of Pediatrics, Ospedale Papa Giovanni XXIII, Bergamo, Italy. 6Department of Gynecology and Obstetrics, Fondazione IRCSS San Gerardo dei Tintori, Monza, Italy. 7Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy. 8Unit of Pediatric Endocrinology, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
Introduction: Among girls assessed for pubertal precocity, pelvic ultrasound (pUS) may represent a pivotal tool to predict the time expected to elapse between sonographic assessment and the onset of menarche (TUS-M). Accordingly, the present analysis is meant to define the statistical relationship between sonographic parameters and TUS-M, in order to identify the most reliable predictor of the timing of menarche.
Methods: Retrospective, multicenter analysis. Girls assessed for sexual precocity and showing sonographic and clinical findings consistent with pubertal onset upon referral were considered eligible. Patients treated with GnRH analogues were excluded and only those who had subsequently achieved complete and spontaneous pubertal attainment and for whom the exact date of menarche was available were included. Overall, we enrolled 184 girls from five tertiary-care Italian Centers.
Results: The time elapsed (months) between baseline endocrine assessment and spontaneous achievement of menarche showed a negative statistically significant correlation (P <0.0001) with LH (r:-0.61), FSH (r:-0.59), estradiol (r:-0.52) and stimulated LH values (r:-0.58). Among pUS parameters, ovarian volume (r:-0.17 left, -0.30 right) and uterine body-to-cervix ratio (r:-0.18) poorly correlated with TUS-M, while uterine diameters (r:-0.61 longitudinal, -0.64 anteroposterior) and volume (r:-0.70) achieved a highly statistical significance (P <0.0001). Uterine volume (UV) showed a negative logarithmic relationship with TUS-M and represented the most reliable predictor of the timing of menarche in uni- and multivariable analyses (P <0.001). By running dedicated ROC analyses, we identified the “best cut-off points” for uterine volume, longitudinal and anteroposterior diameters, namely the threshold values that show the best statistical accuracy in predicting the onset of menarche within 18, 12 and 6 months. Uterine best cut-off points and their statistical accuracy are reported in Table 1.
| Uterine parameter | Time threshold (months) | Best cut-off point | AUC | Sensitivity | Specificity |
| Uterine volume | 18 | 3.76 ml | 0.908 | 0.83 | 0.85 |
| 12 | 6.02 ml | 0.957 | 0.89 | 0.87 | |
| 6 | 8.80 ml | 0.966 | 0.86 | 0.95 | |
| Uterine longitudinal diameter | 18 | 40.5 mm | 0.857 | 0.80 | 0.85 |
| 12 | 43.5 mm | 0.913 | 0.82 | 0.85 | |
| 6 | 48 mm | 0.896 | 0.71 | 0.92 | |
| Uterine anteroposterior diameter | 18 | 11.6 mm | 0.875 | 0.78 | 0.80 |
| 12 | 13.6 mm | 0.923 | 0.86 | 0.88 | |
| 6 | 14.5 mm | 0.954 | 1.00 | 0.88 |
Conclusions: The logarithm of UV shows the best statistical performance in predicting the timing of menarche in girls assessed for pubertal precocity. Accordingly, we developed a user-friendly application that provides clinicians with an estimation of the months expected to elapse before menarche, based on the UV recorded upon pUS. It is available at: https://b4-uni25-5627493duksfy852qr80fewbsn3986g43jkgkzie8.shinyapps.io/ECO-PUB/
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