IMPE Abstracts

Background: Assessment of pubertal disorders is challenging for the pediatricians causing unnecessary evaluation on one hand while missing pathology on the other. The paucity of pediatric endocrine centers further adds to the problem in resource poor settings. We have developed puberty interpreter, a mobile application that provides instantaneous guidance regarding diagnosis and management of children and adolescents with concern for pubertal disorders based on the input of age, tanner staging (breast, pubic hair, and menarchal status in girls; testicular volume and pubic hair status in boys), and growth parameters (height and height SDS for bone age).

Aim: To evaluate the predictive accuracy of puberty interpreter in children and adolescents with concerns of early or delayed puberty.

Methods: The study involved the development and validation of the mobile application. The diagnostic algorithm was based on published protocols for evaluating pubertal disorders using clinical data (height, age, pubertal status, and bone age). The algorithms were then uploaded to our Mobile application. The guidance provided by the application was compared to clinical diagnosis in 412 children (127 boys) presenting with concern for pubertal disorders (250 with early and 162 with delayed puberty).

Results: The application guidance was concordant with clinical diagnosis in 405 (98.3%) cases. Discordance with clinical diagnosis included an erroneous diagnosis of central cause in a boy with CAH with triggered puberty and the labelling of three girls with central cause as peripheral. In subjects with delayed puberty the application guidance included an inaccurate diagnosis of obstructive cause in a girl with acquired hypogonadism, CDGP in a girl with hypopituitarism and Complete androgen insensitivity syndrome in a girl with systemic disease.

Conclusion: Puberty Interpreter based guidance for the assessment of pubertal disorders is expected to allow a rational point of care evaluation in the community.