Diagnostic value of pituitary volume in girls with precocious puberty

Wu, Shaohua; Yang, Yan; Wang, Yujiao; Liu, Qianqi; Zhu, Ziyang; Gu, Wei

doi:10.1186/s12887-020-02283-7

Cited by 13 publications

(18 citation statements)

References 28 publications

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“…Other investigators recommended basal LH levels instead of GnRHST, but the cutoff values of basal LH varied from 0.1 to 0.83 IU/L (ICMA) with 64% to 93% diagnostic sensitivity ( 18 , 19 ). Similarly, pelvic ultrasonography or pituitary magnetic resonance imaging could not distinguish prepubertal and pubertal stages ( 20 , 21 ). As a major inhibitor of hypothalamic GnRH secretion, serum MKRN3 concentration declines before puberty onset in girls and might be useful for the assessment of pubertal development ( 22 ); however, it is also invasive.…”

Section: Discussionmentioning

confidence: 96%

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

Zhan

Xiao-dong

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Although gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP), it is invasive, expensive, and time-consuming, requiring multiple blood samples to measure gonadotropin levels. Objective We evaluated whether urinary hormones could be potential biomarkers for pre- or post- puberty, aiming to simplify the current diagnosis and prognosis procedure. Design, Setting, and Participants We performed a cross-sectional study of a total of 355 girls with CPP in National Clinical Research Center for Child Health in China, including 258 girls with positive and 97 girls with negative results from GnRHST. Twenty patients received GnRH analogue (GnRHa) treatment and completed a six-month follow up. Main Outcome Measures We measured luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, progesterone, testosterone, and human chorionic gonadotropin in the first morning voided urine samples. Results Their urinary LH levels and the ratios of LH: FSH increased significantly with the advancement in Tanner Stages. uLH levels were positively associated with basal and peak LH levels in the serum after GnRH stimulation. A cut-off value of 1.74 IU/L for uLH reached a sensitivity of 69.4% and a specificity of 75.3% in predicting a positive GnRHST result. For the combined threshold (uLH≥1.74+uLH: uFSH ratio >0.4), the specificity reached 86.6%. After 3 months of GnRHa therapy, the uLH and uFSH levels decreased accordingly. Conclusions uLH could be a reliable biomarker for the initial CPP diagnosis and screening; uLH also could be an effective marker for evaluating the efficacy of clinical treatment.

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Section: Discussionmentioning

confidence: 96%

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

Zhan

Xiao-dong

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…35 ROC analysis showed that PV could be a marker for CPP. 13 Pituitary measurements varied in small-sized children in different age groups with 2D MR images. 36 Compared to previous research, 13 a radiomics signature model with features extracted from 3D MR images in our study had improved diagnostic value and also had higher net benefit than aPV and aPH models based on DCA analysis.…”

Section: Discussionmentioning

confidence: 99%

“…13 Pituitary measurements varied in small-sized children in different age groups with 2D MR images. 36 Compared to previous research, 13 a radiomics signature model with features extracted from 3D MR images in our study had improved diagnostic value and also had higher net benefit than aPV and aPH models based on DCA analysis. In details, the original_shape_MinorAxisLength and Maximum2DDiameterRow were significantly associated with HPG axis activation.…”

Section: Discussionmentioning

confidence: 99%

“…12 Therefore, it is important to simplify the GnRH stimulation test or seek alternative methods to more easily evaluate the HPG axis activation. 13,14 Hypophysial MRI is the currently preferred technique to image the pituitary gland and is performed in many tertiary care centers to rule out brain abnormalities. 5 Previous studies have shown that the height of the pituitary gland and the pituitary volume is higher in the CPP group than in the normal group.…”

mentioning

confidence: 99%

“…5 Previous studies have shown that the height of the pituitary gland and the pituitary volume is higher in the CPP group than in the normal group. 13,15 However, due to the limitations of two-dimensional MR image resolution, the real pituitary height and volume cannot be obtained, the diagnostic performance of pituitary height and volume on precocious puberty in previous studies are not high. 16,17 Thus, the diagnostic efficiency of adenohypophyseal MRI features for assessing activation of HPG axis may be undervalued.…”

mentioning

confidence: 99%

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MRI Radiomics Features of Adenohypophysis Determine the Activation of Hypothalamic‐Pituitary‐Gonadal Axis in Peri‐Puberty Children

Liu,

Lv,

Liu

et al. 2023

Magnetic Resonance Imaging

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BackgroundThe status of the hypothalamic‐pituitary‐gonadal (HPG) axis is important for assessing the onset of physiological or pathological puberty. The reference standard gonadotropin‐releasing hormone (GnRH) stimulation test requires hospital admission and repeated blood samples. A simple noninvasive method would be beneficial.ObjectivesTo explore a noninvasive method for evaluating HPG axis activation in children using an MRI radiomics model.Study TypeRetrospective.PopulationTwo hundred thirty‐nine children (83 male; 3.6–14.6 years) with hypophysial MRI and GnRH stimulation tests, randomly divided a training set (168 children) and a test set (71 children).Field Strength/Sequence3.0 T, 3D isotropic fast spin echo (CUBE) T1‐weighted imaging (T1WI) sequences.AssessmentRadiomics features were extracted from sagittal 3D CUBE T1WI, and imaging signatures were generated using the least absolute shrinkage and selection operator (LASSO) with 10‐fold cross‐validation. Diagnostic performance for differential diagnosis of HPG status was compared between a radiomics model and MRI features (adenohypophyseal height [aPH] and volume [aPV]).Statistical TestsReceiver operating characteristic (ROC) and decision curve analysis (DCA). A P value <0.05 was considered statistically significant.ResultsEight hundred fifty‐one radiomics features were extracted and reduced to 10 by the LASSO method in the training cohort. The radiomics model based on CUBE T1WI showed good performance in assessment of HPG axis activation with an area under the ROC curve (AUC) of 0.81 (95% CI: 0.71, 0.91) in the test set. The AUC of the radiomics model was significantly higher than that of aPH (0.81 vs. 0.65) but there was no significant difference compared to aPV (0.81 vs. 0.78, P = 0.58). In DCA analysis, the radiomics signature showed higher net benefit over the aPV and aPH models.Data ConclusionsThe MRI radiomics model has potential to assess HPG axis activation status noninvasively, potentially providing valuable information in the diagnosis of patients with pathological puberty onset.Evidence Level4Technical EfficacyStage 2

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Pitfalls of diagnosing pituitary hypoplasia in the patients with short stature

Kiremitci Yilmaz,

Yilmaz Ovali,

Ozalp Kizilay

et al. 2024

Endocrine

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Purpose Height age (HA) and bone age (BA) delay is well known in the patients with short stature. Therefore assessing pituitary hypoplasia based on chronological age (CA) might cause overdiagnosis of pituitary hypoplasia. We aimed to investigate the diagnostic and prognostic value of the PH and PV based on CA, HA, or BA in the patients with GHD. Methods Fifty-seven patients with severe and 40 patients with partial GHD and 39 patients with ISS assigned to the study. For defining the most accurate diagnosis of pituitary hypoplasia, PH and PV were evaluated based on CA, BA and HA. The relationship of each method with clinical features was examined. Results The mean PV was significantly larger in patients with ISS compared to the GH-deficient patients. PV was more correlated with clinical features including height SDS, stimulated GH concentration, IGF-1 and IGFBP-3 SDS, height velocity before and after rGH therapy. We found BA-based PV could discriminate GHD from ISS (Sensitivity: 17%, specificity: 98%, positive predictive value: 94%, negative predictive value: 39%), compared to the other methods based on PH or PV respect to CA and HA. 3% of patients with ISS, 17% of patients with GHD had pituitary hypoplasia based on PV-BA. Conclusion PV based on BA, has the most accurate diagnostic value for defining pituitary hypoplasia. But it should be kept in mind that there might be still misdiagnosed patients by this method. PV is also a significant predictor for the rGH response.

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Diagnostic value of pituitary volume in girls with precocious puberty

Cited by 13 publications

References 28 publications

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

MRI Radiomics Features of Adenohypophysis Determine the Activation of Hypothalamic‐Pituitary‐Gonadal Axis in Peri‐Puberty Children

Pitfalls of diagnosing pituitary hypoplasia in the patients with short stature

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