G1. SELECTING GIRLS WITH PRECOCIOUS PUBERTY FOR BRAIN IMAGING: EUROPEAN VALIDATION OF AN EVIDENCE-BASED DIAGNOSIS RULE

M. Chalumeau, C.G. Hadjiathanasiou, S.M. Ng, A. Cassio, D. Mul, M. Cisternino, C.J. Partsch, C. Theodoridis, M. Didi, E. Cacciari, W. Oostdijk, A. Borghesi, W.G. Sippell, G. Bréart, R. Brauner.

INSERM U149, Paris-France and Pediatric Endocrinology Departments in Athens-Greece, Liverpool-UK, Bologna and Pavia-Italy, Rotterdam and Leiden-The Netherlands, Kiel-Germany, Paris-France

Background: Central precocious puberty (CPP) reveals an occult intracranial lesion (OICL) in 5–10% of affected girls. Systematic brain imaging is recommended but is normal and then not contributive in 90–95% of the cases. Recently, two American groups formulated distinct guidelines to select girls with CPP who require brain imaging. A previous single-center study found those recommendations to lack sensitivity to identify OICL and had proposed a 100% sensitivity, evidence-based, diagnosis rule, combining two independent predictors of OICL: age at puberty onset (ie, breast development) <6 years, and estradiol (E2) level >45th percentile of girls with idiopathic CPP.

Aim: To validate our previous findings on a large population.

Methods: A retrospective, multicenter, hospital-based, cohort study was performed, including all girls with CPP seen in 7 centers, in 6 European countries during given periods. American recommendations and the stability of our previously derived diagnosis rule were tested.

Results: 443 girls with CPP, including 35 with OICL, were recruited. American recommendations did not identify all OICL. Previously identified independent risk factors for OICL were confirmed: age <6 years (adjusted odds ratio 20.5, 95% CI 8.1–52.1) and E2 >45th percentile (3.0, 95% CI 1.3–7.1). The previously derived diagnosis rule had 100% sensitivity (95% CI 90–100): all girls with OICL had either an age <6 years or an E2 level >45th percentile. The specificity was 39% (95% CI 34–44).

Conclusions: American recommendations do not seem safe to select European girls with CPP who require brain imaging. In settings where systematic brain imaging is not possible, the …