RESUMO
The aim of this study was to describe the ovarian structure (OS) and its relationship with hyperandrogenism in girls with premature pubarche (PP). A pelvic ultrasound was carried out in 23 girls with PP and in 57 prepubertal age-matched controls (C), and the OS was subdivided into five classes (c): 1-homogeneous; 2-microcystic, 3-multicystic, 4-polycystic and 5-follicular. In the girls with PP, an ACTH test was performed, and the presence of hormonal levels >3 SD of postpubertal normal levels and not compatible with late-onset congenital adrenal hyperplasia were considered an exaggerated response. The fasting levels of glucose (G) and insulin (I) were measured and the fasting I to G ratio (FIGR) was calculated. FIGR >22 was suggestive of I resistance (IR). The microcystic structure (c2) was more frequently found in the PP than in the C group (63% vs 35%, p=0.03). In the PP group, we observed the following OS: cl (n=6), c2 (n=15), c3 (n=1) and c4 (n=1). 11-Deoxycortisol--both basal and after ACTH--was greater in the PPc2 group than in PPc1 (p=0.04, p=0.0008, respectively). We also observed an exaggerated response to ACTH in 87% of the girls with PP, greater in the PPc2 group than in PPc1 (p=0.04). The FIGR showed IR in 44% of girls with PP, but I levels and FIGR were similar between PPc1 and PPc2. These findings suggest generalized adrenocortical hyperresponsiveness in girls with PP, which is more accentuated in PPc2. Long-term follow-up of girls with PP into adulthood is warranted to ascertain whether microcystic ovarian structure precedes functional ovarian hyperandrogenism.
Assuntos
Hiperandrogenismo/fisiopatologia , Ovário/anatomia & histologia , Puberdade Precoce , Hormônio Adrenocorticotrópico/sangue , Androgênios/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Cistos Ovarianos/classificação , Ovário/patologiaRESUMO
This paper reviews the clinical findings, pituitary gonadotrophin reserve, plasma estradiol and androgens, radiological findings and pelvic ultrasound appearance in 17 girls with true precocious puberty (PP), and attempts to asses the value of these tests diagnosis in the clinical management of such patients and better understanding of the pathogenesis of this disorder. As noted in other series, acceleration of growth is one of the earliest features of PP and at the time of diagnosis bone age can be already significantly advanced. In 3 (18%) patients intracranial abnormalities were present. Ultrasound examination showed changes similar to those seen during normal puberty. To conclude, the introduction of high-resolution methods (CT scan and RM) and techniques for ultrasound examination have greatly simplified the clinical investigation of female precocious puberty.