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Objective To evaluate the role of ultrasound and color Doppler analyses in improving the differential diagnosis of pubertal precocities. Methods Sixty-nine girls with premature (< 8 years old) breast development and/or pubic hair growth underwent: auxological (height, weight, body mass index, skeletal maturation), hormonal (basal, gonadotropin releasing hormone (GnRH)-test, adrenocorticotropic hormone test), and sonographic (uterine and ovarian volume and endometrial echo) including color Doppler (uterine arteries) evaluations. Results The uterine size was greater in girls with a pubertal response to the GnRH test (Group II, n = 16; 7.48 ± 4.18 mL) than in those with a prepubertal response to the GnRH test (Group I, n = 17; 3.02 ± 1.36 mL; P = 0.006), an isolated pubarche (Group III; n = 20; 2.58 ± 1.32 mL; P < 0.001) or an isolated thelarche (Group IV, n = 16; 1.82 ± 1.07 mL; P < 0.001). Endometrial echo was observed in 87.5%, 29.4% and 5% of girls, respectively, in Groups II, I and III. The Doppler analysis of the uterine arteries showed the lowest impedance to be in patients with a pubertal response to the GnRH test (Group II). Conclusions Sonographic and color Doppler parameters may improve the diagnosis of GnRH-dependent precocious puberty and may be useful to determine which girls need treatment. [ABSTRACT FROM AUTHOR]