| ObjectiveBy observing the imaging characteristics of pituitary development and bone development in ICPP(Idiopathalamic Central Precocious Puberty) and PT(Premature thelarche), comparing the results between the two types of precocity after GnRH stimulation tests, and analyzing the relationship between the imaging index and quantitation of gonadal hormone, to provide reference for differential diagnosis of ICPP and PT.Methods35 cases with ICPP and PT respectively were selected from Feb 2010 to Feb 2011 in Henan Women and Children hospital as research subjects. Age of ICPP was 7.1±1.1, and age of PT group was 6.9±1.1. 35 normal healthy girls from Child Care Outpatient Clinic for growth consulting whose age was 7.2±1.1 were also selected as a control. All the cases were performed MRI scanning of the head saddle area (hypothalamus-pituitary gland area), measured pituitary height, observed the pituitary morphology and divided into five grades according to Elster grading. All cases were detected Bone Age (BA), and calculated the Bone Age Index(BAI). The uterine and ovaian of all cases were also observed by using Color Dopper Imaging. Meanwhile, the fasting serum FSH, LH, and E2 were detected by using the ICMA. The peak value of LH, FSH after GnRH stimulation test were also measured and the ratio of LH/FSH were calculated. The control group only had head saddle area pituitary scanning and BA test. The differences of pituitary height, morphology and bone age index among the three groups were compared. The differences of the basis LH, LH/FSH and peak LH and LH/FSH after GnRH stimulation test between the ICPP group and PT group were also compared. Furthermore, the correlation between pituitary height and BAI, or the basis value of LH, E2, LH/FSH or the peak LH and LH/FSH after GnRH stimulation test was analyzed.Results1. Pituitary height The average value of pituitary height of ICPP group, PT group and the control group were 5.177±1.010mm,4.300±0.384mm, and 4.454±0.477mm, respectively. There was a statistically significant difference among the three groups (F=16.492, P<0.001). By comparing in pairs, the average value of pituitary height of ICPP was highter than that of PT group, it was also found that there was a statistically significant difference between ICPP group and PT group (q=5.378, P<0.001). Similarly, the average value of pituitary height of ICPP was highter than that of the control group, a statistically significant difference between ICPP group and the control group (q=4.432, P<0.001) was also obtained. However, there was no statistically significant difference between PT group and the control group (q=0.946, P=0.346>0.05).2. BAI The average values of BAI of ICPP group, PT group, the control group were 1.227±0.078,1.067±0.048, and 1.043±0.042, respectively. There was a statistically significant difference among the three groups (F=103.672, P<0.001). By comparing in pairs, the average value of BAI of ICPP group was larger than that of PT group. A statistically significant difference between the two groups (q=11.494, P<0.001) was obtained. Similary, the average value of BAI of ICPP group was highter than that of the control group. There was also a statistically significant difference between the two groups (q=13.237, P<0.001). However, there was no statistically significant difference between PT group and the control group (q=1.724, P=0.088>0.05).3. Hormone Level For ICPP group, the basis value of LH, LH/FSH and the peak value of LH, LH/FSE were 1.166±1.026IU/L,0.312±0.223,17.534±14.908IU/L, 1.436±0.828, respectively. In the case of PT group, the value of LH, LH/FSH and the peak value of LH, LH/FSE were 0.129±0.057IU/L,0.068±0.030,3.877±0.885IU/L, 0.274±0.082, respectively. All the results of ICPP group were highter than that of PT group (P<0.001).4. The correlation between the pituitary height and gonadal hormone level There was a significant linear relationship between the pituitary height and the basis value of LH, LH/FSH, E2, and peak value of LH and LH/FSH after GnRH stimulate (r= 0.701,0.577,0.698,0.422,0.383, and P<0.05) in ICPP group.5. The Elster's grade of pituitary morphology The Elster's grade of pituitary morphology which was equal or greater than IV grade of ICPP group, PT group, and the control group were accounted for 82.857%,25.714%, and 22.857%, respectively. The ratio of ICPP group was highter than that of PT group and the control group (χ2=23.026,χ2=25.283, respectively, and P<0.001).Conclusion1. The pituitary height of ICPP group is higher than that of PT group, and the morphology is mainly equal or greater than IV grade. However the morphology is mainly equal or smaller than III grade in PT group. The method of observing pituitary height and morphology by using MRI can be a differential diagnosis reference index.2. There is a positive correlation between the pituitary height and Gonadal axis function in ICPP group.3. The BAI of ICPP group is highter than that of PT group and the contrpl group. The value of BAI is an useful reference for ICPP diagnosis.4. There is a significant value in the GnRH stimulation test for differential diagnosis for ICPP and PT. |
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