Pelvic ultrasound findings in prepubertal girls with precocious adrenarche born appropriate for gestational age.
BACKGROUND
Precocious adrenarche (PA) refers to the clinical onset of excess androgen in girls before the age of 8. It is associated with an increased risk of functional ovarian hyperandrogenism after puberty. PA may be associated with polycystic ovary syndrome (PCOS). We compared pelvic ultrasound (US) findings of girls with PA born appropriate for gestational age (AGA) to healthy body mass index (BMI)-matched peers to determine whether US findings in AGA-born PA girls are associated with PCOS antecedents.


METHODS
We conducted a cross-sectional study on 56 AGA-born girls with PA (6·9 ± 0·6 years) and 33 BMI-matched prepubertal AGA-born peers (7·1 ± 1·0 years). Hormonal data, homeostasis model assessment of insulin resistance (HOMA-IR), insulin sensitivity index (ISIcomp ) and pelvic US findings were compared. Associations of pelvic US findings with clinical and metabolic data were investigated.


RESULTS
Precocious adrenarche girls had greater height and bone age-adjusted uterine length (UL; P = 0·01) and UL standard deviation score (SDS) (P = 0·02) than BMI-matched peers. Mean ovarian volume (MOV), MOV SDS, uterine volume, uterine cross-sectional area and ovarian morphology were similar between the groups (P > 0·05). MOV and MOV SDS correlated with ISIcomp (r = -0·683, P < 0·001; r = -0·760, P < 0·001; respectively). Correlations of pelvic US findings with other biochemical data did not reach significance (P > 0·05). Multivariate regression analysis revealed that in girls with PA, ISIcomp had the most significant effect on MOV SDS (R(2) = 0·731, β = -4·784, P = 0·001).


CONCLUSIONS
Appropriate for gestational age-born PA girls have greater UL measurements than AGA-born BMI-matched peers. In AGA-born girls with PA, decreasing insulin sensitivity is strongly and independently associated with an increase in MOV. Longitudinal follow-up of our cohort after menarche will allow us to establish how many AGA-born girls with PA will ultimately develop PCOS.
Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Ahmet
A
Uçar
Oğuz Bulent
OB
Erol
Ensar
E
Yekeler
Ismail
I
Yildiz
Serdar
S
Bozlak
Nurçin
N
Saka
Firdevs
F
Baş
Şükran
Ş
Poyrazoğlu
Rüveyde
R
Bundak
Ayse
A
Kubat Uzum
Nurdan
N
Gul
Feyza
F
Darendeliler
D050499:Adrenarche; D000886:Anthropometry; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D008137:Longitudinal Studies; D010388:Pelvis / Q000000981:diagnostic imaging*; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000175:diagnosis*; D012741:Sexual Maturation; D014463:Ultrasonography
D007328:Insulin