J Korean Med Sci.  2017 Feb;32(2):296-302. 10.3346/jkms.2017.32.2.296.

Predictive Value of Dental Maturity for a Positive Gonadotropin-Releasing Hormone Stimulation Test Result in Girls with Precocious Puberty

• Baik JS
• Choi JW
• Kim SJ
• Kim JH
• Kim S
• Kim JH

• KMID: 2364174
• DOI: http://doi.org/10.3346/jkms.2017.32.2.296

Abstract

Dental maturity is associated with skeletal maturity, which is advanced in girls with central precocious puberty (CPP). We investigated the performance of dental maturity as a screening method for CPP using mandibular second premolar and molar calcification stages, assessed the associated anthropometric and laboratory factors, and evaluated pubertal response predictors using the gonadotropin-releasing hormone stimulation test (GnRHST) in prepubertal and pubertal girls. A prospective case-control study was conducted in girls, aged 7.0-8.9 years, classified into pubertal (peak luteinizing hormone [LH] after GnRHST ≥ 5 IU/L), prepubertal (peak LH < 5 IU/L), and control groups. Auxological and biochemical tests, panoramic radiographs, and GnRHSTs in participants with breast development were conducted. Dental maturity was assessed using the Demirjian index (DI). We included 103 girls (pubertal, 40; prepubertal, 19; control, 44). Chronological age (CA) was not significantly different between groups. Bone age (BA) and BA advancement was higher in the pubertal and prepubertal groups. Increased DI values at the mandibular second premolar and molar were significantly associated with CA, BA, BA advancement, height standard deviation score (SDS), peak LH after GnRHST, and insulin-like growth factor-I (IGF-I) (all P < 0.05). Moreover, odds ratio (OR) of the mandibular second premolar and molar (a DI value of ≥ E) for predicting a positive response to GnRHST was 8.7 (95% confidence intervals [CI], 2.9-26.1) and 5.2 (95% CI, 2.2-12.7), respectively. Dental maturity was a strong predictor for diagnosing CPP. Determining dental maturity in girls with suspected precocious puberty might help determine the performance of GnRHSTs.

Keyword

Dental Maturity; Precocious Puberty; Diagnosis; Girls

MeSH Terms

Bicuspid
Breast
Case-Control Studies
Diagnosis
Female*
Gonadotropin-Releasing Hormone*
Humans
Luteinizing Hormone
Mass Screening
Methods
Molar
Odds Ratio
Prospective Studies
Puberty, Precocious*
Gonadotropin-Releasing Hormone
Luteinizing Hormone

Figure

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  Fig. 1 Schematic illustration of the DI for dental maturity (13). DI = Demirjian index.

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  Fig. 2 Distributions of DIs among the participants according to teeth and groups. DI = Demirjian index.

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  Fig. 3 Differences between the factors according to the DI. DI = Demirjian index, BA = bone age, LH = luteinizing hormone, GnRHST = gonadotropin-releasing hormone stimulation test, IGF-I = insulin-like growth factor-I.

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