Study On The Value Of Ultrasound Diagnosis Of Girls With Precocious Puberty

Part one Diagnostic value of ultrasound for central precocious pubertyObjective To explore the value of ultrasound in the diagnosis of central precocious p uberty(CPP).Methods Among children in the endocrine Department of Shanghai Children,s Hospital between June 2015 and December 2017 for breast development,40 children with central precocity precocity were selected as CPP group,40 children with incomplete precocity were selected as IPP group and 40 healthy girls as control group.For these three groups,pelvic ultrasound,breast ultrasound,and bone age films were taken.The LH and FSH hormones were measured in the first two groups,and the LH and FSH peaks were measured in the Gn RH test.Paired t-test was used to compare the ultrasound multi-parameter measurement data and clinical data of central precocious puberty,incomplete precocious puberty and normal girls.Analysis of three groups of ultrasound parameters,clinical data differences and characteristics.The Gn RH test is used to diagnose central precocious puberty and incomplete precocious puberty as the gold standard.Kappa consistency test was used to analyze the consistency of ultrasound diagnosis of central precocious puberty and incomplete precocious puberty with gold standards.Results The CPP group and the IPP group and the control group were examined by ultrasound.The uterus and ovary volume of the CPP group were significantly higher than those of the IPP group and the control group.The difference was statistically significant(t=3.21,P=0.00;t=7.50,P=0.00;t=6.02,P = 0.00;t = 10.64,P = 0.00).There were significant differences in uterus and ovary between IPP group and control group(t=5.05,P=0.00;t=7.20,P=0.00).There was a statistically significant difference in breast development between the CPP group and the IPP group(t=4.18,P=0.00).Ultrasound diagnosis of central precocity and incomplete precocity wasbetter consistent with the results of the Gn RH test(Kappa=0.63,P=0.00).In clinical data,there were no significant differences in the actual age of CPP group,IPP group and control group,but the bone age of CPP group was significantly higher than that of IPP group and control group(t=7.47,P=0.00;t=11.38,P=0.00).There was no significant difference in bone age between the IPP group and the control group(t=0.40,P=0.63).The levels of LH and FSH in CPP group were significantly higher than those in IPP group,and the difference was statistically significant(t=5.93,P=0.00;t=2.53,P=0.02).The peak values of LH,FSH and LH / FSH in CPP group were significantly higher than those in IPP group(t=9.46,P=0.00;t=2.95,P=0.01;t=10.70,P=0.00).Conclusions Ultrasound can accurately measure the volume of uterus and ovaries in real time,and dynamically observe the development of the breast.Ultrasound sonogram can directly reflect the development of the second gonad,and make a preliminary diagnosis of children with precocious puberty.The close follow-up of the children diagnosed with incomplete precocious precocity,they don't need Gn RH test temporarily.To some extent,they avoid the pain of repeated blood extraction,and save cost.Part two The Value of Ultrasound in the Diagnosis of Peripheral PrecocityObjective To investigate the value of ultrasound in the diagnosis of peripheral precocious puberty.Methods Selection of 35 cases of peripheral precocity diagnosed with breast enlargement,vaginal hemorrhage and body hair increase in the endocrine Department of Shanghai Children,s Hospital from 2015-2017 as PPP group.Selection Selection of 40 healthy girls in the same period as Control group.All children underwent ultrasound examination of thyroid,kidney and adrenal gland,uterus and ovary,breast area,and blood test LH,FSH basic values,E2,T3,T4,TSH,17-OHP,Gn RH test to detect LH,FSH peak,bone age film was taken.Using nonparameter Wilcoxon test to compare the volume of uterus and ovary of PPP group with control group.and the ultrasonographic features of peripheral precocious puberty caused by different causes were analyzed.Results Among the 35 cases of peripheral precocious puberty,there were 3 cases of primary hypothyroidism,16 cases of solitary ovarian cysts,8 cases of contraceptives,and 8 cases of congenital adrenal hyperplasia.Except for congenital adrenal hyperplasia in 35 cases of peripheral precocious puberty,there was a statistically significant difference among 27 children whose uterus was larger than that of normal girls.Children with isolated ovarian cysts,the volume of the affected ovary was higher than that of normal girls.the difference was statistically significant(Z=3.516,P=0.000).There was no significant difference in the volume of the ovary in the healthy side compared with the normal ovary volume(Z=0.982,P = 0.326).In children with misuse of contraceptives,the ovary volume was no significantly different than the ovary volume of normal girls(Z=0.140,P=0.889;Z=1.400,P=0.161).The uterus volume of 8 children with congenital adrenal hyperplasia was not significantly different from that of girls of the same age(Z=0.980,P=0.327).The volume of bilateral ovaries was smaller than that of normal girls of the same age.The difference was statistically significant(Z=-2.521,P = 0.012;Z =-2.240,P = 0.025).Two of the 3 children with primary hypothyroidism showed ultrasonographic of small thyroid morphology and 1 thyroid ectopic.In children with isolated ovarian cysts,a cystic mass with a diameter of not less than 20 mm can be seen in one ovary.Only 3 cases of congenital adrenal cortical hyperplasia showed that the adrenal gland was larger than the same age and the cortical echo was enhanced,the other 5 cases of adrenal ultrasound images showed no obvious characteristic changes.Conclusion Ultrasonic images have certain characteristics in children with peripheral precocious precocity caused by different causes,which can provide valuable information for clinical treatment and provide important evidence for further diagnosis and treatment.Part three The value of ultrasound in assessing Leuprorelin treatment response of girls with central precocious pubertyObjective To investigate the value of ultrasound in assessing Leuprorelin treatment response of girls with central precocious puberty.Methods Forty girls with central precocious puberty scheduled for Leuprorelin treatment were enrolled in this study.Ultrasound examination as well as the serum hormone level test of Luteinizing Hormone(LH)and Follicle Stimulating Hormone(FSH)were performed prior to the treatment,after 3 and 9 months of treatment.Wilcoxon test was used to compare the changes of uterus and ovarian volume before and after treatment,and Spearman correlation analysis was used to analyze the correlation between the change rate of uterus and ovary volume and the change rate of hormone LH and FSH.Results After 3 months and 9 months of Leuprorelin treatment,both the volumes of uterus and ovary and the levels of LH and FSH were significant reduced(all P<0.05).After 3 months of Leuprorelin treatment,the reduction rate in ovarian volume was positively correlated with the reduction rate of LH and FSH(r=0.335,P=0.034;r=0.334,P=0.035).No correlation was found between the reduction rate of uterine volume and hormone level changes(r=0.110,P=0.501;r=0.257,P=0.109).After 9 months of treatment,the ovarian volume reduction rate was positively correlated with the reduction rate of LH and FSH(r=0.327,P=0.039;r=0.356,P=0.024),and the uterine volume reduction rate was positively correlated with the reduction rate of LH and FSH(r=0.439,P=0.005;r=0.433,P=0.005).Conclusion Leuprorelin could effectively inhibit hormone release and gonadal development in girls with central precocious puberty.Ultrasound examination,as a noninvasive and convenient method,could dynamically monitor the volume changes of uterus and ovary,thus reflect the development of gonadal development directly and the changes of hormone level indirectly.It could be used as a routine outpatient follow-up method after central precocious medicine treatment.Part four Preliminary Application of Three-dimensional Ultrasound in the Diagnosis of Sexual PrecocityObjective To explore the value of three-dimensional ultrasound in the diagnosis of precocious puberty in girls.Methods A total of 32 children with precocious puberty were randomly selected from Xinhua Hospital from January 2018 to August 2018.Two-dimensional and three-dimensional pelvic ultrasound examinations were performed.The uterus and ovarian volume and numbers of follicles,maximum follicle diameter,ovarian blood flow parameters were recorded under these two examination methods.At the same time,the serum levels of Luteinizing Hormone(LH),Follicle Stimulating Hormone(FSH)and estradiol(E2)were determined.Spearman correlation analysis was used to analyze the correlation between the measured parameters(uterine,ovarian volume,number of follicles,maximum diameter of follicles,blood flow parameters)and hormones.Wilcoxon test was used to compare the measurement parameters by twodimensional and three-dimensional ultrasound measured.Analyze the value of 3D and 2D ultrasound in the diagnosis of girls with precocious puberty.Results Three-dimensional ultrasound can clearly show the internal structure of the uterus and ovaries.The number of follicles with diameter more than 4 mm in three-dimensional ultrasound(7.66±2.56)was more than that of two-dimensional ultrasound(6.13±1.83),and the difference was statistically significant(Z=4.112,P=0.000);There was a positive correlation between the number of follicles with three-dimensional count diameter more than 4 mm and the hormones LH and FSH(r=0.404,P=0.024;r=0.362,P=0.046),There was no correlation between the number of follicles with a two-dimensional count diameter more than 4 mm and the hormones LH and FSH.The maximum follicle diameter(7.19±2.18mm)measured in three-dimensional was greater than two-dimensional(6.95±2.04mm),and the difference was statistically significant(Z=3.290,P=0.001).The correlation between the maximum follicular diameter and the levels of hormone LH and FSH measured in three dimensions(r=0.721,P=0.001;r=0.638,P=0.000)was strong and two-dimensional(r=0.687,P=0.000;r=0.578,P =0.001).The threedimensional blood flow showed significantly better than two-dimensional,the three-dimensional ovarian blood flow showed a rate of 87.5%(28/32),and the two-dimensional ovarian blood flow showed a rate of 28.13%(9/32).Three-dimensional power Doppler vascular index(VI),blood flow index(FI),vascular-blood flow index(VFI)were positively correlated with maximum follicle diameter(r=0.433,P=0.024;r=0.436,P=0.020;r =0.535,P=0.003),and there was no correlation with the number of follicles,which diameter more than 4 mm(r=0.022,P=0.915;r=0.102,P=0.606;r=0.064,P=0.745).There was no significant difference in the volume of uterus and ovaries between two-dimensional and three-dimensional(Z=0.262,P=0.793;Z=0.636,P=0.525).Two-dimensional and three-dimensional measurements of ovarian volume were positively correlated with basal levels of hormone LH and FSH(r=0.441,P=0.011;r=0.399,P=0.024;r=0.388,P=0.028;r=0.381,P=0.031).Conclusion Three-dimensional ultrasonography is better than two-dimensional ultrasound in counting the number of follicles,showing that ovarian blood flow.Three-dimensional ultrasound provides a new and objective measurement method for the diagnosis of precocious puberty.