Precocious Puberty
Dr. Mrs. Meena P. Desai
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Precocious Puberty - Investigations
Q. What investigations are helpful ?
A. Bone age is advanced in TPP and is extremely helpful at the time of initial diagnosis as well as on follow up. Pelvic sonography for uterine and ovarian size and morphology are necessary and also help in excluding a primary ovarian pathology. Bilateral enlargement of ovaries with small follicular cysts and enlargement of uterus favors HPG axis activation. CNS imaging is very valuable in excluding intracranial organic lesions and detecting hypothalamic hamartomas. Vaginal cytology shows marked estrogen effect in TPP. Hormonal evaluation includes estimation of sex steroids, serum Estradiol (>10pg/ml) or testosterone (>0.2ng/ml) and gonadotropins (>1 IU/L) which may be in the pubertal range. LH, FSH response to GnRH stimulation test with a LH/FSH ratio exceeding 1, favors CPP.
Study of thyroid hormones, adrenal androgens and 17 - hydroxyprogesterone may be undertaken as indicated. ACTH stimulation and Dexamethasone suppression tests may be required in girls with premature adrenarche to differentiate from primary adrenal disease such as congenital adrenal hyperplasia. Adrenal imaging be occasionally required to exclude virilizing adrenal tumor. Bilateral adrenal hyperplasia may be seen in cases with CAH.
Dr. Mrs. Meena P. Desai
Precocious Puberty
Precocious Puberty
02/25/2001
02/25/2001
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Contributor Information and Disclosures
Dr. Mrs. Meena P. Desai
Consultant Pediatrician
Sir Hurkisondas Nurrotumdas Hospital,
Hon. Director, Sir H.N. Medical Research Society,
Consultant-Endocrinology Division
Bai Jerbai Wadia Hospital For Children, and
Institute of Child Health & Research Centre.
First Created: 02/25/2001