Abstract:
Background: Precocious puberty is characterized by the onset of secondary sexual characteristics before 8 years in girls and 9 years in boys and may have a central or peripheral origin. Its evaluation is necessary due to the potential implications for growth, adult height, and psychosocial development. In this context, bone age determined by hand and wrist radiography allows for the assessment of skeletal maturation and its advancement relative to chronological age, contributing to the estimation of pubertal progression and growth potential.This review aimed to evaluate the role of imaging methods in the assessment of precocious puberty.
Methods: A narrative literature review was conducted using PubMed, SciELO, and LILACS. The search strategy included the terms “Early Puberty,” “Precocious Puberty,” “Puberty, Precocious,” “Bone Age,” “Skeletal Age,” “Bone Maturation,” “Skeletal Maturation,” and “Diagnostic Imaging,” combined using the AND and OR operators. Articles published between 2021 and 2026 in Portuguese, English, or Spanish, with the full text available, were included. Case reports, editorials, animal studies, duplicates, and studies inconsistent with the review objective were excluded.
Results: Studies indicate that the evaluation of precocious puberty should include clinical signs, associated factors, skeletal maturation, hormonal parameters, and imaging methods. Bone age (BA), determined primarily by hand and wrist X-rays, was found to be more advanced in girls with central precocious puberty (CPP) compared to their chronological age. Its use alone had limitations: considering an advance of more than 2 standard deviations, sensitivity was 29.4% (95% CI: 10.3–56) and specificity was 96.2% (95% CI: 80.4–99.9). Elbow bone age was found to be more advanced than that of the hand, and its correlation with the VUNO score (r = 0.898) reinforces the possibility of using different anatomical regions. The combination of ultrasound (US) and BA yielded complementary results. Pelvic ultrasound showed high specificity but limited sensitivity, with the uterine body >3 cm and ovarian volume being the most notable findings. Uterine volume showed a stronger correlation with BA than with chronological age. In breast ultrasound, the identification of breast tissue showed higher sensitivity, a good correlation with the Tanner stage, and a 48% probability of progression, although specificity was low. The combination of methods showed better diagnostic performance: bone age combined with ultrasound achieved an AUC of 0.895 (95% CI: 0.851–0.938), which was higher than ultrasound alone (0.869) and bone age alone (0.758).Recent studies using artificial intelligence also suggest potential improvements in the reproducibility and accuracy of bone age assessment.
Conclusion: Bone age assessment remains a valuable imaging tool in the evaluation of precocious puberty, particularly for assessing skeletal maturation and growth potential. However, its limited sensitivity when used alone highlights the importance of integrating bone age with clinical, hormonal, and other imaging findings. Ultrasound provides complementary information on target organs and may improve diagnostic performance when combined with bone age assessment. Further studies are needed to standardize alternative anatomical approaches, validate artificial intelligence-based methods across populations, and expand evidence in boys.
Biography:
Maria Clara Regadas is a third-year medical student at Uni Christus, Brazil, She has previous experience in scientific research, including an undergraduate research project focused on Brazilian youth in marginalized communities. She currently works as a Pathology teaching assistant and serves as President of the Radiology and Diagnostic Imaging League at her University. Her academic interests include pediatrics, diagnostic imaging, and clinical research. She has contributed to several scientific studies and presented research at regional and national medical conferences.
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