19 9group. The sensitivity and specificity of various diagnostic cutoffs for basal and
stimulated LH and estradiol are summarized in the table given below.Parameters Cutoffs Sensitivity (%) Specificity (%)
Basal
LH ≥0.3 IU/L 35 100
E 2 ≥10 pg/ml 39 100
Leuprolide (20 μg/Kg)
LH at 60/120 min ≥5 IU/L 78 100
E 2 at 24h ≥50 pg/ml 84 100
Triptorelin (0.1 mg/m2)
LH at 3h ≥8 IU/L 76 100
E 2 at 24h ≥80 pg/ml 79 100- What are the ultrasonographic parameters used to determine the onset of
puberty in a girl child?
Ultrasonography is a noninvasive, inexpensive, and widely available diagnostic
modality with a good sensitivity and specificity for the evaluation of precocious
puberty in girls. Assessment of uterine length, uterine body/cervix ratio, uterine
echogenicity, and ovarian volume are the sonographic parameters to determine
the onset of puberty. The various age-based cutoffs are mentioned in the table
given below.
Parameters Neonate Prepubertal Pubertal
Uterine length (cm) 3.5a <3.5 5–8
Uterine body/cervix ratio 1:2 1:1 2–3:1
Endometrial echo Echogenic Not apparent Echogenic
Uterine shape – Tubular shaped Pear shaped
Ovarian volume (cm^3 ) 1 ≤1.6 ≥2.8
aUterine length is greater in neonates as compared to prepubertal girls because of transplacental
transfer of maternal estrogen
- What is the role of ultrasonography in the evaluation of precocious puberty in girls?
Uterine length >3.5 cm, uterine volume >2 ml, presence of endometrial echo,
and ovarian volume ≥2.8 ml on pelvic ultrasonography in a girl less than
8 years of age suggest the diagnosis of precocious puberty. These imaging char-
acteristics are the evidence of estrogen exposure and denote onset of puberty,
but do not differentiate between GDPP from GIPP. Increased ovarian volume is
the best index for the diagnosis of precocious puberty, whereas increased uter-
ine length (>3.5 cm) is the best discriminator between isolated premature the-
larche and premature thelarche associated with precocious puberty. In addition,
ovarian follicular cyst size <9 mm may be present in normal prepubertal girls6 Precocious Puberty