Automatic bone age determination in adult height prediction for girls with early variants puberty and precoccious puberty

Abstract

Introduction: In cases of precocious puberty, the determination of bone age (BA) is usually performed by clinicians using the Greulich Pyle (GP) atlas, and there can be significant variation between assessors. The aim of this study is to compare predicted adult height (PAH) calculations based on BA read by the automated bone age method (BoneXpert) with clinician-determined BA-based PAH calculations. Method: A total of forty-four girls who presented with suspicion of precoccious puberty and normal pubertal variants such as premature thelarche and premature adrenarche, and whose BA determined by both BoneXpert and two different clinicians were followed-up until reaching near final height (NFH). Those whose breast development started before the age of 8 years were considered as precocious puberty. Four PAH calculations were performed with 2 different estimated height calculation methods [Bayley Pineau-BP and Roche-Wainer-Thissen-RWT] based on two different BA predictions [Clinician-GP and BoneXpert-GP). PAH-standard deviation score (PAH-SDS) and NFH-SDS values of the patients were compared. Results: The median chronological age at the presentation was 9.3 years, while the median BA was 10.4 years and 10.6 years according to Clinician-GP and BoneXpert-GP, respectively; mean height-SDS was 0.75 and TH-SDS was -0.28. When they reached NFH, the height-SDS was -0.02. Final analyzes were performed on 26 cases who did not have low birth weight and did not receive puberty arresting treatment. Delta PAH-SDS - NFH-SDS (Δ-SDS) was compared according to 4 different PAH values. The closest PAH-SDS value measurement to NFH-SDS was calculated by BP based on BA determined by the BX-GP method (-0.09). Conclusion: PAH calculations using the BP method based on BoneXpert-derived GP readings most accurately predict near-final height in girls with precocious puberty, and normal pubertal variants.