Usefulness of ovarian volume and cysts in female isosexual precocious puberty

Abstract

The real-time pelvic sonograms of 32 girls under 8 years old with true isosexual precocity (23 cases), pseudosexual precocity (four cases), premature adrenarche (four cases), and an undetermined problem (one case) were evaluated retrospectively for ovarian volume and presence and size of cysts. Sonographic findings were compared to those of 181 age-matched controls to determine the best sonographic indicator of precocious puberty. Ovarian volume was 4.6 cm3 in girls with true isosexual precocity, 4.1 cm3 in girls with pseudosexual precocity, and less than 1 cm3 in the other patients as well as in the control population. Ovarian enlargement was bilateral in true precocity and unilateral in pseudosexual precocity. Of the 181 subjects in the control group, 96 (53%) had ovarian cysts, almost all of which were small (less than 9 mm in diameter). Ovarian cysts occurred in 22 of 32 patients (69%) with precocity. The cysts generally were smaller than 9 mm in true isosexual precocity and larger than 9 mm in pseudosexual precocity. In conclusion, small ovarian cysts are not specific to precocious puberty and its various subtypes. Bilateral ovarian enlargement appears to be a reliable indicator of true isosexual puberty, whereas unilateral ovarian enlargement in combination with macrocysts is suggestive of pseudosexual precocity.

Sonographic assessment of uterine and ovarian development in normal girls aged 1 to 12 years

“…In our study, a homogeneous, solid echopattern was present in a higher proportion in younger ages, whereas macrocystic ovaries appeared after the age of 8 years and were seen with a higher frequency after the age of 10, even in prepubertal subjects ( Figure 5). This presence of ovarian follicles in prepubertal subjects has also been described by others 5,7,8,12,13,20,22 and has been confirmed by postmortem studies that have shown that ovaries are active throughout child- hood with an increasing number and size of follicles. 23 With regard to Tanner staging, our results show, surprisingly, that there is no statistically significant difference in uterine and ovarian size between prepubertal and pubertal subjects aged 10-12 years ( Figure 6).…”

Monitoring of girls undergoing medical therapy for isosexual precocious puberty.

“…The presence of cysts alone, isolated from ovarian volume and other morphologic criteria, is not a reliable indicator of stimulation. 5 The suppressed ovaries may contain more than one 5 mm cyst in addition to minute hypoechoic follicles (Fig. 5).…”

“…8 The regression of all sonographic parameters after 1 year of therapy has been documented. 5 Our series represents a longitudinal study in which the patients were evaluated at uni· form time intervals with sonographic, laboratory and clinical correlates obtained on the same day. The time course of the hormonal-gonadal interaction is an important factor to keep in mind when evaluating these patients.…”

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).…”