Distinguishing Central Precocious Puberty from Non-Progressive Breast Development: Adiposity and DXA Body Composition
Daniela Fava, Amanda Casirati, Maria Grazia Calevo, Alessia Angelelli, Alessia Pepe, Nadia Gabriella Maiorano, Lucia Acquarone, Chiara Santucci, Claudia Caridi, Valentina Tosto, Marta Panciroli, Caterina Tedesco, Flavia Napoli, Anna Elsa Maria Allegri, Giuseppa Patti, Alessandro Naim, Roberto Gastaldi, Mohamad Maghnie, Natascia Di IorgiAbstract
Objective
Distinguishing central precocious or early puberty (CPP/EP) from non-progressive premature breast development (npPBD) is challenging, particularly in the context of increasing childhood adiposity, which may affect growth and skeletal maturation independently of hypothalamic-pituitary-ovarian (HPO) axis activation.
Methods
We retrospectively evaluated 100 girls (69 CPP/EP, 31 npPBD) and 16 age-matched prepubertal girls with obesity as controls. Assessments included auxology, bone age, hormonal and metabolic profiles, pelvic ultrasound, DXA-derived body composition, and lifestyle factors.
Results
Anthropometric parameters and bone age were similar between CPP/EP and npPBD, whereas LH, FSH, estradiol, and IGF-1 SDS (all p < 0.001) remained the main discriminators between groups. Overall body composition was comparable, except for a higher android-to-gynoid fat ratio in npPBD (p = 0.03). In both diagnostic groups, overweight/obesity was associated with greater height relative to target height (p = 0.004 in CPP/EP; p = 0.03 in npPBD) and higher IGF-1 SDS (p < 0.001 and p = 0.02, respectively) compared with controls. Among normal-weight girls, those with CPP/EP showed greater height relative to target height (p = 0.009) and more advanced bone age (p = 0.02) than those with npPBD, whereas these differences were not observed in girls with overweight/obesity.
Conclusions
Excess adiposity reduces the diagnostic specificity of auxological and skeletal maturation parameters in girls with early breast development. Biochemical assessment remains central, with IGF-1 SDS providing additional supportive information.