ESPE Abstracts

There is significant variability among diagnostic studies used for precocious puberty and their cutoff points for diagnosis. Pelvic ultrasound (PU) is a non-invasive, ionizing radiation-free diagnostic tool. Doppler flow analysis in uterine arteries, specifically the uterine pulsatility index (PI), can be a useful tool in the diagnosis and/or treatment of central precocious puberty (CPP) and has the advantage of being sensitive to hormonal changes. Its value decreases as vascular resistance decreases, with increasing levels of circulating estrogen. This characteristic may give it an advantage over other parameters observed by imaging studies. The variability in PI cutoff points between European and Latin American studies highlights the need for a specific study for our population. Objectives include to verify the effectiveness of PI as an adjunct in the diagnosis of CPP and correlate these results with other parameters in patients with clinical suspicion. The study design is retrospective, cross-sectional, and observational. Inclusion criteria include patients under 9 years of age who presented signs of precocious puberty before 8 years of age, treated at a pediatric hospital from January 2021 to July 2022, who had a breast Tanner stage at least of 2 on physical examination, LH levels greater than or equal to 0.3 IU/L, bone age assessment, pelvic and breast ultrasound. Exclusion criteria considered patients with treatments or diseases that could alter the results and patients who did not meet the inclusion criteria. Physical examination of all patients was performed, as well as LH, FSH, estradiol measurements, pelvic and breast ultrasound, and bone age determination. Of the 33 girls included, with an average age of 7.24 years (+/- 1.1 years), 42.4% showed a PI equal to or less than 5 and a uterine length greater than or equal to 35 mm, considered positive for precocious puberty. Sensitivity and specificity for these measurements were 50% and 77.8%, respectively. These data were correlated with ovarian volumes, hormone levels, bone age, breast ultrasound, and physical examination. It is concluded that there is a need to validate precise and non-invasive coadyuvant tools for the diagnosis of precocious puberty, considering the variability in PI values according to the studied population and the multiple diagnostic tests and cutoff values that exist today for the diagnosis of CPP. It is proposed to deepen the study with prepubertal population.