Monitoring of girls undergoing medical therapy for isosexual precocious puberty.

Abstract

We evaluated the use of sonography in monitoring the efficacy of suppressive therapy with a gonadotropin releasing hormone analogue in girls being treated for isosexual precocious puberty. Ten girls 5 to 9 years of age underwent serial sonography and hormonal stimulation tests on the same day. Sonographic trends of decreasing ovarian volume and uterine length indicated early suppression even when absolute values were above threshold. Isosexual precocious puberty in girls can be defined as the premature development of secondary sexual characteristics with associated ovarian and uterine maturation that is inappropriate Changes in ovarian volume were the most sensitive predictor of pituitary-gonadal suppression. Sonography is a sensitive and accurate method of monitoring medical therapy; ovarian volume and analysis of interval change are the most sensitive barometers of change. KEY WORDS: Ultrasonography in infants and children; Pelvic organs; Ovary; Uterus; Precocious puberty. for the patient's age. Clinically, the diagnosis is considered in girls who develop secondary sexual characteristics before 8 years of age or menses before 9 years of age. 1 Approximately 80% of these cases are due to idiopathic activation of the hypothalamicpituitary-~nadal axis without an underlying anatomic cause. In evaluating the patient at the time of initial diagnosis, sonography is capable of describing the initial morphologic changes that have taken place in the uterus and ovaries, and can identify the rare instances of primary gonadal or adrenal neoplasm.4The key physiologic factor that makes sonography useful for monitoring these patients is that the maturational morphologic changes of the uterus and ovaries associated with hormonal stimulation are reversible. When endocrinologic neuraxis suppression is achieved, these organs revert to an infantile (nonstimulated) appearance. 5 ' 6 This regression of sonographic morphologic features normally is observed in women at menopause.Tanner staging measures maturation by means of

Avaliação ultra-sonográfica da genitália interna de meninas com puberdade precoce central idiopática antes e durante o tratamento com análogo de GnRH

“…A diminuição do volume ovariano e do comprimento do útero, mesmo com valores ainda acima dos limiares da normalidade, já pode indicar início da supressão do eixo 16 . Em 33 meninas com puberdade precoce central idiopática havia aumento do útero e ovários na maioria das pacientes antes do tratamento.…”

“…A ultra-sonografia pélvica provou ser técnica não invasiva e precisa na avaliação da genitália interna de meninas com puberdade precoce central. Vários parâmetros ultra-sonográficos são citados como indicadores do efeito da secreção estrogênica, destacando-se o aumento dos volumes uterino [11][12][13][14] e ovariano [15][16][17] , o incremento do comprimento longitudinal do útero 16 e da relação entre as medidas do corpo e do colo uterinos 17,18 e a presença do eco endometrial 11,14,17,18 . Após e durante o tratamento, a ultra-sonografia pélvica pode monitorizar se essas mudanças puberais precocemente desenvolvidas estão regredindo.…”

Crescimento em meninos e meninas com puberdade precoce

“…Há discrepância quanto à morfologia dos ovários após tratamento com GnRHa. Prevalência aumentada de ovários policísticos foi observada em meninas que usaram GnRHa e GH associados (39); entretanto, ovários policísticos-símile foram vistos raramente em pacientes tratadas com GnRHa isoladamente (38,40,41). A fertilidade e a gestação são normais mesmo após uso prolongado de GnRHa (28).…”

The role of ovarian volume in reproductive medicine

“…This may also allow differentiation between true isosexual precocity when the enlargement of the ovaries is bilateral, and pseudosexual precocity in which there is unilateral ovarian enlargement (King et al, 1993). Moreover, measurement of ovarian volume is the most sensitive index with which to assess the efficiency of GnRH analogue treatment of these cases (Ambrosino et al, 1994;Jensen et al, 1998).…”

“…Precocious puberty and growth disorders (Stanhope et al, 1985) Idiopathic precocious puberty, hypogonadotrophic hypogonadism (King et al, 1993) Isosexual precocity, pseudosexual precocity, premature adrenache (Bridges et al, 1993) GH insufficiency, skeletal dysplasia, tall stature (Ambrosino et al, 1994) Isosexual precocity (Griffin et al, 1995b) Precocious puberty, premature thelarche (Ciotti et al, 1995) Precocious puberty (Haber et al, 1995) Premature thelarche, central precocious puberty (Bridges et al, 1995) Untreated central precocious puberty, central precocious puberty treated with GnRHa, premature thelarche, premature adrenarche (Jensen et al, 1998) Idiopathic central precocious puberty Menstrual disorders (Venturoli et al, 1995) Persistent menstrual irregularity (Herter et al, 1996) Menstrual irregularity Eating disorders (Lai et al, 1994) Anorexia nervosa (Sobanski et al, (1997) Anorexia nervosa (Andolf et al, 1997) Anorexia nervosa, bulimia GH = growth hormone; GnRHa = gonadotrophin hormone releasing hormone agonoist. Zaidi et al (1995) measured stromal peak systolic blood flow velocity (V max ) on day 2-3 of cycles of PCOS patients and normal controls (Zaidi et al, 1995).…”