CENTRAL PRECOCIOUS PUBERTY IN GIRLS - INTERNAL GENITALIA BEFORE, DURING, AND AFTER TREATMENT WITH LONG-ACTING GONADOTROPIN-RELEASING-HORMONE ANALOGS

Pelvic ultrasonography was systematically performed on 33 girls with i diopathic central precocious puberty to investigate the impact of trea tment with gonadotropin-releasing hormone analogues on female internal genitalia. All girls were treated with a long-acting gonadotropin-rel easing hormone analogue (Decapeptyl Depot; Ferring Co., Copenhagen, De nmark) 75 mu g/kg every 4 weeks. Before, during, and after treatment, pelvic ultrasonography was performed and ovarian and uterine volumes w ere calculated. The size of follicles > 5 mm were accurately measured. The results were related to a normative study of healthy Danish schoo lgirls. Our data demonstrated that ovaries and uterus are enlarged in a significant number of girls (50%) with the diagnosis of central prec ocious 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 t o 3.5 SD). Within 3 months of treatment, both ovarian and uterine volu mes decreased significantly (p < 0.01) to normal values appropriate fo r age. Median ovarian volume after 3 months of treatment was 0.0 SD (r ange -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 s tandard deviation scores) after discontinuation of treatment. Follicle s and macrocysts regressed during treatment. None of the girls' ovarie s had a polycystic appearance during or after treatment with the gonad otropin-releasing hormone analogue. Our results confirmed pelvic ultra sonography 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 analo gues. We suggest that repeated investigations be performed when evalua ting treatment because the morphologic changes, including follicular m aturation or regression, reflect ovarian stimulation or suppression. W e found no evidence that girls with precocious puberty treated with lo ng-acting gonadotropin-releasing hormone analogues have enlarged polyc ystic ovaries develop.