Pelvic ultrasonography in premenarcheal girls: relation to puberty and sex hormone concentrations.

Salardi, S; Orsini, L.; Cacciari, E; Bovicelli, Luciano; Tassoni, P; Reggiani, A

doi:10.1136/adc.60.2.120

Cited by 134 publications

(81 citation statements)

References 11 publications

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“…Technical advances in ultrasonography, including methods of enhanced anatomical resolution, have revealed that microcysts of the ovary can be a normal finding in females during the later part of infancy and early childhood (5,6). Maturation of the ovaries begins in early childhood, with the ovarian volumes correlated with age.…”

Section: Discussionmentioning

confidence: 99%

“…Maturation of the ovaries begins in early childhood, with the ovarian volumes correlated with age. The uterus, however, does not begin to mature until about 7 yr of age, after which increases in uterine volume and corpus to cervix ratio become apparent (6). Females with premature thelarche, a developmental variant of normal puberty, have been shown to have an increased frequency of follicular cysts of the ovary, measuring up to 10 mm in diameter (5, 7), with ovarian and uterine volumes being maintained in the normal range (7).…”

Section: Discussionmentioning

confidence: 99%

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Menstrual Bleeding in a Female Infant with Congenital Adrenal Hyperplasia: Altered Maturation of the Hypothalamic-Pituitary-Ovarian Axis

Uli

Chin²,

David³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

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Vaginal bleeding during the neonatal period is commonly related to the withdrawal of maternal estrogens. Vaginal bleeding has also been reported in female infants with congenital adrenal hyperplasia and has been proposed to be due to a treatment-induced activation of the hypothalamic-pituitary-ovarian axis.We report a female infant with the salt-losing form of congenital adrenal hyperplasia due to 21-hydroxylase deficiency, who had the onset of vaginal bleeding at 3 months of life. Adrenal steroid suppression had been achieved by 2.5 weeks of age. At the time of bleeding, imaging studies revealed an enlarged right ovary with a dominant 3-cm cyst and additional small cysts that had not been seen on the newborn sonogram. The uterus was enlarged and stimulated. Three weeks later (1 week after the cessation of bleeding), repeat ultrasound demonstrated a marked decrease in the size of the right ovary, and the dominant cyst was no longer seen. The patient had a heightened FSH response to GnRH and elevated levels of estradiol for age. At 5 months of age, no further episodes of sustained vaginal bleeding were observed. Repeat hormonal levels were prepubertal, and pelvic sonogram demonstrated no evidence of stimulation.The findings in our patient suggest that a decline in adrenal androgens after glucocorticoid treatment resulted in an increase in gonadotropin levels, which then triggered a transient and augmented end-organ response (menses). Further, we suggest that our infant's hormonal findings may reflect a delay in the timely development of the negative restraint by sex steroids on gonadotropins that is normally observed in infancy. (J Clin Endocrinol Metab 82: 3298 -3302, 1997)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Menstrual Bleeding in a Female Infant with Congenital Adrenal Hyperplasia: Altered Maturation of the Hypothalamic-Pituitary-Ovarian Axis

Uli

Chin²,

David³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

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“…El crecimiento del útero y los ovarios es proporcional a la edad cronológica, la edad ósea y el estadio puberal. Es importante señalar que en condiciones normales tanto el ovario inmaduro como el maduro tienen folículos en diferentes fases de desarrollo y en atresia [53][54][55] . En las niñas sometidas a radioterapia por debajo del diafragma (por ejemplo, ICT en el régimen de acondicionamiento de un TMO y radioterapia abdominal en el tumor de Wilms) puede haber afectación del crecimiento uterino y de su flujo sanguíneo, y a nivel del ovario puede observarse un volumen disminuido y una reducción en el número y el tamaño de los folículos antrales 56,57 .…”

Section: Estudio De La Función Ovárica En Pacientes Pediátricas Superunclassified

Evaluación de la pubertad y la función gonadal en pacientes pediátricos supervivientes de un cáncer infantil

Ibáñez

Martínez

Parareda

et al. 2007

Anales de Pediatría

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Tabla 2. Agentes citotóxicos más usados en Pediatría. Bloqueadores de la síntesis proteica L-Asparraginasa La radioterapia también tiene como finalidad la erradicación tumoral. Mediante la irradiación se generan moléculas con radicales libres altamente reactivas que alteran la estructura del ADN, llevando a una alteración en la proliferación celular. Se puede utilizar antes de la cirugía en un tumor inoperable, o con posterioridad a la misma para eliminar restos tumorales. También puede estar indicada en los síndromes dolorosos o compresivos producidos por el tumor o sus metástasis. Como las secuelas a largo plazo de la irradiación son dosis-dependientes, los niños que la precisan se tratan con la menor dosis eficaz. Sin embargo, la dosis de radioterapia, su fraccionamiento, la duración del tratamiento y el campo de irradiación dependerán del tipo de cáncer, la extensión de la enfermedad, la edad del paciente y su tolerancia al tratamiento. En general, los efectos adversos derivados de la radioterapia no aparecen de forma inmediata tras su administración, sino que se presentan después de un periodo de latencia más o menos Introducción 7 largo 7,10,11 . En la Tabla 3 se presenta la diferente radiosensibilidad de las células del organismo 12 . Grupo farmacológico Fármacos más usadosTabla 3. Tipos celulares según su radiosensibilidad. En algunos casos, el tratamiento del cáncer incluye la realización de un trasplante de médula ósea (TMO), ya sea autólogo o alogénico. El TMO se usa en el tratamiento de ciertos pacientes afectos de leucemia linfoblástica aguda (LLA), leucemia aguda no linfoblástica y aplasia medular grave 7,8,10,13 . Para ello, previamente se ha de preparar al receptor con regímenes de acondicionamiento que consisten en irradiación corporal total (ICT), o bien quimioterapia intensiva, por ejemplo, con busulfán y ciclofosfamida. Radiosensibilidad Tipos celulares Ejemplos AltaLos avances en la terapia antineoplásica han llevado a un significativo aumento de los índices de supervivencia en las últimas décadas, siendo actualmente el índice medio de curación del cáncer infantil del 70% 13,14 . Durante los últimos años se han producido mejorías en los tratamientos de quimioterapia y radioterapia, en los medios para Efectos secundarios del tratamiento antineoplásicoSe estima que casi la mitad de los supervivientes de un cáncer infantil pueden desarrollar problemas que afecten a su calidad de vida 10,11,13,15 . Aproximadamente dos tercios de los supervivientes tienen como mínimo un efecto tardío del tratamiento oncológico, y en un tercio de ellos las complicaciones que aparecen son graves 13 .Se han descrito secuelas de la terapia antineoplásica a nivel de todos los órganos y sistemas, dependiendo de la terapia específica a la que se ha expuesto el paciente (cirugía, quimioterapia única o combinada, radioterapia, trasplante de médula ósea) y su edad al inicio de la misma [10][11][12][13]15,17,18 . A pesar de que los niños toleran la toxicidad aguda del tratamiento mejor que los adultos, el niño puede ser má...

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“…The following variables were studied retrospectively in both groups: chronological age (CA) at onset of thelarche; CA at the first appointment; height centiles calculated from height curves of the National Center for Health Statistics (NCHS) 11 ; growth velocity centiles in the first year of follow up using the growth velocity curves of Tanner and Whitehouse 12 ; initial bone age (BA) at the first appointment was compared using the standards of Greulich and Pyle 13 for hands and wrists; bone age after 1 or 2 years of follow up, analyzing the DBA/DCA ratio; computerized tomography or magnetic resonance of hypothalamus-pituitary area; pelvic ultrasonography following the standards of Salardi et al 14 and Orsini et al 15 for uterine and ovarian volumes in children and adolescents, assuming an upper limit for uterine volume of 4 mL and for ovarian volume of 2 mL as the normal upper limits for the prepubertal age group; the frequency of the microcystic condition of the ovaries; basal levels of LH and FSH were performed using commercially available radioimmunoassay (RIA) kits (RIA Gnost, Groupe Oris, France) and immunofluorimetric assay (IFMA) kits (Delfia -Pharmacia Diagnostic, Uppsala, Sweden). Gonadotropin response to LHRH (LHRH-Serono, 100 mg in bolus) was assessed by collecting blood samples for determination of LH and FSH just before the administration of LHRH, and subsequently at 15, 30, 60, and 90 minutes.…”

Section: Methodsmentioning

confidence: 99%

Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty

et al. 2002

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PURPOSE:Two groups of girls with premature breast development were studied retrospectively. We tried to identify clinical, radiological, and hormonal parameters that could distinguish between a benign, nonprogressive premature thelarche and a true precocious puberty. METHODS:The clinical outcome of 88 girls with breast enlargement before 6.1 years of age was analyzed. Taking into account the progression of their sexual maturation, we allocated the children into 2 groups: "Isolated Premature Thelarche" (n = 63) and "Precocious Puberty" (n = 25) groups. Chronological and bone ages, height and growth velocity centiles, computerized tomography of hypothalamus-pituitary area, pelvic ultrasonography, gonadotropin response to luteinizing hormone-releasing hormone stimulation as well as basal levels of luteinizing hormone, follicle-stimulating hormone, estradiol, and prolactin were studied in both groups. Statistical analysis were performed using the Student t test to compare the sample means. Fisher's exact test and c 2 test were used to analyze the nonparametric variables.RESULTS: Isolated premature thelarche most frequently affected girls younger than 2 years who presented exaggerated follicle-stimulating hormone response to luteinizing hormone-releasing hormone stimulation test. The precocious puberty group had higher initial stature, accelerated growth rate and bone age, increased uterine and ovarian volumes, high spontaneous luteinizing hormone levels by immunofluorimetric assay, as well as a high luteinizing hormone response and peak luteinizing hormone/folliclestimulating hormone ratio after luteinizing hormone-releasing hormone stimulation.CONCLUSION: At initial presentation, girls who undergo true precocious puberty present advanced bone age, increased uterine and ovarian volumes in addition to breast enlargement, as well as an luteinizing hormone -predominant response after a luteinizing hormone-releasing hormone stimulation test.

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Pelvic ultrasonography in premenarcheal girls: relation to puberty and sex hormone concentrations.

Cited by 134 publications

References 11 publications

Menstrual Bleeding in a Female Infant with Congenital Adrenal Hyperplasia: Altered Maturation of the Hypothalamic-Pituitary-Ovarian Axis

Menstrual Bleeding in a Female Infant with Congenital Adrenal Hyperplasia: Altered Maturation of the Hypothalamic-Pituitary-Ovarian Axis

Evaluación de la pubertad y la función gonadal en pacientes pediátricos supervivientes de un cáncer infantil

Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty

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