Diagnostic Value of Pituitary Volume in Girls with Precocious Puberty

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Abstract
To date, the gonadotropin-releasing hormone (GnRH) stimulation test is still the pivotal guarantee of precocious puberty (PP) diagnosis. However, it has many disadvantages, including low sensitivity, high cost, and invasive operation. This study aimed to evaluate the impacts of magnetic resonance imaging (MRI)-derived variables on the diagnosis of PP in girls, providing a non-invasive diagnostic method for PP. Methods: A total of 288 young female patients who presented to the Clinic of Pediatric Endocrinology for evaluation of PP from January 2015 to December 2017 were enrolled. The sample included 90 girls diagnosed with premature thelarche (PT), 133 girls determined as idiopathic central precocious puberty (ICPP), 35 early pubertal girls, and 30 normal girls. All patients received pituitary MRI. Results: The largest pituitary volume (PV) and pituitary height were shown in the ICPP and pubertal groups, followed by the PT group. The receiver operating characteristic (ROC) curve analysis showed that PV might be a predictive marker for ICPP, with a sensitivity of 54.10% and a specificity of 72.20% at the cutoff value of 196.01 mm3. By univariate analysis, PV was significantly and positively associated with peak luteinizing hormone (LH), LH/follicle-stimulating hormone (FSH), age, bone age, and Body Mass Index (BMI) (all P < 0.05). However, bone age and peak LH were the only significant predictors of PV by the stepwise multivariate regression analysis (Model: PV = 9.431 * bone age + 1.230 * peak LH + 92.625 [P = 0.000, R2 = 0.159)). Conclusions: The PV in the ICPP group was significantly higher than that in the PT and control groups, but there was no reliable cutoff value to distinguish ICPP from PT. Pituitary MRI should be combined with clinical and laboratory tests to maximize the diagnostic value of PV for PP.
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