Significance of ultrasonographic examinations in the diagnosis of premature and normal puberty in girls

: Dynamic and individual course of the processes being associated with puberty and also the necessity of establishing instantaneous diagnosis of disturbances occurring at that period made it indispensable to apply simple and non-invasive diagnostic methods. The aim of the study was to estimate the usefulness of ultrasonographic measurements of the first- and second-rate genital features in the course of normal puberty, as well as differentiating, on the basis of the said measurements, various forms of premature puberty. Ultrasonographic examination of the internal genital organs allows for their precise assessment, without any simultaneous invasiveness ascribed to the method. The study material comprised 248 girls. The normal puberty was evaluated in 138 girls. The studied girls were divided into groups by resorting to gynaecological criteria, it means, from the age proceeding since the menarche, considered as being modern and highly objective criteria of development. The study also included 64 girls with different forms of premature puberty, as well as a group of 46 healthy girls lodging in the same age compartment. All the studied persons were evaluated with regard to measurements of the ovary length, width, thickness and volume. The ratio of volume of the left ovary to the right one was calculated, with the size and the number of ovarian follicles being evaluated by employing the four-grade scale in own modification (F1 5 mm). At evaluating the uterus, the accomplished measurements included the length of uterine cervix, the length, width, thickness and the volume of the body of the uterus. Next, the ratio of the cervical length to the body of uterus was calculated. The presence or absence of endometrium in the uterine cavity as well as within the cervical canal was estimated too. In menstruating girls the investigations were performed between 7-9 day of the cycle. The ultrasonographic examinations were carried out with a trans abdominal probe, the frequency being 3.5 or 5 MHz, with apparatus of Bruel & Kjaer or Acusson Companies. The established results were elaborated statistically. In the course of normal puberty the ovarian development is dynamic and involves both glands (Tab. 1-4). At the same period the body of the uterus increases while the cervical length remains unchanged (Tab. 6-9). The termination of the morphological development concerning the first- and second-rate genital features occurs at the time of gynaecological age +2. The girls with premature puberty of the central origin as compared with the control group display higher degree of development of the first- and second-rate genital features (Tab. 10-14). These differences are not observed in girls with premature development of mammary glands (Tab. 11-15) and also with premature growth of public hair (Tab. 12-16). The results of the studies have made it possible to provide the following conclusions: the ultrasonographic examinations of the first- and second-rate genital features constitute a valuable aid for determining the stages of normal puberty, thus facilitating the detection and differentiation of the disturbances. The ultrasonographic examination claims to be a basic diagnostic method for various forms of premature puberty.