Evaluation of the efficiency of treatment in girls with central precocious puberty/rapidly progressive puberty via ultrasonography

Year 2022, , 664 - 669, 15.03.2022

Nurdan Fidan , Havva Nur Peltek Kendirci

https://doi.org/10.32322/jhsm.1026635

Abstract

Introduction: Central precocious puberty (CPP) is defined as the development of secondary sexual characteristics in girls before the age of 8 years due to the activation of the hypothalamus-pituitary-gonadal (HPG) axis, and long-acting GnRH analogues (GnRHa) are used in its standard treatment. The gold standard method for evaluating the efficiency of treatment is to demonstrate the suppression of the LH response with the GnRH stimulation test. Pelvic ultrasonography (US) is an easily accessible, safe, free of ionizing radiation and non-invasive imaging method, which is used for the evaluation of internal genital organs, monitoring of sexual development, and excluding ovarian mass. This study aimed to evaluate the effect of GnRHa treatment on internal genital organs and to determine the role of pelvic ultrasonography in treatment follow-up.
Material and Method: Between January 2017 and May 2021, 50 girls who were started on GnRHa treatment due to the diagnosis of CPP or rapidly progressing puberty were followed up, and who underwent pelvic US imaging at the beginning of treatment and in the 1st year of treatment were included in the study. The clinical and sonographic findings were compared before and after the treatment.
Results: Of the 50 patients in the study, 52% (n=26) were being followed up with CPP, and 48% (n=24) with rapidly progressive puberty. In the first year of GnRHa treatment, while the suppression of the HPG axis was detected in 82% (n=41) of the cases with the GnRHa test, there was no suppression in 18% (n=9). A decrease in ovarian volume was observed in 73.2% (n=30) of 41 patients with suppression of the HPG axis, a decrease in uterine volume in 65.9% (n=27), and a decrease in uterine anterior-posterior size in 61% (n=25). While endometrial thickness could be measured in 64% (n=32) of the cases before treatment, measurable endometrial thickness was detected in only 6% (n=3) of the cases in the 1st year of treatment.
Conclusion: We detected in this study that GnRHa treatment in girls with a diagnosis of CPP/rapid puberty caused a significant regression in ovarian and uterus dimensions and endometrial echo selectability. Our results, in line with the literature, support that pelvic ultrasonography is an appropriate modality for monitoring the suppression of the HPG axis during CPP treatment and may reduce the need for repeated GnRH stimulation tests.

Keywords

Central precocious puberty, ultrasonography, GnRHa therapy, uterine diamater, ovarian volume

Supporting Institution

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Project Number

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Thanks

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