1
|
Smets AM, Sofia C, Bruno C, Ključevšek D, Lobo ML, Napolitano M, Ozcan HN, Stafrace S, Petit P, Müller LSO. Abdominal imaging in precocious puberty in girls: can imaging determine onset of puberty? Pediatr Radiol 2024:10.1007/s00247-024-05992-8. [PMID: 39069591 DOI: 10.1007/s00247-024-05992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
Precocious puberty in girls is defined by the appearance of secondary sex characteristics before the age of 8 years. Precocious puberty is either peripheral or central. In most cases, the cause of central precocious puberty is unknown. Rapidly progressive forms of central precocious puberty may benefit from puberty suppression to prevent compromised final height and psychosocial problems related to the physical changes. Idiopathic central precocious puberty in girls can be a challenging diagnosis. Clinical examination, evaluation of growth charts, bone age, and hormonal tests are part of the workup. The role of pelvic ultrasound to evaluate pubertal features of the internal genitalia in this context is controversial. In this paper, we have reviewed the literature to find the scientific bases for several proposed ultrasound parameters and cutoff values for the determination of onset of puberty in girls with suspected central precocious puberty. There are no reliable cutoffs for the measurements of uterus and ovaries for the diagnosis of central precocious puberty and there is overlap in the appearance of the organs in both prepubertal and pubertal girls. The interpretation of the findings on pelvic ultrasound must be done with caution and always in close communication with the referring clinicians.
Collapse
Affiliation(s)
- Anne M Smets
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Costanza Bruno
- Radiology Department, AOUI Verona (Azienda Ospedaliera Universitaria Integrata), Verona, Italy
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Maria Luisa Lobo
- Unidade Local de Saúde de Santa Maria (ULSSM, Former CHULN), Av Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - H Nursun Ozcan
- Department of Radiology/Division of Pediatric Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Samuel Stafrace
- McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Petit
- Department of Pediatric Radiology, Hôpital Timone Enfants, Aix Marseille-Université, Marseille, France
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
2
|
Sun J, Wang W, Xiao Y, Cao NN, Wang YF, Zhang HR, Jiang SQ. Correlation between serum vitamin D level and uterine volume in girls with idiopathic central precocious puberty. J Pediatr Endocrinol Metab 2024; 37:144-149. [PMID: 38114464 DOI: 10.1515/jpem-2023-0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Investigate serum vitamin D (vit D) levels' relation to uterine volume in idiopathic central precocious puberty (ICPP) girls and compare findings with normal peers. METHODS Analyzed 278 ICPP cases from January 2017 to September 2022 alongside 239 normally developing girls. Collected clinical data and lab markers and performed subgroup analysis based on vit D levels. Correlation and regression analyses were conducted. RESULTS The ICPP group exhibited elevated uterine volume and lower serum vit D compared to controls (p<0.05). A weak negative correlation was noted between vit D and uterine volume in ICPP (r=-0.193, p=0.004), and no such correlation in controls (r=-0.073, p=0.319). The ICPP vit D deficiency subgroup displayed higher uterine volume than the insufficiency and sufficiency subgroups (p<0.05). Uterine volume in the insufficiency subgroup exceeded the sufficiency subgroup (p<0.05). After adjusting for confounders, lower vit D is linked to increased ICPP uterine volume (non-standardized regression coefficient β=-25.55, 95 % CI= -46.23, -4.87, p=0.016). A Limited correlation between vit D and uterine volume was seen in girls with normal pubertal timing. CONCLUSIONS We demonstrated a correlation between vit D and uterine volume in ICPP girls, absent in normal peers. ICPP girls often exhibit lower vit D levels and increased uterine volume. Further research is vital for understanding vit D's role in ICPP pathogenesis and guiding prevention and treatment strategies.
Collapse
Affiliation(s)
- Jun Sun
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Wei Wang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Ya Xiao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Niu-Niu Cao
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Yi-Fan Wang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Hong-Ru Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| | - Shu-Qin Jiang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P.R. China
| |
Collapse
|
3
|
Mondal S, Gargari P, Nagendra L, Mandal S, Kumar RC, Shah P, Haldar M, Chowdhury S, Mukhopadhyay S. Growth hormone therapy is associated with improved uterine dimensions in girls with Turner syndrome prior to oestrogen replacement. Clin Endocrinol (Oxf) 2024; 100:66-75. [PMID: 37555570 DOI: 10.1111/cen.14957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Adult women with Turner syndrome (TS) have high rates of miscarriage, presumably due to the abnormal size and shape of the uterus. There is a paucity of data regarding the determinants of uterine volume (UtVol) in young girls with TS before the initiation of oestrogen replacement therapy (ERT). METHODS We performed a cross-sectional study on premenarchal girls with TS, aged 5-15 years, pubertal stage B1-B3, not having received ERT (n = 73) and 50 age-matched healthy controls. Anthropometric parameters and a history of growth hormone (GH) therapy (≥1 year) were noted. Uterine length (UtL), UtVol, and mean-ovarian-volume (MOV) standard-deviation scores (SDS) were determined from transabdominal ultrasonography data. RESULTS Girls with TS had lower median UtVol-SDS (-1.07 vs. 0.86; p < .001), UtL-SDS (-3.72 vs. -0.41; p < .001) and MOV-SDS (-5.53 vs. 1.96; p < .001) compared to age-matched controls. Among TS girls, recipients of GH (n = 38) had higher UtVol-SDS (-0.63 vs. -1.39; p = .0001), UtL-SDS (-1.73 vs. -6.49; p < .0001) but similar MOV-SDS compared to nonrecipients (n = 35). Those with normal uterine volume for age (NUVA, n = 29) had earlier initiation (7.8 vs. 9.3 years; p = .03) and a longer duration of GH (3.71 vs. 2.14 years; p = .002) than those with low UtVol for age (n = 44). UtVol-SDS correlated with duration of GH (ρ = 0.411, p = .01) and negatively with age at GH initiation (ρ = -0.479, p = .003). In a model adjusted for pubertal status, karyotype and height-SDS, GH use could independently predict having NUVA (odds ratio: 5.09, confidence interval: 1.63-15.94, p = .005). CONCLUSION GH therapy has a stimulatory effect on uterine dimensions in pre-and peripubertal girls with TS. Earlier initiation and longer duration of GH is important in TS girls before ERT.
Collapse
Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Piyas Gargari
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Santanu Mandal
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Rathin C Kumar
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Pooja Shah
- Department of Radiology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | | | - Subhankar Chowdhury
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Satinath Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
| |
Collapse
|
4
|
Federici S, Goggi G, Quinton R, Giovanelli L, Persani L, Cangiano B, Bonomi M. New and Consolidated Therapeutic Options for Pubertal Induction in Hypogonadism: In-depth Review of the Literature. Endocr Rev 2022; 43:824-851. [PMID: 34864951 DOI: 10.1210/endrev/bnab043] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Indexed: 01/15/2023]
Abstract
Delayed puberty (DP) defines a retardation of onset/progression of sexual maturation beyond the expected age from either a lack/delay of the hypothalamo-pituitary-gonadal axis activation or a gonadal failure. DP usually gives rise to concern and uncertainty in patients and their families, potentially affecting their immediate psychosocial well-being and also creating longer term psychosexual sequelae. The most frequent form of DP in younger teenagers is self-limiting and may not need any intervention. Conversely, DP from hypogonadism requires prompt and specific treatment that we summarize in this review. Hormone therapy primarily targets genital maturation, development of secondary sexual characteristics, and the achievement of target height in line with genetic potential, but other key standards of care include body composition and bone mass. Finally, pubertal induction should promote psychosexual development and mitigate both short- and long-term impairments comprising low self-esteem, social withdrawal, depression, and psychosexual difficulties. Different therapeutic options for pubertal induction have been described for both males and females, but we lack the necessary larger randomized trials to define the best approaches for both sexes. We provide an in-depth and updated literature review regarding therapeutic options for inducing puberty in males and females, particularly focusing on recent therapeutic refinements that better encompass the heterogeneity of this population, and underlining key differences in therapeutic timing and goals. We also highlight persistent shortcomings in clinical practice, wherein strategies directed at "the child with delayed puberty of uncertain etiology" risk being misapplied to older adolescents likely to have permanent hypogonadism.
Collapse
Affiliation(s)
- Silvia Federici
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Giovanni Goggi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Richard Quinton
- Department of Endocrinology, Diabetes & Metabolism, Newcastle-upon-Tyne Hospitals, Newcastle-upon-Tyne NE1 4LP, UK.,Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne NE1 4EP, UK
| | - Luca Giovanelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Biagio Cangiano
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| | - Marco Bonomi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20100 Milan, Italy.,Department of Endocrine and Metabolic Medicine, IRCCS Istituto Auxologico Italiano, 20100 Milan, Italy
| |
Collapse
|
5
|
Cheng B. Menarche in primary ovarian insufficiency after a month of hormone replacement therapy: a case report. J Med Case Rep 2021; 15:92. [PMID: 33618767 PMCID: PMC7901185 DOI: 10.1186/s13256-020-02603-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background Gynecologic anomalies, including uterine agenesis and ovarian dysgenesis, are some of the several differential diagnoses in adolescent females with primary amenorrhea and delayed puberty. Primary ovarian insufficiency is reported in the clinical practice of reproductive endocrinology can be determined by conducting sex hormone tests to evaluate the hypothalamic-pituitary-ovarian axis. However, confirmation of Mullerian agenesis by image modalities can be extremely challenging. Once the diagnosis is established, breakthrough bleeding usually occurs 2 to 3 years after hormonal replacement therapy. Case presentation We report a case of a seventeen year old Taiwanese female, 46 XX karyotype, with ovarian dysgenesis and an initial tentative diagnosis of uterine agenesis who experienced a breakthrough bleeding after a month of hormonal replacement therapy. Conclusions The breakthrough bleeding after a month of estrogen therapy in primary ovarian insufficiency is uncommon, and the diagnosis of the absent uterus can have an extensive psychological impact on patients and their families.
Collapse
Affiliation(s)
- Biwen Cheng
- Endocrinology Division, Department of Pediatrics, Hsinchu Mackay Memorial Hospital, No. 690, Section 2, Guangfu Rd., East District, Hsinchu, 300, Taiwan.
| |
Collapse
|
6
|
Villalobos Gálvez M, Beltrán Salazar VP, Pérez Adell M, Durán Feliubadalo C, Corripio R. Updated reference values in pelvic ultrasonography for a Spanish population of healthy girls between 6 and 12 years old. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00233. [PMID: 34277960 PMCID: PMC8279629 DOI: 10.1002/edm2.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 11/06/2022]
Abstract
Background Pelvic ultrasonography (PUS) of the uterus and ovaries allows the diagnosis of changes in sexual development. However, the reference values used in Spain originate from old studies conducted in other countries. Objective To determine reference uterine and ovarian measurements by PUS and according to pubertal status and bone age in a Spanish population of healthy girls aged between 6 and 12 years. Materials and methods Descriptive cross-sectional study performed on 221 healthy girls from 2017 to 2019. Ovarian and uterine measurements were described and associated with chronological age, bone age, and Tanner stage. ROC curves were used to assess the predictive value of tests for Tanner stage II. Results We described reference values for all PUS uterine and ovarian measurements assessed. Subjects in Tanner II (thelarche) had a mean age of 9.7 years (SD = 1.1) and mean BMI of 19.2 kg/m2. Fundal-cervical ratio changed from 1:1 to 2:1 at 12 years of chronological age (62.5% with 1:1 ratio; p < 0.0001) and 13 years of bone age (2:1 in 85.71%, p < 0.0001). Mean uterine length for Tanner II was 4.065 cm (SD = 0.736); mean ovarian volume was 2.466 cm3 (SD = 1.719). Bone age, ovarian volume, and uterine length were good predictors of Tanner stage II. Conclusion This is the first study providing reference uterine and ovarian PUS values in a Spanish population of healthy girls aged 6 to 12 years. Use of updated data characteristic of a specific population increases the diagnostic accuracy.
Collapse
Affiliation(s)
| | | | - Mireia Pérez Adell
- Pediatric Endocrine Department Parc Tauli Sabadell Hospital Universitari Sabadell Spain
| | | | - Raquel Corripio
- Pediatric Endocrine Department Parc Tauli Sabadell Hospital Universitari Sabadell Spain
| |
Collapse
|
7
|
Obara-Moszynska M, Dzialach L, Rabska-Pietrzak B, Niedziela M, Kapczuk K. Uterine Development During Induced Puberty in Girls with Turner Syndrome. Front Endocrinol (Lausanne) 2021; 12:707031. [PMID: 34295308 PMCID: PMC8290974 DOI: 10.3389/fendo.2021.707031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Most girls and women with Turner syndrome (TS) require estrogen replacement therapy (ERT) to initiate or maintain pubertal development. Most likely, the most fundamental effect of ERT in hypogonadism is the promotion of uterine growth. The optimal ERT model is still being discussed. The present study aimed to assess uterine size in girls with TS in the prepubertal state during and after the induction of puberty and compare it to a healthy population. METHODS The analysis encompassed 40 TS girls. The prepubertal and postpubertal control groups contained 20 healthy girls each. All patients with TS were treated with 17-ß estradiol. Uterine imaging was performed with two-dimensional (2D) transabdominal ultrasound. The uterine volume (UV) and fundocervical antero-posterior ratio (FCR) were calculated in patients with TS before the pubertal induction, after 6-12 months of estrogen replacement therapy (ERT), after ≥ 36 months of ERT or ≥ 12 months after menarche. RESULTS The average age of TS patients at estrogen introduction and at the last control visit, when the uterus was considered mature, was 12.9 years and 16.1 years, respectively. The UV in patients with TS at the beginning of ERT was 1.55 ± 1.22 cm3 and was not significantly different from the UV in the prepubertal controls. The mature UV in patients with TS was 31.04 ± 11.78 cm3 and was significantly smaller than the UV of the postpubertal controls (45.68 ± 12.51 cm3, p<0.001). The FCR in girls with TS did not differ significantly from that in the prepubertal and postpubertal control groups, respectively. No prognostic factors could be established for the final UV. By the last control visit, thelarche had advanced in most patients to Tanner 4 and 5 (37.5% and 40%, respectively). CONCLUSIONS Before the onset of ERT, patients with TS have a uterus similar in size to that in prepubertal healthy girls. Pubertal induction in patients with TS causes a significant increase in the UV that is detectable after 6-12 months of ERT. The mature uterus is smaller in patients with TS than in the age-matched healthy population.
Collapse
Affiliation(s)
- Monika Obara-Moszynska
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
- *Correspondence: Monika Obara-Moszynska,
| | - Lukasz Dzialach
- Student Scientific Society of Paediatric Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara Rabska-Pietrzak
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Niedziela
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
| | - Karina Kapczuk
- Department of Paediatric Endocrinology and Rheumatology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland
- Department of Gynaecology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
8
|
Alaaraj N, Soliman AT, De Sanctis V, Hamed N, Alyafai F, Ahmed S, Khalil A, Bedair E, Elawwa A. Growth, bone maturation and ovarian size in girls with early and fast puberty (EFP) and effects of three years treatment with GnRH analogue (GnRHa). ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021333. [PMID: 35075088 PMCID: PMC8823566 DOI: 10.23750/abm.v92i6.10809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Early puberty (EP) in girls is defined as the onset of thelarche that begins after 6 years and before 8 years and/or acceleration in the tempo of pubertal development. The stage of puberty and the ovarian volume at presentation and the effect of treatment with GnRH analogue (GnRHa) on final adult height are still debated. PATIENTS AND METHODS We analyzed the data of 22 girls, who presented early and fast puberty (FEP). The clinical stage of puberty, hormonal levels and the ovarian volume (OV) (measured by ovarian ultra-sonography) at presentation were studied. We recorded the effects of 3 years treatment with GnRHa on their growth in relation to their mid parental height, pubertal progression, and bone maturation. RESULTS AND CONCLUSION GnRHa therapy decreased the fast progress of puberty, skeletal maturation, and GV/year. It was successful in increasing the predicted final adult height comparable to or surpassing their mid-parenteral height. A larger OV at presentation was associated with reduced Ht-SDS after 3 years of GnRHa treatment. Clearly, a definitive evaluation of the efficacy of GnRHa as treatment for EFP in girls will require expanded and concerted studies.
Collapse
Affiliation(s)
- Nada Alaaraj
- Pediatric Endocrinology Department, Hamad General Hospital, Doha, Qatar
| | - Ashraf T Soliman
- Pediatric Endocrinology Department, Hamad General Hospital, Doha, Qatar
| | - Vinenzo De Sanctis
- Coordinator of the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A), Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Noor Hamed
- Pediatric Endocrinology Department, Hamad General Hospital, Doha, Qatar
| | - Fawziya Alyafai
- Pediatric Endocrinology Department, Hamad General Hospital, Doha, Qatar
| | - Shayma Ahmed
- Pediatric Endocrinology Department, Hamad General Hospital, Doha, Qatar
| | - Ahmed Khalil
- Pharmacy Department, Hamad General Hospital, Doha, Qatar
| | - Elsaid Bedair
- Radiology Department, Hamad General Hospital, Doha, Qatar
| | - Ahmed Elawwa
- Department of Pediatrics, Sidra Medicine, Doha, Qatar and University of Alexandria, Alexandria, Egypt
| |
Collapse
|
9
|
Nguyen NN, Huynh LBP, Do MD, Yang TY, Tsai MC, Chen YC. Diagnostic Accuracy of Female Pelvic Ultrasonography in Differentiating Precocious Puberty From Premature Thelarche: A Systematic Review and Meta-analysis. Front Endocrinol (Lausanne) 2021; 12:735875. [PMID: 34539579 PMCID: PMC8442957 DOI: 10.3389/fendo.2021.735875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The gonadotropin-releasing hormone (GnRH) stimulation test is the benchmark for diagnosing precocious puberty (PP). However, it is invasive, time-consuming, costly, and may create an unpleasant experience for participants. Moreover, some overlaps may occur between PP and premature thelarche (PT) in the early stage of PP. Female pelvic ultrasonography may provide additional information to help differentiate PP from PT and subsequently initiate early treatment. In this study, we aimed to first directly compare pelvic ultrasonography parameters between PP and PT groups and secondly, investigate their diagnostic accuracy compared with the GnRH stimulation test. METHODS A systematic search of the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane Library databases was performed up to March 31, 2021. All types of studies, except for case reports and review articles, were included. The GnRH stimulation test was used to confirm PP diagnosis. Those whose organic conditions might cause PP were excluded. The mean, standard deviation, sensitivity, and specificity of each parameter were documented. Forest plots were constructed to display the estimated standardized mean differences (SMDs) from each included study and the overall calculations. A bivariate model was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). RESULTS A total of 13 studies were included for analysis. The SMDs (95% confidence interval - CI) in ovarian volume, fundal-cervical ratio, uterine length, uterine cross-sectional area, and uterine volume between PP and PT groups were 1.12 (0.78-1.45; p < 0.01), 0.90 (0.07-1.73; p = 0.03), 1.38 (0.99-1.78; p < 0.01), 1.06 (0.61-1.50; p < 0.01), and 1.21 (0.84-1.58; p <0.01), respectively. A uterine length of 3.20 cm yielded a pooled sensitivity of 81.8% (95% CI 78.3%-84.9%), specificity of 82.0% (95% CI 61.0%-93.0%), PLR of 4.56 (95% CI 2.15-9.69), NLR of 0.26 (95% CI 0.17-0.39), and DOR of 19.62 (95% CI 6.45-59.68). The area under the summary receiver operating characteristics curve was 0.82. CONCLUSION Female pelvic ultrasonography may serve as a complementary tool to the GnRH stimulation test in differentiating PP from PT. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232427, ID: CRD42021232427.
Collapse
Affiliation(s)
- Nam Nhat Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Linh Ba Phuong Huynh
- Ph.D. Program in School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Minh Duc Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tien Yun Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Meng-Che Tsai
- Division of Genetics, Endocrinology, and Metabolism, Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Meng-Che Tsai, ; Yang-Ching Chen,
| | - Yang-Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Meng-Che Tsai, ; Yang-Ching Chen,
| |
Collapse
|
10
|
Habiba M, Heyn R, Bianchi P, Brosens I, Benagiano G. The development of the human uterus: morphogenesis to menarche. Hum Reprod Update 2020; 27:1-26. [PMID: 33395479 DOI: 10.1093/humupd/dmaa036] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/23/2020] [Indexed: 12/14/2022] Open
Abstract
There is emerging evidence that early uterine development in humans is an important determinant of conditions such as ontogenetic progesterone resistance, menstrual preconditioning, defective deep placentation and pre-eclampsia in young adolescents. A key observation is the relative infrequency of neonatal uterine bleeding and hormone withdrawal at birth. The origin of the uterus from the fusion of the two paramesonephric, or Müllerian, ducts was described almost 200 years ago. The uterus forms around the 10th week of foetal life. The uterine corpus and the cervix react differently to the circulating steroid hormones during pregnancy. Adult uterine proportions are not attained until after puberty. It is unclear if the endometrial microbiome and immune response-which are areas of growing interest in the adult-play a role in the early stages of uterine development. The aim is to review the phases of uterine development up until the onset of puberty in order to trace the origin of abnormal development and to assess current knowledge for features that may be linked to conditions encountered later in life. The narrative review incorporates literature searches of Medline, PubMed and Scopus using the broad terms individually and then in combination: uterus, development, anatomy, microscopy, embryology, foetus, (pre)-puberty, menarche, microbiome and immune cells. Identified articles were assessed manually for relevance, any linked articles and historical textbooks. We included some animal studies of molecular mechanisms. There are competing theories about the contributions of the Müllerian and Wolffian ducts to the developing uterus. Endometrium features are suggestive of an oestrogen effect at 16-20 weeks gestation. The discrepancy in the reported expression of oestrogen receptor is likely to be related to the higher sensitivity of more recent techniques. Primitive endometrial glands appear around 20 weeks. Features of progestogen action are expressed late in the third trimester. Interestingly, progesterone receptor expression is higher at mid-gestation than at birth when features of endometrial maturation are rare. Neonatal uterine bleeding occurs in around 5% of neonates. Myometrial differentiation progresses from the mesenchyme surrounding the endometrium at the level of the cervix. During infancy, the uterus and endometrium remain inactive. The beginning of uterine growth precedes the onset of puberty and continues for several years after menarche. Uterine anomalies may result from fusion defects or atresia of one or both Müllerian ducts. Organogenetic differentiation of Müllerian epithelium to form the endometrial and endocervical epithelium may be independent of circulating steroids. A number of genes have been identified that are involved in endometrial and myometrial differentiation although gene mutations have not been demonstrated to be common in cases of uterine malformation. The role, if any, of the microbiome in relation to uterine development remains speculative. Modern molecular techniques applied to rodent models have enhanced our understanding of uterine molecular mechanisms and their interactions. However, little is known about functional correlates or features with relevance to adult onset of uterine disease in humans. Prepubertal growth and development lends itself to non-invasive diagnostics such as ultrasound and MRI. Increased awareness of the occurrence of neonatal uterine bleeding and of the potential impact on adult onset disease may stimulate renewed research in this area.
Collapse
Affiliation(s)
- Marwan Habiba
- Department of Health Sciences, University of Leicester and University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - Rosemarie Heyn
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Bianchi
- Department of Medico-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Ivo Brosens
- Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Giuseppe Benagiano
- Department of Maternal and Child Health, Gynaecology and Urology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
11
|
Burt E, Davies MC, Yasmin E, Cameron-Pimblett A, Mavrelos D, Talaulikar V, Conway GS. Reduced uterine volume after induction of puberty in women with hypogonadism. Clin Endocrinol (Oxf) 2019; 91:798-804. [PMID: 31487390 DOI: 10.1111/cen.14092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Adequate uterine growth is an essential component of pubertal induction with exogenous oestradiol in those with hypogonadism. Poor uterine development will render the individual vulnerable in the context of fertility. We assessed uterine size using ultrasound in those who had undergone pubertal induction treatment compared with a reference group who had experienced spontaneous puberty. DESIGN This is a single-centre, retrospective, cross-sectional study of women who underwent pubertal induction compared with a reference group. PATIENTS Ninety-five women with hypogonadism who had previously undergone pubertal induction and were receiving maintenance oestrogen replacement as adults were recruited: 48 women with Turner syndrome, 32 with premature ovarian insufficiency and 15 with gonadotrophin deficiency. The reference group consisted of 35 nulliparous women attending with male factor subfertility with a normal pelvis on ultrasonography. MEASUREMENTS Pelvic ultrasound was performed by a single observer. Uterine dimensions (total length, anterior-posterior (AP), transverse, uterine volume and fundal cervical AP ratio (FCR) measurements) were recorded. Clinical details were also recorded. RESULTS Those with hypogonadism had significantly reduced uterine dimensions compared with the reference group (uterine length 64 mm vs 71 mm P = <.05, uterine volume 28.9 mL vs 43.9 mL P = <.05). All women in the reference group attained a mature uterine configuration with a FCR >1, compared with 84% of those with hypogonadism (P = .01). A total of 24% and 48% of the diagnostic group had total uterine length and uterine volume measurements less than the 5th percentile of the reference group, respectively. In a subgroup of 22 women in whom serum oestradiol concentrations could be analysed, there was a positive correlation between this parameter and uterine volume. CONCLUSION Despite standard oestrogen therapy, uterine growth is often compromised in those with hypogonadism. Uterine health has historically been overlooked in pubertal induction protocols; however, with increasing options for fertility treatment, adequate uterine development is crucial. Given the variation in uterine size witnessed, a more tailored approach to treatment with regular monitoring of uterine dimensions should be advocated.
Collapse
Affiliation(s)
- Elizabeth Burt
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Melanie C Davies
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | | | - Dimitri Mavrelos
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Vikram Talaulikar
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Gerard S Conway
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| |
Collapse
|
12
|
Geimanaite L, Trainavicius K. Pediatric ovarian torsion: Follow- up after preservation of ovarian tissue. J Pediatr Surg 2019; 54:1453-1456. [PMID: 30851955 DOI: 10.1016/j.jpedsurg.2019.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 02/14/2019] [Accepted: 02/14/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficiency of the preservation of ovarian tissue in cases of ovarian torsion. MATERIALS AND METHODS A retrospective study was performed of patients treated at our hospital for ovarian torsion from January 2007 to December 2017. This research does not include patients with antenatal ovarian torsion and 1 girl with an immature teratoma, in whom the twisted ovary was removed during the initial operation. Follow-up ultrasonography of all patients was performed after 4-6 weeks and again after more than 12 weeks. Volume, blood flow and folliculogenesis of the ovary were measured and assessed. RESULTS All 42 ovaries (39 patients) preserved their normal anatomy and folliculogenesis after detorsion. All patients had an enlarged ovary at the time of detorsion. In all cases of ovarian torsion, enlargement of the ovary up to an average of 58.14 ± 52.86 (17.37-86.83) ml was detected. After 4-6 weeks, all untwisted ovaries decreased in volume by an average of 9.01 ± 13.69 (2.33-9.30) times, and 59.5% of them became normal in size. In 3 girls, enlarged ovaries were still observed after 12 weeks. Teratoma was diagnosed for these patients and ovarian sparing operations were performed. CONCLUSIONS It is safe to perform detorsion regardless of the level of ischemia or volume of the affected ovary. The follow-up is essential, especially for the further diagnostics of potential pathological structures or tumors; therefore, the normalization of blood flow and the volume of the ovary must be monitored. TYPE OF STUDY Prognosis retrospective study. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Lina Geimanaite
- Vilnius University, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius, Lithuania; Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Department of Pediatric Surgery, Vilnius, Lithuania.
| | - Kestutis Trainavicius
- Vilnius University, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius, Lithuania; Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos, Department of Pediatric Surgery, Vilnius, Lithuania
| |
Collapse
|
13
|
Berglund A, Burt E, Cameron-Pimblett A, Davies MC, Conway GS. A critical assessment of case reports describing absent uterus in subjects with oestrogen deficiency. Clin Endocrinol (Oxf) 2019; 90:822-826. [PMID: 30820975 DOI: 10.1111/cen.13963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The dual diagnosis of hypoplastic uterus in association with ovarian dysgenesis is regularly reported but the pathogenesis of the association is unclear. The uterus, however, may be invisible to all imaging modalities without at least six months of exogenous oestrogen exposure in complete ovarian failure. We assessed all available case reports in this category to estimate whether the apparent association between primary ovarian insufficiency or Turner syndrome and Mullerian agenesis can be largely accounted for by oestrogen deficiency. DESIGN A literature review of all cases in which an association between ovarian insufficiency or Turner syndrome and hypoplastic uterus has been reported. PATIENTS PubMed was searched for all case reports associated with relevant key terms. In total, 22 publications with a total of 25 patients were identified and reviewed; 14 subjects had the normal female karyotype (46,XX), and 11 subjects had Turner Syndrome. MEASUREMENTS Proportion of subjects who had been exposed to adequate oestrogen prior to the absent uterine diagnosis. RESULTS A diagnosis of absent uterus was made prior to exposure to exogenous oestrogen in 22/25 (88%) of subjects with primary hypogonadism including 14/14 females with normal karyotype and 8/11 females with Turner syndrome. CONCLUSIONS Oestrogen deficiency is a possible explanation for most subjects being reported as having Mullerian agenesis in association with Turner syndrome or primary ovarian insufficiency. In the presence of oestrogen deficiency, no conclusion can be made about the status of the uterus until adequate exposure to exogenous oestrogen has been completed and we suggest reassessment of the uterus when full adult dose has been reached towards the end of induction of puberty.
Collapse
Affiliation(s)
- Agnethe Berglund
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth Burt
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | | | - Melanie C Davies
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| | - Gerard S Conway
- Reproductive Medicine Unit, Institute for Women's Health, University College London Hospitals, London, UK
| |
Collapse
|
14
|
Uterine function, pregnancy complications, and pregnancy outcomes among female childhood cancer survivors. Fertil Steril 2019; 111:372-380. [PMID: 30691634 DOI: 10.1016/j.fertnstert.2018.10.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether abdominal-pelvic radiotherapy for childhood cancer impairs uterine function and increases the risk of pregnancy complications and adverse pregnancy outcomes. DESIGN Nested cohort study. SETTING Not applicable. PATIENT(S) Childhood cancer survivors previously exposed to abdominal-pelvic radiotherapy (RT-exposed CCSs) as part of their treatment for childhood cancer. INTERVENTION(S) Radiotherapy-exposed CCSs (n = 55) were age- and parity-matched to nonirradiated CCSs (non-RT-exposed CCSs; n = 110) and general population controls (n = 110). MAIN OUTCOME MEASURES Uterine volume, pregnancy complications, and pregnancy outcomes. RESULT(S) Among nulligravidous participants, median (interquartile range) uterine volume was 41.4 (18.6-52.8) mL for RT-exposed CCSs, 48.1 (35.7-61.8) mL for non-RT-exposed CCSs, and 61.3 (49.1-75.5) mL for general population controls. Radiotherapy-exposed CCSs were at increased risk of a reduced uterine volume (<44.3 mL) compared with population controls (odds ratio [OR] 5.31 [95% confidence interval 1.98-14.23]). Surprisingly, the same was true for non-RT-exposed CCSs (OR 2.61 [1.16-5.91]). Among gravidous participants, RT-exposed CCSs had increased risks of pregnancy complications, preterm delivery, and a low birth weight infant compared with population controls (OR 12.70 [2.55-63.40], OR 9.74 [1.49-63.60], and OR 15.66 [1.43-171.35], respectively). Compared with non-RT-exposed CCSs, RT-exposed CCSs were at increased risk of delivering a low birth weight infant (OR 6.86 [1.08-43.75]). CONCLUSION(S) Uterine exposure to radiotherapy during childhood reduces adult uterine volume and leads to an increased risk of pregnancy complications and adverse pregnancy outcomes. Preconceptional counseling and appropriate obstetric monitoring is warranted.
Collapse
|
15
|
Bumbuliene Z, Sragyte D, Klimasenko J, Bumbul-Mazurek E. Abnormal uterine bleeding in adolescents: ultrasound evaluation of uterine volume. Gynecol Endocrinol 2019; 35:356-359. [PMID: 30480465 DOI: 10.1080/09513590.2018.1538345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate ultrasonographic measurements of internal genitalia in girls suffering from abnormal uterine bleeding (AUB) and to compare the appearances with those of healthy girls. DESIGN Prospective case - control study. METHODS One hundred and five not sexually active adolescent girls were enrolled - 67 patients were suffering from AUB and there were 38 healthy peers. The groups did not differ in chronological age, or in postmenarcheal age. All girls underwent assessment of their history, clinical data and transabdominal pelvic ultrasound to evaluate their uterus and ovaries. In order to avoid the impact of endometrium cycle fluctuations, the uterine volume was calculated including and excluding its thickness. RESULTS The uterine volume among the girls suffering from AUB was significantly larger than in the control group. The mean uterine volume including endometrium in the study and control groups was 63.2 ± 24.8 and 47.8 ± 17.5 cm3, respectively (p=.001), and excluding the endometrium was 34.7 ± 13.1 and 29.1 ± 13.8 cm3 (p=.043). We did not find any significant difference in ovarian volume between the groups. CONCLUSIONS The girls in the AUB group have significantly larger uterine volume than healthy girls. This finding does not depend on endometrial thickness.
Collapse
Affiliation(s)
- Zana Bumbuliene
- a Clinic of Obstetrics and Gynecology , Faculty of Medicine, Institute of Clinical Medicine, Vilnius University , Vilnius , Lithuania
| | - Diana Sragyte
- a Clinic of Obstetrics and Gynecology , Faculty of Medicine, Institute of Clinical Medicine, Vilnius University , Vilnius , Lithuania
| | - Jelena Klimasenko
- a Clinic of Obstetrics and Gynecology , Faculty of Medicine, Institute of Clinical Medicine, Vilnius University , Vilnius , Lithuania
| | | |
Collapse
|
16
|
Kelsey TW, Ginbey E, Chowdhury MM, Bath LE, Anderson RA, Wallace WHB. A Validated Normative Model for Human Uterine Volume from Birth to Age 40 Years. PLoS One 2016; 11:e0157375. [PMID: 27295032 PMCID: PMC4905658 DOI: 10.1371/journal.pone.0157375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/28/2016] [Indexed: 12/05/2022] Open
Abstract
Transabdominal pelvic ultrasound and/or pelvic Magnetic Resonance Imaging are safe, accurate and non-invasive means of determining the size and configuration of the internal female genitalia. The assessment of uterine size and volume is helpful in the assessment of many conditions including disorders of sex development, precocious or delayed puberty, infertility and menstrual disorders. Using our own data from the assessment of MRI scans in healthy young females and data extracted from four studies that assessed uterine volume using transabdominal ultrasound in healthy females we have derived and validated a normative model of uterine volume from birth to age 40 years. This shows that uterine volume increases across childhood, with a faster increase in adolescence reflecting the influence of puberty, followed by a slow but progressive rise during adult life. The model suggests that around 84% of the variation in uterine volumes in the healthy population up to age 40 is due to age alone. The derivation of a validated normative model for uterine volume from birth to age 40 years has important clinical applications by providing age-related reference values for uterine volume.
Collapse
Affiliation(s)
- Thomas W. Kelsey
- School of Computer Science, University of St Andrews, St Andrews KY16 9SX, United Kingdom
| | - Eleanor Ginbey
- School of Medicine, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Moti M. Chowdhury
- Department of Paediatric Radiology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
| | - Louise E. Bath
- Department of Endocrinology and Diabetes, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - W. Hamish B. Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
- * E-mail:
| |
Collapse
|
17
|
Orbach DN, Marshall CD, Würsig B, Mesnick SL. Variation in Female Reproductive Tract Morphology of the Common Bottlenose Dolphin (Tursiops truncatus). Anat Rec (Hoboken) 2016; 299:520-37. [PMID: 26788790 DOI: 10.1002/ar.23318] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/08/2015] [Accepted: 12/13/2015] [Indexed: 11/07/2022]
Abstract
Cetaceans exhibit vaginal folds, unusual protrusions of the vaginal wall into the vaginal lumen. Inconsistent terminology and a lack of anatomical landmarks in the literature have hindered comparative studies of the form and function of vaginal folds. Our objectives are to: (1) develop a standardized measurement protocol for the reproductive tracts of female cetaceans, (2) assess variation in morphometrics within the common bottlenose dolphin (Tursiops truncatus), and (3) determine if vaginal muscle is skeletal, and therefore of somatic origin in this species. We selected 15 measurements to characterize female reproductive tracts and evaluated variability using fresh or frozen-thawed specimens from southeastern USA representing a range of sexual maturity states and reproductive states (n = 18 specimens). Presence of skeletal muscle and variation in the density of muscle banding were assessed using 90 histological samples (n = 5 specimens). Analyses of the gross morphological data revealed that the dolphins generally had one large vaginal fold that bisected the vaginal lumen. Vaginal morphology was similar for sexually mature and immature specimens and across reproductive states. The histological data revealed that the vaginal musculature consisted of smooth muscle, consistent with other mammals, leading us to conclude that vaginal contractions are likely under autonomic rather than somatic control. No differences were found in the density of smooth muscle banding among vaginal regions or sexual maturity states. Our systematic protocol lays the foundation for evaluating the function (e.g., sexual selection, natural selection) and evolution of vaginal folds.
Collapse
Affiliation(s)
- Dara N Orbach
- Department of Marine Biology, Texas A&M University at Galveston, Galveston, Texas
| | - Christopher D Marshall
- Department of Marine Biology, Texas A&M University at Galveston, Galveston, Texas.,Department of Wildlife and Fisheries Sciences, Texas A&M University, College Station, Texas
| | - Bernd Würsig
- Department of Marine Biology, Texas A&M University at Galveston, Galveston, Texas.,Department of Wildlife and Fisheries Sciences, Texas A&M University, College Station, Texas
| | - Sarah L Mesnick
- National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Southwest Fisheries Science Center, La Jolla, California
| |
Collapse
|
18
|
Bumbuliene Z, Klimasenko J, Sragyte D, Zakareviciene J, Drasutiene G. Uterine size and ovarian size in adolescents with functional hypothalamic amenorrhoea. Arch Dis Child 2015; 100:948-51. [PMID: 26177656 DOI: 10.1136/archdischild-2014-307504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 06/24/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Functional hypothalamic amenorrhoea (FHA) is a condition characterised by the absence of menses due to suppression of the hypothalamic-pituitary-ovarian axis. OBJECTIVE The purpose of the study was to estimate uterine and ovarian sizes in adolescents with FHA and to compare these results with findings in peers having regular menstrual cycles. DESIGN Prospective case-controlled study. SETTINGS Vilnius University Hospital Santariskiu Klinikos, Lithuania. PATIENTS Lithuanian adolescents--45 with FHA and 40 comparison group participants. MAIN OUTCOME MEASURES We assessed ultrasound measurements of internal reproductive organs, levels of luteinising hormone, follicle-stimulating hormone, prolactin, oestradiol and calculated body mass index (BMI). RESULTS The mean age of the participants was 16.3 ± 1.2 years, the mean age after menarche--3.6 years. In adolescents with FHA the BMI was 17.8 ± 1.8 kg/m(2) and 20.4 ± 1.4 kg/m(2) in the comparison group, p < 0.001. The uterine volume (14.7 ± 6.3 cm(3) vs 31.7 ± 10.6 cm(3), p < 0.001), cervical length (2.3 ± 0.4 cm vs 2.6 ± 0.5 cm, p = 0.03), volume of both ovaries (9.3 ± 3.6 cm(3) vs 13.8 ± 4.3 cm(3), p < 0.001) and levels of LH (2.70 ± 2.59 vs 6.01 ± 2.44, p < 0.001) were significantly lower in girls with FHA. A significantly positive correlation between volume of uterus and levels of LH (r = 0.415; p < 0.001) was found. We identified a positive correlation between uterine volume, uterine corpus length, cervical length, ovarian volume and weight, BMI. CONCLUSIONS In adolescents with FHA the dimensions of uterus and ovaries were smaller than in girls having regular menstrual cycles. Our study confirmed the influence of oestrogen on uterus size: oestrogen deficiency causes a reduction in uterine size. Uterine size and ovarian size correlate positively with BMI.
Collapse
Affiliation(s)
- Zana Bumbuliene
- Vilnius University Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Vilnius, Lithuania
| | - Jelena Klimasenko
- Vilnius University Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Vilnius, Lithuania
| | - Diana Sragyte
- Vilnius University Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Vilnius, Lithuania
| | - Jolita Zakareviciene
- Vilnius University Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Vilnius, Lithuania
| | - Grazina Drasutiene
- Vilnius University Faculty of Medicine, Clinic of Obstetrics and Gynaecology, Vilnius, Lithuania
| |
Collapse
|
19
|
Hagen CP, Mouritsen A, Mieritz MG, Tinggaard J, Wohlfahrt-Veje C, Fallentin E, Brocks V, Sundberg K, Jensen LN, Juul A, Main KM. Uterine volume and endometrial thickness in healthy girls evaluated by ultrasound (3-dimensional) and magnetic resonance imaging. Fertil Steril 2015; 104:452-9.e2. [DOI: 10.1016/j.fertnstert.2015.04.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 12/27/2022]
|
20
|
Burckhardt MA, Obmann V, Wolf R, Janner M, Flück CE, Mullis PE. Ovarian and uterine development and hormonal feedback mechanism in a 46 XX patient with CYP19A1 deficiency under low dose estrogen replacement. Gynecol Endocrinol 2015; 31:349-54. [PMID: 25585547 DOI: 10.3109/09513590.2014.995619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Aromatase deficiency may result in a complete block of estrogen synthesis because of the failure to convert androgens to estrogens. In females, this results in virilisation at birth, ovarian cysts in prepuberty and lack of pubertal development but virilisation, thereafter. OBJECTIVE AND METHODS We studied the impact of oral 17β-estradiol treatment on ovarian and uterine development, and on LH/FSH and inhibin B during the long-term follow-up of a girl harboring compound heterozygote point mutations in the CYP19A1 gene. RESULTS In early childhood, low doses of oral 17β-estradiol were needed. During prepuberty treatment with slowly increasing doses of E2 resulted in normal uterine and almost normal development of ovarian volume, as well as number and size of follicles. Regarding hormonal feedback mechanisms, inhibin B levels were in the upper normal range during childhood and puberty. Low doses of estradiol did not suffice to achieve physiological gonadotropin levels in late prepuberty and puberty. However, when estradiol doses were further increased in late puberty levels of both FSH and LH declined with estradiol levels within normal range. CONCLUSION Complete aromatase deficiency provides an excellent model of how ovarian and uterine development in relation to E2, LH, FSH and inhibin B feedback progresses from infancy to adolescence.
Collapse
Affiliation(s)
- Marie-Anne Burckhardt
- Pediatric Endocrinology, Diabetology and Metabolism, University Children's Hospital , Inselspital, Bern , Switzerland and
| | | | | | | | | | | |
Collapse
|
21
|
Biro FM, Pinney SM, Huang B, Baker ER, Walt Chandler D, Dorn LD. Hormone changes in peripubertal girls. J Clin Endocrinol Metab 2014; 99:3829-35. [PMID: 25029416 PMCID: PMC4184081 DOI: 10.1210/jc.2013-4528] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
CONTEXT Studies of hormone changes in the peripubertal period note increases in adrenal hormones prior to increases in sex steroids. It is unclear how these processes are related to each other, except through this temporal relationship. OBJECTIVE Examine relationships in adrenal and sex hormones in 252 peripubertal girls. SETTING AND DESIGN Longitudinal observation study. School districts, at the Cincinnati site of the Breast Cancer and the Environment Research Centers, between 2004-2010. Participants were recruited between ages 6 and 7 years of age and were seen every 6 months. Main outcome measures included height, weight, maturation status, and fasting blood specimen. Serum was analyzed for selected hormones every six months, beginning 30 months prior to, and extending to 6 months after, breast development. Androstenedione, estradiol, estrone, and T were measured by high-performance liquid chromatography (HPLC) with tandem mass spectrometry. Dehydroepiandrosterone-sulfate (DHEA-S) and SHBG also were measured. RESULTS DHEA-S concentrations increased 24 months before breast development; androstenedione and estrone between 12 to 18 months before breast development; whereas estradiol and T increased, and SHBG fell between 6 and 12 months before breast development. Girls with greater body mass index had lower estradiol concentrations at onset of breast development as well as 6 months after pubertal onset. CONCLUSIONS Serum estrone and DHEA-S increased prior to estradiol concentrations, and the increase in estradiol occurred prior to breast development. Heavier peripubertal girls have lower estradiol levels at puberty, suggesting peripheral conversion of adrenal androgens to estrone.
Collapse
Affiliation(s)
- Frank M Biro
- Cincinnati Children's Hospital Medical Center (F.M.B., B.H., E.R.B.); Department of Environmental Health (S.M.P.), University of Cincinnati College of Medicine, Cincinnati, Ohio 45229; Esoterix Laboratories, Endocrine Sciences (D.W.C.), Calabasas Hills, California 91301; and the Pennsylvania State University (L.D.D.), University Park, Pennsylvania 16801
| | | | | | | | | | | |
Collapse
|
22
|
Savasi I, Jayasinghe K, Moore P, Jayasinghe Y, Grover SR. Complication rates associated with levonorgestrel intrauterine system use in adolescents with developmental disabilities. J Pediatr Adolesc Gynecol 2014; 27:25-8. [PMID: 24315712 DOI: 10.1016/j.jpag.2013.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To assess the complication rates with the use of the levonorgestrel intrauterine system (LNG IUS) in adolescents with developmental disabilities. DESIGN Retrospective chart review of all adolescents with developmental disabilities taken to the operating room for LNG IUS insertion between January 2000 and July 2009 at the Royal Children's Hospital, Melbourne, Australia. Cases identified from the surgical database, and medical records reviewed. MAIN OUTCOME MEASURES Complication rates with LNG IUS use in adolescents with development disabilities: non-insertion, uterine perforation, infection, and expulsion. RESULTS Fifty-six adolescents with developmental disabilities had an attempted LNG IUS insertion. The average age at insertion was 15.6 years (range 10.5-21.5 y). The LNG IUS was used as first line therapy in 14 cases (25%). Pre-insertion ultrasonography was ordered in 48% of cases, out of which 5 cases had uterine lengths <6 cm. Despite this, 4 of these cases had successful insertions. Two insertion attempts were abandoned intra-operatively (3.6%); one due to inadequate uterine length of 4 cm, and the other due to anatomic distortion. One spontaneous expulsion occurred at approximately 5 months (1.9%). Four IUDs were removed prematurely (7.4% withdrawal rate); 1 for persistent abdominal pain, 1 for irregular bleeding, and 2 for suspected malpositions. There were no documented cases of infection, perforation, or pregnancy. CONCLUSION Our experience in this population has been very positive and confirms that complication rates are comparable to that in adults.
Collapse
Affiliation(s)
- Ingrid Savasi
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kokum Jayasinghe
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Patricia Moore
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yasmin Jayasinghe
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sonia R Grover
- Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
| |
Collapse
|
23
|
Panidis D, Tziomalos K, Papadakis E, Vosnakis C, Betsas G, Tsourdi E, Katsikis I. Uterine volume and endometrial thickness in the early follicular phase in patients with polycystic ovary syndrome. Endocr Pract 2013; 20:540-7. [PMID: 24325993 DOI: 10.4158/ep13058.or] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to evaluate uterine volume and endometrial thickness during the early follicular phase in patients with polycystic ovary syndrome (PCOS) and healthy controls. METHODS We studied 1,016 PCOS patients and 182 healthy controls. The anthropometric, endocrine, and metabolic characteristics of PCOS were determined. Uterine volume and endometrial thickness were also recorded. RESULTS Uterine volume progressively increased with age both in PCOS patients and controls. Patients with PCOS and body mass index (BMI) ≥25 kg/m2 had greater uterine volumes than PCOS patients with BMI <25 kg/m2 (P<.001). Patients with the classic PCOS phenotypes (i.e., with oligo-ovulation and/or anovulation [ANOV] and hyperandrogenemia [HA] with or without polycystic ovaries [PCO]) had smaller uterine volume than PCOS patients with the additional phenotypes introduced by the Rotterdam criteria (i.e., with PCO and either ANOV or HA; P = .033) and controls (P = .045). CONCLUSION Uterine volume increases progressively with age and obesity in PCOS patients. The smaller uterine volumes and endometrial thicknesses in the classic PCOS phenotypes might be attributed to the more severe HA of these patients.
Collapse
Affiliation(s)
- Dimitrios Panidis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Papadakis
- Third Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Vosnakis
- Third Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Betsas
- Third Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ekaterini Tsourdi
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Katsikis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
24
|
Kelsey TW, Dodwell SK, Wilkinson AG, Greve T, Andersen CY, Anderson RA, Wallace WHB. Ovarian volume throughout life: a validated normative model. PLoS One 2013; 8:e71465. [PMID: 24019863 PMCID: PMC3760857 DOI: 10.1371/journal.pone.0071465] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/07/2013] [Indexed: 12/18/2022] Open
Abstract
The measurement of ovarian volume has been shown to be a useful indirect indicator of the ovarian reserve in women of reproductive age, in the diagnosis and management of a number of disorders of puberty and adult reproductive function, and is under investigation as a screening tool for ovarian cancer. To date there is no normative model of ovarian volume throughout life. By searching the published literature for ovarian volume in healthy females, and using our own data from multiple sources (combined n = 59,994) we have generated and robustly validated the first model of ovarian volume from conception to 82 years of age. This model shows that 69% of the variation in ovarian volume is due to age alone. We have shown that in the average case ovarian volume rises from 0.7 mL (95% CI 0.4–1.1 mL) at 2 years of age to a peak of 7.7 mL (95% CI 6.5–9.2 mL) at 20 years of age with a subsequent decline to about 2.8 mL (95% CI 2.7–2.9 mL) at the menopause and smaller volumes thereafter. Our model allows us to generate normal values and ranges for ovarian volume throughout life. This is the first validated normative model of ovarian volume from conception to old age; it will be of use in the diagnosis and management of a number of diverse gynaecological and reproductive conditions in females from birth to menopause and beyond.
Collapse
Affiliation(s)
- Thomas W. Kelsey
- School of Computer Science, University of St Andrews, St Andrews, Fife, United Kingdom
| | - Sarah K. Dodwell
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - A. Graham Wilkinson
- Department of Paediatric Radiology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Tine Greve
- Laboratory of Reproductive Biology, Section 5712, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Claus Y. Andersen
- Laboratory of Reproductive Biology, Section 5712, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - W. Hamish B Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
- * E-mail:
| |
Collapse
|
25
|
Ovarian torsion in a 5-year old: a case report and review. Case Rep Emerg Med 2013; 2012:679121. [PMID: 23326720 PMCID: PMC3542900 DOI: 10.1155/2012/679121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/22/2012] [Indexed: 11/17/2022] Open
Abstract
Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.
Collapse
|
26
|
de Vries L, Phillip M. Pelvic ultrasound examination in girls with precocious puberty is a useful adjunct in gonadotrophin-releasing hormone analogue therapy monitoring. Clin Endocrinol (Oxf) 2011; 75:372-7. [PMID: 21521352 DOI: 10.1111/j.1365-2265.2011.04086.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As there are no standard criteria for monitoring suppression during treatment of central precocious puberty (CPP) with gonadotrophin-releasing hormone analogues (GnRHa), we assessed the use of pelvic ultrasound examination for this purpose. DESIGN/PATIENTS/MEASUREMENTS In 31 girls with CPP, transabdominal pelvic ultrasound examination was performed before initiation of therapy with GnRHa, after approximately 3 and 6 months, at last treatment visit and after its discontinuation. RESULTS Three months after treatment initiation, there was a significant decrease in most uterine and ovarian parameters, with at least three parameters decreased in each patient. Endometrial echo was found in 80% of girls before therapy, in 52% (13/25) after 3 months of therapy, in 24% (6/25) after 6 months and in none on the last treatment visit (P < 0·001). In the course of treatment (mean therapy duration 2·5 ± 0·9 years), uterine parameters showed no significant change; ovarian parameters initially showed a decrease and later a modest increase although they were still smaller than before therapy. Within 3-11 months after therapy discontinuation, endometrial echo was detected in 85%, with a significant increase in uterine and ovarian parameters. CONCLUSIONS This prospective study indicates that comparison of individual ultrasound measurements throughout the course of treatment in girls with CPP provides a valid assessment of the suppression of the hypothalamo-pituitary-gonadal axis achieved GnRH therapy. Uterine parameters and absence of endometrial echo were found to be better indicators of adequate suppression than ovarian parameters.
Collapse
Affiliation(s)
- Liat de Vries
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel.
| | | |
Collapse
|
27
|
Cleemann L, Holm K, Fallentin E, Skouby SO, Smedegaard H, Møller N, Borch-Christensen H, Jeppesen EM, Wieslander SB, Andersson AM, Cohen A, Højbjerg Gravholt C. Uterus and ovaries in girls and young women with Turner syndrome evaluated by ultrasound and magnetic resonance imaging. Clin Endocrinol (Oxf) 2011; 74:756-61. [PMID: 21521266 DOI: 10.1111/j.1365-2265.2011.03995.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine uterine and ovarian size in Turner syndrome (TS) and to compare uterine and ovarian size evaluated by transabdominal ultrasound (US) and magnetic resonance imaging (MRI) in girls with TS and two groups of controls. DESIGN A cross-sectional study. PATIENTS Forty-one girls with TS (17·0 ± 3·3 years, range 11·2-24·9 years), 50 healthy age-matched controls (16·9 ± 3·2 years, range 12·5-25·0 years) and 107 Tanner-stage-matched controls (15·0 ± 3·2 years, range 10·1-24·2). MEASUREMENTS Uterine and ovarian volume by US and MRI. RESULTS Ovaries were detected in 37% in TS by US and in 55% in TS by MRI (P = 0·1). Total ovarian volume was lower in TS compared to both groups of controls (TS vs C-US: median 1·1 ml (range 0·1-29·3) vs 11·52 ml (1·9-77·9), P = 0·001, TS vs C-MRI: 1·0 ml (0·1-34·2) vs 13·2 ml (2·4-30·1), P < 0·0005). Mean difference in total ovarian volume measured by MRI and US in patients with TS was 2·3 ± 3·8 ml (P = 0·01). Mean uterine volume by MRI was lower in TS compared to controls (29·5 ± 25·1 vs 54·3 ± 23·3 ml, P < 0·0005). Uterine volume by US was lower in TS at Tanner stage B5 compared to controls (TS vs C: 33·6 ± 18·2 vs 50·2 ± 18·0 ml, P = 0·007). CONCLUSIONS A larger ovarian volume was detected by MRI in TS compared to US. This finding is important with the advancements of performing ovarian biopsies for cryopreservation and later reimplantation. Mean uterine volumes by MRI and US in fully matured TS were lower compared to controls despite appropriate hormonal replacement therapy in TS.
Collapse
Affiliation(s)
- Line Cleemann
- Department of Pediatrics, Hillerød Hospital, Hillerød, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Razzaghy-Azar M, Ghasemi F, Hallaji F, Ghasemi A, Ghasemi M. Sonographic measurement of uterus and ovaries in premenarcheal healthy girls between 6 and 13 years old: correlation with age and pubertal status. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:64-73. [PMID: 20572067 DOI: 10.1002/jcu.20723] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND To provide normal references of sonographic uterine and ovarian size in premenarcheal healthy girls aged 6-13 years in different stages of puberty. METHODS Two hundred forty girls were enrolled into the study (mean age ± SD, 9.5 ± 1.7 years [range, 6-13.5 years]). Pubertal status was classified according to Tanner staging. All subjects underwent pelvic sonographic examination for the measurement of uterine volume, body and cervical length, anteroposterior diameter of fundus, body, and cervix, ovarian volume, and both right and left prominent follicular diameter. RESULTS A gradual increase with age was observed in all uterine and ovarian measurements. Both uterine and ovarian parameters were significantly correlated to age, height and weight, and stages of puberty. Uterine volume was <3.5 cm(3) in 98% of prepubertal girls, and in stage 2 it was significantly more than in stage 1 (3 ± 3.2 versus 1.7 ± 1.7, respectively) (p < 0.001). Uterine body length was also significantly greater in stage 2 than stage 1 (17.5 ± 4.5 versus 14.6 ± 3.3, respectively) (p < 0.001). CONCLUSION The reference values for uterus and ovaries were determined in healthy girls. There is a progressive increase in size of internal female genitalia in relation to age, height, weight, and puberty. Uterine volume and body length presented the best correlation with age and stage of puberty.
Collapse
Affiliation(s)
- Maryam Razzaghy-Azar
- Department of Pediatrics, H. Aliasghar Hospital, Iran University of Medical Sciences, Tehran 1919816766, Iran
| | | | | | | | | |
Collapse
|
29
|
Karabulut A, Balci Y, Demirlenk S, Semiz S. Gonadal dysfunction and pelvic sonographic findings in females with thalassaemia major. Gynecol Endocrinol 2010; 26:307-10. [PMID: 20021296 DOI: 10.3109/09513590903511471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate pubertal and menstrual problems and evaluate pelvic sonographic findings in patients with beta-thalassaemia major. MATERIAL AND METHODS Twenty-five female patients followed for thalassaemia major constituted the study population. Sexual maturation and hormonal status were assessed. Pubertal and menstrual problems were investigated. RESULTS There was one patient with delayed puberty and five patients with arrested puberty. Mean ferritin level in this group of patients was slightly but not significantly higher than patients with normal pubertal maturation (2620 +/- 994 ng/ml vs. 2409 +/- 1348 ng/ml, p > 0.05). There were 10 patients with primary amenorrhoea, three with secondary amenorrhoea, five with oligomenorrhoea and irregular menstruation and one with regular menstruation. Compared to menstruating patients, the mean uterine size was smaller (4.1 +/- 3.5 cm(3) vs. 52.8 +/- 14.5 cm(3)) in all patients with delayed and arrested puberty (p < 0.05). Ten patients were taking hormone replacement therapy (HRT). The mean uterine size in these patients was larger than that in patients with amenorrhoea who were not taking HRT, but smaller than that in menstruating patients (9.1 +/- 15.9 cm(3), 2.7 +/- 1.3 cm(3) and 52.8 +/- 14.5 cm(3), respectively) (p < 0.05). CONCLUSION Thalassaemia major has important side effects on the hypothaloma-pituitary-gonadal axis resulting in pubertal and menstrual abnormalities. HRT should be given to provide normal sexual maturation in these patients.
Collapse
Affiliation(s)
- Aysun Karabulut
- Department of Obsterics and Gynecology, Denizli State Hospital, Denizli, Turkey.
| | | | | | | |
Collapse
|
30
|
Ultrasonographic patterns of reproductive organs in infants fed soy formula: comparisons to infants fed breast milk and milk formula. J Pediatr 2010; 156:215-20. [PMID: 19846109 DOI: 10.1016/j.jpeds.2009.08.043] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 07/09/2009] [Accepted: 08/19/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine if differences exist in hormone-sensitive organ size between infants who were fed soy formula (SF), milk formula (MF), or breast milk (BF). STUDY DESIGN Breast buds, uterus, ovaries, prostate, and testicular volumes were assessed by ultrasonography in 40 BF, 41 MF, and 39 SF infants at age 4 months. RESULTS There were no significant feeding group effects in anthropometric or body composition. Among girls, there were no feeding group differences in breast bud or uterine volume. MF infants had greater (P < .05) mean ovarian volume and greater (P < .01) numbers of ovarian cysts per ovary than did BF infants. Among boys, there were no feeding group differences in prostate or breast bud volumes. Mean testicular volume did not differ between SF and MF boys, but both formula-fed groups had lower volumes than BF infants. CONCLUSIONS Our data do not support major diet-related differences in reproductive organ size as measured by ultrasound in infants at age 4 months, although there is some evidence that ovarian development may be advanced in MF-fed infants and that testicular development may be slower in both MF and SF infants as compared with BF. There was no evidence that feeding SF exerts any estrogenic effects on reproductive organs studied.
Collapse
|
31
|
Sivasankaran S, Itam P, Ayensu-Coker L, Sanchez J, Egler RA, Anderson ML, Brandt ML, Dietrich JE. Juvenile granulosa cell ovarian tumor: a case report and review of literature. J Pediatr Adolesc Gynecol 2009; 22:e114-7. [PMID: 19576820 DOI: 10.1016/j.jpag.2008.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 08/04/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Juvenile granulosa cell tumors (JGCT) are rare ovarian tumors that frequently present with precocious puberty. Presentation in infants less than a year of age is also rare. CASE We describe a 10-month-old infant who presented with both premature thelarche and adrenarche due to JGCT. Laboratory evaluation revealed classic elevation of estradiol and inhibin B, and less classic elevation of total and free testosterone. Oophorectomy and staging resulted in a diagnosis of Stage IA JGCT. SUMMARY AND CONCLUSION Survival rates are >95% among patients diagnosed under 10 years of age. Tumor recurrence is rare but can occur as late as 48 months. Therefore, tumor surveillance is warranted for patients with even a Stage IA JGCT and involves monitoring serial inhibin B levels along with intermittent imaging.
Collapse
Affiliation(s)
- Sujatha Sivasankaran
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Bannink EMN, van Sassen C, van Buuren S, de Jong FH, Lequin M, Mulder PGH, de Muinck Keizer-Schrama SMPF. Puberty induction in Turner syndrome: results of oestrogen treatment on development of secondary sexual characteristics, uterine dimensions and serum hormone levels. Clin Endocrinol (Oxf) 2009; 70:265-73. [PMID: 19200215 DOI: 10.1111/j.1365-2265.2008.03446.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Besides short stature, gonadal dysgenesis leading to a lack of oestrogen is one of the main characteristics of Turner syndrome (TS). In most TS girls, puberty is induced with exogenous oestrogens. OBJECTIVE To describe the pubertal development and uterine dimensions achieved by low-dose 17beta-oestradiol (17beta-E2) orally started at an appropriate age. Additionally, to determine whether serum hormone levels aid evaluation of pubertal progression. DESIGN In 56 TS girls, we prospectively studied pubertal stage, serum E2, LH, FSH, SHBG and oestrone (E1), starting oestrogen treatment with a low-dose 17beta-E2 (5 microg/kg/day) during GH treatment at mean (SD) age 12.7 (0.7) years. Hormone levels were measured at start, 3 months after start and after increasing 17beta-E2 dosage. Uterine dimensions were measured in 39 TS women at age 19.9 (2.2) years. RESULTS Although breast and pubic hair development were similar to that in normal Dutch girls up to Tanner stage B5 and P5, respectively, breast development was 2 years later. Before oestrogen therapy, E2 levels were comparable to those in prepubertal girls. With a 17beta-E2 dose of 5 microg/kg/day, these levels increased significantly, becoming comparable to normal late pubertal or adult concentrations, whereas SHBG levels were unchanged. At the adult 17beta-E2 dose, SHBG had increased significantly. Uterus shape was juvenile in four (10.2%), cylindrical in four and mature-adult shaped in 31 (79.5%) of TS patients. CONCLUSIONS During GH treatment in TS girls, normal breast development up to B5 can be mimicked, with just a 2-year delay. In a clinical setting, serum hormone levels provide no additional information for evaluating pubertal progression. After age-appropriate pubertal induction, uterine dimensions in women aged nearly 20 years were subnormal. It remains unclear whether this was related to E2 dosage, timing or duration, or factors related to TS.
Collapse
Affiliation(s)
- E M N Bannink
- Department of Paediatrics, Division of Endocrinology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
33
|
Badouraki M, Christoforidis A, Economou I, Dimitriadis AS, Katzos G. Sonographic assessment of uterine and ovarian development in normal girls aged 1 to 12 years. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:539-544. [PMID: 18726968 DOI: 10.1002/jcu.20522] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To provide normal references of sonographic uterine and ovarian size in girls aged 1-12 years. METHOD Ninety-nine girls were enrolled in the study (mean age +/- SD, 6.9 +/- 2.4 years [range, 1-12 years]). Pubertal status was classified according to Tanner staging, whereas for height and weight assessment a standard stadiometer and weight scale were employed. All subjects underwent pelvic sonographic examination for the measurement of uterine length, volume, ratio of anteroposterior diameter at the fundus divided by the anteroposterior diameter at the cervix (fundal-cervical [F/C] ratio), and ovarian volume and morphology. RESULTS A gradual increase with age was observed in all uterine and ovarian measurements. Cubic model analysis provided the best curve estimation for uterine length, uterine volume, and ovarian volume in relation to age. Uterine length, uterine volume, ovarian volume and F/C ratio were significantly correlated to both age and height. With respect to ovarian morphology, there was a gradual decrease in frequency of the homogeneous and the paucicystic appearances with increasing age. The macrocystic appearance was observed after the age of 6 years, and its frequency increased gradually with age. CONCLUSION There is a continuous increase in size of internal female genitalia from early childhood until the onset of puberty. We have provided reference percentile charts of normal uterine length, uterine volume, and ovarian volume in girls aged 1-12 years.
Collapse
Affiliation(s)
- Maria Badouraki
- Paediatric Radiology Unit, Hippokration Hospital, 49 Konstantinoupoleos Str., 54642, Thessaloniki, Greece
| | | | | | | | | |
Collapse
|
34
|
Badouraki M, Christoforidis A, Economou I, Dimitriadis AS, Katzos G. Evaluation of pelvic ultrasonography in the diagnosis and differentiation of various forms of sexual precocity in girls. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:819-827. [PMID: 18951545 DOI: 10.1002/uog.6148] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES This study was conducted to assess the role of pelvic ultrasound variables in discriminating between normal girls and girls with different forms of sexual precocity, and to establish reliable cut-off limits of pelvic ultrasound measurements for differentiating between these conditions. METHODS Eighty-eight girls with different forms of sexual precocity (23 with premature thelarche, 15 with premature pubarche and 50 with central precocious puberty) were enrolled. All diagnoses were based on clinical examination with confirmation using the gonadotropin-releasing hormone-stimulation test. Additionally, 81 prepubertal girls, aged 0-10 years, were included as a control group. For statistical analysis and to facilitate comparisons, the groups were subdivided by age intervals (0-6, > 6-8 and > 8-10 years). All subjects underwent pelvic ultrasound examination for the measurement of uterine length, uterine volume, ovarian volume and the anteroposterior diameter at the fundus divided by the anteroposterior diameter at the cervix (fundal/cervical ratio, (F/C)). Finally, the morphological appearance of the ovaries was assessed. RESULTS Patients with central precocious puberty had significantly higher values for all the ultrasound variables (with the exception of uterine length in the 1-6-year age group) in comparison to normal girls. Patients with premature thelarche and patients with premature pubarche showed similar pelvic ultrasound parameters to those of normal girls. Ovarian volume was the best parameter for identifying patients with central precocious puberty (a cut-off of 3.04 cm(3) had a sensitivity of 100% and a specificity of 97.1% for age interval 0-6 years, a cut-off of 3.35 cm(3) had a sensitivity of 100% and a specificity of 89.5% for age interval > 6-8 years, and a cut-off of 4.46 cm(3) had a sensitivity of 80.8% and a specificity of 88.5% for age interval > 8-10 years). Uterine length was the best parameter for distinguishing between patients with central precocious puberty and patients with premature thelarche (a cut-off of 3.185 cm had a sensitivity of 85.7% and a specificity of 91.7% for age interval 0-6 years, and a cut-off of 3.83 cm had a sensitivity of 82.4% and a specificity of 90.9% for age interval > 6-8 years). CONCLUSIONS Ultrasound examination of the uterus and ovaries could serve as a complementary tool for the diagnosis of central precocious puberty and, consequently, for the early initiation of appropriate treatment.
Collapse
Affiliation(s)
- M Badouraki
- Paediatric Radiology Unit, Hippokration Hospital, Thessaloniki, Greece
| | | | | | | | | |
Collapse
|
35
|
Yollin E, Jonard S, Reyss AC, Cortet-Rudelli C, Dewailly D. Retard pubertaire avec hypotrophie utérine majeure: ne pas conclure trop vite à l'absence d'utérus. ACTA ACUST UNITED AC 2006; 34:1029-35. [PMID: 17055317 DOI: 10.1016/j.gyobfe.2006.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 09/08/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To emphasize the difficulties to distinguish between uterine agenesis and extreme uterine hypotrophy in the context of primary amenorrhoea with delayed puberty. PATIENTS AND METHODS Among adolescents who consulted with our center because of primary amenorrhoea, from 1997 to 2005, three patients were referred for a suspicion of Mayer-Rokitansky-Kuster-Hauser Syndrome, after ultrasonography had failed to visualize the uterus. The 3 patients underwent endocrine and genetic evaluations. Transabdominal ultrasonography and MRI performed pelvic examination. Patients were placed under estrogen treatment. RESULTS Endocrine evaluation indicated primary ovarian failure for patient 1, and hypogonadotrophic hypogonadism for patients 2 and 3. Karyotype was 46,XX in all patients. Initial pelvic ultrasonography revealed the absence of uterus. MRI allowed visualizing prepubertal uterus for patient 1, a hypotrophic uterus for patient 3 and concluded to uterine agenesis for patient 2. In all cases estradiol substitutive therapy induced uterine growth and confirmed retrospectively the diagnosis of extreme uterine hypotrophy. DISCUSSION AND CONCLUSION Pelvic ultrasonography can be misleading in the evaluation of primary amenorrhoea. No visualization of uterus on ultrasonography can occur in the context of delayed puberty and should not induce a premature diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome. Indeed, such a diagnosis has therapeutic, reproductive and psychological consequences.
Collapse
Affiliation(s)
- E Yollin
- Service de gynécologie endocrinienne et médecine de la reproduction, clinique gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | | | | | | | | |
Collapse
|
36
|
Martínez-Aguayo A, Hernández MI, Beas F, Iñiguez G, Avila A, Sovino H, Bravo E, Cassorla F. Treatment of central precocious puberty with triptorelin 11.25 mg depot formulation. J Pediatr Endocrinol Metab 2006; 19:963-70. [PMID: 16995580 DOI: 10.1515/jpem.2006.19.8.963] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new triptorelin 11.25 mg long depot formulation is now available for the treatment of central precocious puberty (CPP). The aim of our study was to evaluate the efficacy of triptorelin 11.25 mg administered every 90 days to suppress gonadotropin and sex steroid secretion and pubertal signs in children with CPP during 2 years of treatment. Inclusion criteria were clinical pubertal development before the age of 8 years in girls or 9 years in boys, advanced bone age and a pubertal LH response (peak >5 mIU/ml) to GnRH. We studied 20 patients (19 girls and 1 boy), with a median age at entry into the study of 7.5 +/- 0.2 years for girls, and 9 years for the boy. The basal and GnRH-stimulated serum levels of LH and FSH decreased significantly from baseline to 3 months of therapy (p <0.0001). All patients had a GnRH-stimulated peak below 3 mIU/ml between 6 and 24 months of treatment. The pituitary-gonadal axis recovered adequately after discontinuation of therapy. These results suggest that 3-month depot triptorelin is a satisfactory alternative for the therapy of children with CPP. The longer interval between injections may increase acceptability and compliance with treatment.
Collapse
Affiliation(s)
- A Martínez-Aguayo
- Institute of Maternal and Child Research, University of Chile, School of Medicine, Santiago
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Mason HD, Key A, Allan R, Lask B. Pelvic ultrasonography in anorexia nervosa: what the clinician should ask the radiologist and how to use the information provided. EUROPEAN EATING DISORDERS REVIEW 2006; 15:35-41. [PMID: 17676670 DOI: 10.1002/erv.719] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pelvic ultrasonography is generally regarded as the gold standard for determination of pelvic maturity and hence the need for further weight gain in patients with anorexia nervosa. Many clinicians, however, have limited knowledge of this technique. Here, we describe the use of pelvic ultrasonography in anorexia nervosa and present an algorithm to assist the clinician, both with what questions to ask from the radiologist, and how to use the information provided to determine the morphology and hence maturity of the pelvic organs. We then show how this information can be used to assign the level of pelvic maturity a grade from 1 to 5. Finally, we demonstrate use of this system in two patients who progressively gained weight until pelvic maturity was achieved.
Collapse
Affiliation(s)
- Helen D Mason
- Division of Clinical Developmental Sciences, St. George's University of London, London, UK.
| | | | | | | |
Collapse
|
38
|
Wu MH, Lin SJ, Wu LH, Cheng YC, Chou YY, Pan HA. Clinical suppression of precocious puberty with cetrorelix after failed treatment with GnRH agonist in a girl with gonadotrophin-independent precocious puberty. Reprod Biomed Online 2005; 11:18-21. [PMID: 16102281 DOI: 10.1016/s1472-6483(10)61293-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This report presents the case of a 7-year-old girl with gonadotrophin-independent precocious puberty treated with cetrorelix [gonadotrophin-releasing hormone (GnRH) antagonist] after poor response to GnRH agonist therapy was observed in the endocrinology outpatient clinic. Uterine and ovarian morphology returned to within the normal prepubertal range after GnRH antagonist was injected subcutaneously. Vaginal bleeding stopped completely. The effects of GnRH antagonist treatment were comparable to those of GnRH agonist. The potential advantage of GnRH antagonists would be a clinically significant direct effect on the ovary, if it exists, and GnRH antagonists should be available for use in such children.
Collapse
Affiliation(s)
- Meng-Hsing Wu
- Department of Obstetrics and Gynecology, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
This article reviews salient features of pediatric gynecologic ultrasound. It reviews technologic factors, technique, and normal anatomy used to evaluate the pediatric gynecologic tract for abnormality. It reviews and illustrates clinical imaging information necessary to know in the ultrasonic analysis of several clinical problems in the pediatric gynecologic tract. This includes ovarian torsion, ambiguous genitalia, pelvic mass, and precocious puberty, as well as acute pelvic pain occurring from newborn life through puberty.
Collapse
Affiliation(s)
- Rita S Ratani
- Division of Body Imaging, SUNY at Stony Brook School of Medicine, NY, USA
| | | | | |
Collapse
|
40
|
Tsilchorozidou T, Conway GS. Uterus size and ovarian morphology in women with isolated growth hormone deficiency, hypogonadotrophic hypogonadism and hypopituitarism. Clin Endocrinol (Oxf) 2004; 61:567-72. [PMID: 15521958 DOI: 10.1111/j.1365-2265.2004.02126.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE AND SUBJECTS Current data suggest a permissive role for the somatotrophic axis in the reproductive process, mainly by affecting the onset of puberty and the maintenance of regular menstrual cyclicity. To assess a possible interface between GH and reproductive axes in determining the uterus size, we retrospectively evaluated 58 pelvic ultrasound scans in adult women with either isolated growth hormone deficiency (GHD; n = 12), hypogonadotrophic hypogonadism (HH; n = 24) or hypopituitarism (HP; n = 22) of prepubertal onset. Pelvic ultrasound was performed before oestrogen replacement in patients with HH or HP, and after completion of GH treatment in the majority of patients with HP. Eight women with HH and seven with HP had a second pelvic ultrasound examination after being established on oestrogen replacement therapy. A group of 19 young healthy women with no previous history of pregnancy or miscarriage were included for comparison of ultrasound data. RESULTS Uterine measurements, length and uterine cross-sectional area (UXA) were significantly less in the three study groups compared to healthy controls [median UXA: GHD 18.0 cm(2) (range 9.9-28.6 cm(2)), HH 7.0 cm(2) (range 1.3-18.5 cm(2)), HP 11.8 cm(2) (range 1.6-21.8 cm(2)) and controls 23.0 cm(2) (range 16.1-31.7 cm(2)); P < 0.001]. The median age of oestrogen replacement was significantly later in HH [19 years (range 16-26 years)] compared to HP [16.5 years (range 13-20 years)]P = 0.03, while the median age of menarche of GHD patients was 14.5 years (range 11-16 years), which was not statistically different from controls [13.0 years (range 12.5-14.5 years)]. Repeat uterine measurements on oestrogen in the subgroup of 15 patients did not reach the normal values [pretreatment UXA: 4.2 cm(2) (range 1.6-16.1 cm(2)), post-treatment UXA: 12.6 cm(2) (range 4-23 cm(2))]. Ovarian volume was smaller in the two groups of women with gonadotrophin deficiency (HH and HP), while a polycystic ovarian morphology was notably more prevalent in the two groups who had received GH treatment being found in 75 and 58% of women with GHD and HP, respectively, compared with 12.5% in women with HH (P < 0.004). CONCLUSIONS Our findings suggest that GHD might have an independent effect in determining uterus size and therefore the consequences of GHD plus oestrogen deficiency on uterus growth might be additive. The fact that uterine measurements between HH and HP patients did not differed significantly in this study may be explained by the fact that oestrogen replacement has been substituted earlier in the latter group. Furthermore, it appears that standard oestrogen replacement therapy did not result in normal uterine growth. A polycystic ovarian morphology may be a consequence of GH treatment.
Collapse
|
41
|
Sampaolo P, Calcaterra V, Klersy C, Alfei A, De Leonardis C, Maino M, Larizza D. Pelvic ultrasound evaluation in patients with Turner syndrome during treatment with growth hormone. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 22:172-177. [PMID: 12905513 DOI: 10.1002/uog.144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Treatment with growth hormone (GH), alone or in combination with oxandrolone, is used in patients affected by Turner syndrome to improve growth velocity and adult height. Since GH interacts with gonadotropins in the stimulation of the human ovary, the aim of our study was to evaluate the possible effects of GH administration on uterine and ovarian characteristics. METHODS We performed pelvic ultrasound assessment in 29 patients with Turner syndrome aged 7.5-16.6 years (19 with 45,X karyotype; 10 with variant karyotypes) before and during treatment with GH alone. Uterine volume and ovarian size and morphology were compared to those of 23 age-matched girls with Turner syndrome not treated with GH. Both patients and controls were divided into prepubertal and pubertal groups. Cross-sectional and longitudinal studies (before and every 6 months during GH treatment for 2 years) were performed. RESULTS We observed a significantly higher uterine anteroposterior diameter and volume in younger (< or = 11 years) GH-treated Turner syndrome girls than in those who were untreated. Also visualization and heterogeneous echopattern of the ovaries were significantly more frequent in treated than in untreated Turner syndrome patients, particularly before the age of 11 years. The longitudinal study showed a significant increase in uterine volume, more related to treatment than to age. Spontaneous breast development and menarche were found more frequently in GH-treated Turner syndrome girls. CONCLUSION Growth hormone therapy can have a co-gonadotropin role in patients with Turner syndrome.
Collapse
Affiliation(s)
- P Sampaolo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Ultrasound of the adolescent female pelvis is the imaging method of choice for most medical problems presenting with symptoms and signs referable to this area. Recognizing the transition from child to mature female and its manifestations are crucial in directing the workup and interpreting the sonographic findings. A description of the normal anatomy and physiology of the pelvic organs is followed by a discussion of the clinical and imaging findings in primary and secondary amenorrhea, pelvic pain, and pelvic masses.
Collapse
Affiliation(s)
- Melissa R Spevak
- Russell H. Morgan Department of Radiology and Radiologic Service, Johns Hopkins Hospital, John Hopkins University, Baltimore, Maryland 21287, USA.
| | | |
Collapse
|
43
|
Herter LD, Golendziner E, Flores JAM, Moretto M, Di Domenico K, Becker E, Spritzer PM. Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:1237-1248. [PMID: 12418765 DOI: 10.7863/jum.2002.21.11.1237] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To describe pelvic sonographic findings in girls as old as 7 years, to compare prepubertal girls with girls who had isolated thelarche or central precocious puberty, and to verify the accuracy of sonographic variables for distinguishing prepubertal girls from girls with central precocious puberty. METHODS Ninety-six prepubertal girls and 2 reference groups (8 girls with isolated thelarche and 8 with idiopathic central precocious puberty) were included. Ovaries were classified morphologically as homogeneous, paucicystic, macrocystic, multicystic, and having isolated cysts. Receiver operating characteristic curves were used to choose the best cutoff points. RESULTS Chronologic and bone age were correlated with uterine length, area, and volume and ovarian volume in prepubertal girls (P < .0001). Ovarian morphologic characteristics in prepubertal girls differed significantly from those of the reference groups (P < .0001). The best cutoff points were uterine length of 4.0 cm, uterine area of 4.5 cm2, uterine volume of 3.0 cm3, and ovarian volume of 1.0 cm3. CONCLUSIONS Uterine and ovarian growth are proportional to age in prepubertal girls. Mean ovarian volume greater than 1 cm3 showed 100% sensitivity and specificity for discriminating between prepubertal girls and girls with central precocious puberty. Microcysts are common in prepubertal girls, but the presence of 6 or more follicles up to 10 mm in diameter may suggest central precocious puberty in girls younger than 8 years.
Collapse
|
44
|
Abstract
OBJECTIVE To derive norms for the size of uterus, uterine shape (fundal-cervical ratio) and ovarian volume in girls in various Tanners stages of puberty. METHODS Pelvic ultrasound was performed in ninety-two healthy girls in the age group of 8-15 years. These included twenty girls each in Tanner stages 1-4 and twelve in stage 5. All the subjects enrolled in the study had a weight and height within 5th-95th percentile of NCHS standards and their bone ages corresponded to the chronological age. Uterine height, fundal-cervical ratio (FCR) and ovarian volume were measured in all the subjects. The data was stratified according to various pubertal stages as well as for different ages. Statistical analysis was carried out to derive the percentiles for the three parameters in different pubertal stages and to study the correlation between these parameters and age, weight and height of the subjects. RESULTS A statistically significant increase in uterine height, FCR and ovarian volume was observed with progressive pubertal stages. Maximum increase in uterine height was observed during the transition from stage 2 to stage 3. All girls beyond the age of 10 years or beyond Tanner stage 2 had a FCR>1. The ovarian volume, after showing an initial increase, tended to plateau and there was no significant increase from stage 4-stage 5. A significant correlation was found between the three parameters and the subject's age, weight and height, the maximum correlation was with age (correlation coefficients being 0.748, 0.648, 0.568 for uterine height, FCR and ovarian volume respectively). Centiles for these parameters were obtained for different pubertal stages. CONCLUSION This work has provided some guidelines for normative data for various pubertal stages as well as for ages between 8-15 years. These may be used as a reference in evaluation of patients with suspected disorders of puberty.
Collapse
Affiliation(s)
- Anju Seth
- Department of Pediatrics and Radiology, Lady Hardinge Medical College, New Delhi, India.
| | | | | | | | | | | |
Collapse
|
45
|
Herter LD, Golendziner E, Flores JAM, Becker E, Spritzer PM. Ovarian and uterine sonography in healthy girls between 1 and 13 years old: correlation of findings with age and pubertal status. AJR Am J Roentgenol 2002; 178:1531-6. [PMID: 12034633 DOI: 10.2214/ajr.178.6.1781531] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to correlate ovarian and uterine sonographic variables with age and pubertal status in a sample of healthy girls. SUBJECTS AND METHODS In this prospective study, 139 consecutive patients between 1 and 13 years old (mean +/- SD, 6.0 +/- 3.4 years) underwent sonography and hand radiography (for bone-age determination). Pubertal development was classified according to Tanner stages (prepubertal, 5.0 +/- 2.7 years [n = 117]; pubertal, 11.2 +/- 1.2 years [n = 22]). Uterine and ovarian longitudinal, transverse, and anteroposterior diameters were measured. Uterine fundal-cervical ratio was determined. Ovaries were morphologically classified as homogeneous, paucicystic, multicystic, macrocystic, and presenting isolated cysts. A p value less than or equal to 0.05 was considered significant. RESULTS The uterus was identified in 96% of the patients (mean, 6.1 +/- 3.4 years). One ovary was visible in 93% (mean, 6.2 +/- 3.4 years), and both ovaries, in 81% (mean, 6.5 +/- 3.3 years). Neither ovary was visualized in 10 girls (mean, 2.5 +/- 2.2 years). Uterine parameters and ovarian volume were smaller in patients without thelarche (p < 0.0001). Mean ovarian and uterine size was smaller in girls until 8 years, intermediate between 9 and 11 years, and larger after 12 years (p < 0.0001). Chronologic age, bone age, and Tanner stage were correlated even before 7 years. Patients with and without thelarche presented different ovarian morphology (p = 0.01). CONCLUSION Uterine and ovarian growth was associated with age and puberty. Uterine length presented the best correlation with age. Multicystic ovaries seemed to be correlated with normal or premature pubertal stimuli.
Collapse
Affiliation(s)
- Liliane Diefenthaeler Herter
- Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos 2350, 90035-903, Porto Alegre, Brazil
| | | | | | | | | |
Collapse
|
46
|
Della Manna T, Setian N, Damiani D, Kuperman H, Dichtchekenian V. Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty. REVISTA DO HOSPITAL DAS CLINICAS 2002; 57:49-54. [PMID: 11981584 DOI: 10.1590/s0041-87812002000200001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Two groups of girls with premature breast development were studied retrospectively. We tried to identify clinical, radiological, and hormonal parameters that could distinguish between a benign, nonprogressive premature thelarche and a true precocious puberty. METHODS The clinical outcome of 88 girls with breast enlargement before 6.1 years of age was analyzed. Taking into account the progression of their sexual maturation, we allocated the children into 2 groups: "Isolated Premature Thelarche" (n = 63) and "Precocious Puberty" (n = 25) groups. Chronological and bone ages, height and growth velocity centiles, computerized tomography of hypothalamus-pituitary area, pelvic ultrasonography, gonadotropin response to luteinizing hormone-releasing hormone stimulation as well as basal levels of luteinizing hormone, follicle-stimulating hormone, estradiol, and prolactin were studied in both groups. Statistical analysis were performed using the Student t test to compare the sample means. Fisher's exact test and chi2 test were used to analyze the nonparametric variables. RESULTS Isolated premature thelarche most frequently affected girls younger than 2 years who presented exaggerated follicle-stimulating hormone response to luteinizing hormone-releasing hormone stimulation test. The precocious puberty group had higher initial stature, accelerated growth rate and bone age, increased uterine and ovarian volumes, high spontaneous luteinizing hormone levels by immunofluorimetric assay, as well as a high luteinizing hormone response and peak luteinizing hormone/follicle-stimulating hormone ratio after luteinizing hormone-releasing hormone stimulation. CONCLUSION At initial presentation, girls who undergo true precocious puberty present advanced bone age, increased uterine and ovarian volumes in addition to breast enlargement, as well as an luteinizing hormone-predominant response after a luteinizing hormone-releasing hormone stimulation test.
Collapse
Affiliation(s)
- Thais Della Manna
- Unit of the Children's Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
| | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- Carl-Joachim Partsch
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian-Albrechts University, Kiel, Germany
| | | | | |
Collapse
|
48
|
van Hooff MH, Voorhorst FJ, Kaptein MB, Hirasing RA, Koppenaal C, Schoemaker J. Polycystic ovaries in adolescents and the relationship with menstrual cycle patterns, luteinizing hormone, androgens, and insulin. Fertil Steril 2000; 74:49-58. [PMID: 10899496 DOI: 10.1016/s0015-0282(00)00584-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the possible role of inappropriate LH secretion, hyperandrogenism, and hyperinsulinemia in the development of polycystic ovaries (PCO) and the polycystic ovary syndrome. DESIGN Observational. SETTING General population samples. PARTICIPANTS 58 adolescents with regular menstrual cycles, 50 with irregular menstrual cycles, and 29 with oligomenorrhea (age 16.7+/-0.9 years). INTERVENTIONS Transabdominal pelvic ultrasonography and vena puncture. MAIN OUTCOME MEASURES PCO; LH, androstenedione, and testosterone levels; overnight fasting insulin concentrations; and oligomenorrhea. RESULTS The prevalence of PCO increased significantly with the irregularity of the menstrual cycle pattern, as illustrated by the study, finding PCO in 9% of the girls with regular menstrual cycles, 28% of those with irregular menstrual cycles, and 45% of oligomenorrheic girls. The LH and androgen concentrations were significantly higher in girls with PCO; the insulin levels and the glucose-insulin ratio did not differ when the girls with PCO were compared with girls with normal ovaries. Oligomenorrheic girls with PCO had the highest androgen and LH concentrations; their insulin concentrations and glucose-insulin ratio were in the same range as girls with regular menstrual cycles and normal ovaries; and both their hip and waist girths were wider, although their waist-hip ratio was normal. CONCLUSIONS PCO in adolescents is associated with irregular menstrual cycles, oligomenorrhea, and/or high androgen and LH levels; but no relationship was found with the insulin level or glucose-insulin ratio. Thus, it is doubtful that hyperinsulinemia is an important factor in the development of PCO or polycystic ovary syndrome.
Collapse
Affiliation(s)
- M H van Hooff
- Division of Reproductive Endocrinology and Fertility, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
49
|
Jensen AM, Brocks V, Holm K, Laursen EM, Müller J. Central precocious puberty in girls: internal genitalia before, during, and after treatment with long-acting gonadotropin-releasing hormone analogues. J Pediatr 1998; 132:105-8. [PMID: 9470009 DOI: 10.1016/s0022-3476(98)70493-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pelvic ultrasonography was systematically performed on 33 girls with idiopathic central precocious puberty to investigate the impact of treatment with gonadotropin-releasing hormone analogues on female internal genitalia. All girls were treated with a long-acting gonadotropin-releasing hormone analogue (Decapeptyl Depot; Ferring Co., Copenhagen, Denmark) 75 micrograms/kg every 4 weeks. Before, during, and after treatment, pelvic ultrasonography was performed and ovarian and uterine volumes were calculated. The size of follicles > 5 mm were accurately measured. The results were related to a normative study of healthy Danish schoolgirls. Our data demonstrated that ovaries and uterus are enlarged in a significant number of girls (50%) with the diagnosis of central precocious puberty at the time of diagnosis. Median ovarian volume at time of diagnosis was 1.1 standard deviation scores (range -0.6 to 3.2 SD), median uterine volume was 1.8 standard deviation scores (range 0.0 to 3.5 SD). Within 3 months of treatment, both ovarian and uterine volumes decreased significantly (p < 0.01) to normal values appropriate for age. Median ovarian volume after 3 months of treatment was 0.0 SD (range -2.4 to 1.5 SD); median uterine volume was 0.7 SD (range -0.6 to 4.1 SD). Ovarian and uterine volume remained within normal range (< 2 standard deviation scores) after discontinuation of treatment. Follicles and macrocysts regressed during treatment. None of the girls' ovaries had a polycystic appearance during or after treatment with the gonadotropin-releasing hormone analogue. Our results confirmed pelvic ultrasonography as a reliable tool for investigation of internal genitalia in girls with precocious puberty and as a valid method for evaluation of the efficacy of treatment with gonadotropin-releasing hormone analogues. We suggest that repeated investigations be performed when evaluating treatment because the morphologic changes, including follicular maturation or regression, reflect ovarian stimulation or suppression. We found no evidence that girls with precocious puberty treated with long-acting gonadotropin-releasing hormone analogues have enlarged polycystic ovaries develop.
Collapse
Affiliation(s)
- A M Jensen
- Department of Growth and Reproduction, Rigshospitalet, State University Hospital, Denmark
| | | | | | | | | |
Collapse
|
50
|
Verrotti A, Ferrari M, Sabatino G, Morgese G, Chiarelli F. Serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 levels in children with precocious puberty treated with gonadotropin-releasing hormone analog without or in combination with cyproterone acetate. Gynecol Endocrinol 1997; 11:243-50. [PMID: 9272420 DOI: 10.3109/09513599709152541] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In order to assess the behavior of growth hormone, insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) in girls with central precocious puberty treated with gonadotropin-releasing hormone (GnRH) analog-therapy, we studied 14 girls with this condition, the patients were subdivided into two groups, according to the therapy followed. Group A (n = 7; age 4.2-7.1 years) received GnRH analog in combination with cyproterone acetate, and Group B (n = 7; age 4.4-6.9 years) received long-acting analog alone. Before treatment, IGF-I levels were significantly increased compared to healthy age-matched children in the two groups (447 +/- 33 micrograms/l for Group A and 435 +/- 38 micrograms/l for Group B vs. control 175 +/- 78 micrograms/l; p < 0.01). Moreover, serum IGFBP-3 levels were significantly higher than the age-related reference range for IGFBP-3 (4478.2 +/- 178 micrograms/l for Group A and 4532.3 +/- 167 micrograms/l for Group B vs. control 2905 +/- 641 micrograms/l; p < 0.01). During the two years of gonadal suppression, Group A patients showed a significant decrease in IGF-I and IGFBP-3 levels, while in Group B there was no significant change in IGF-I; moreover, in Group B, IGFBP-3 levels increased significantly compared to baseline values during the first year of treatment (4532.3 +/- 167 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.05) and decreased significantly at the end of the second year of treatment (3816.1 +/- 189 micrograms/l vs. 5410.3 +/- 169 micrograms/l; p < 0.01). Our study shows that the two different treatments of precocious puberty (with and without cyproterone acetate) have different effects on IGF-I and IGFBP-3, and suggests that these growth factors are under different metabolic regulation.
Collapse
Affiliation(s)
- A Verrotti
- Department of Pediatrics, University of Chieti, Italy
| | | | | | | | | |
Collapse
|