OVARIES IN SEXUAL PRECOCITY

BACKGROUND AND OBJECTIVE Ovarian ultrasonography may be helpful in distinguishing the various types of precocious puberty, and the ovarian appearances increasingly influence choice of therapy in these girls. We examined retrospectively the ovarian volume and prevalence of polycystic ovarian appearance at ultrasound in girls with sexual precocity. DESIGN Ultrasound examinations were obtained from girls who presented with sexual precocity. If there were several scans from the same individual, the latest was analysed. PATIENTS The girls were divided into groups: untreated central precocious puberty (n = 25), central precocious puberty treated with GnRH analogue (n = 18) or with GnRH analogue and recombinant human GH (n = 11), girls who had stopped treatment with GnRH analogue and GH (n = 12), premature thelarche and thelarche variant (n = 15) and premature adrenarche (n = 14). MEASUREMENTS Ovarian volume was calculated and the ovaries were assessed for polycystic appearance using standard criteria. Ovarian volume standard deviation (SD) scores were calculated using means and standard deviations derived from a control population and compared using analysis of variance. Differences from control data were assessed using Student's t-test. RESULTS Ovarian volume SD scores for all the groups studied were greater than those for control subjects. Girls who had stopped treatment with GnRH analogue and GH had mean ovarian volume of 6.98 ml and ovarian volume SD score (+1.72) greater than that of girls having treatment with GnRH analogue alone (+1.24). Polycystic appearance ovaries were found in 83% of scans in girls who had stopped treatment with GnRH analogue and GH. The ovarian volume SD score of girls with premature adrenarche was less than that of girls with untreated central precocious puberty. CONCLUSIONS Girls with central precocious puberty had large ovaries which did not return to a volume appropriate for age. Girls treated with GnRH analogue and GH developed very large ovaries when they stopped treatment, and had an increased prevalence of ovaries with a polycystic appearance. Central precocious puberty, or some aspect of its treatment, results in an increased prevalence of polycystic ovarian appearance.