Clinical and Laboratory Parameters of Gonadotropin-Releasing Hormone Analog Treatment Effectiveness in Children with Precocious Puberty

Abstract

OBJECTIVE:There are no doubts about the clinical benefits of treatment with GnRH analogs for patients diagnosed with central precocious puberty (CPP). However, laboratory monitoring of CPP is still a matter of considerable controversy in the literature. Therefore, the main objective of this study was to evaluate the cut-off values of stimulated LH that determine gonadotrophic suppression.METHODS:Twenty-four girls, on treatment with leuprorelin acetate (LA) at 3.75 mg IM every 28 days, were studied. The clinical parameters used to indicate clinical effectiveness were regression or maintenance of sexual characteristics according to the Tanner stage, growth velocity reduction, reduction or maintenance of the difference between bone age and chronological age and maintenance or improvement of the final height prediction. For the laboratory effectiveness test, basal estradiol, LH, and FSH levels were collected before and 1 and 2 h after the administration of 3.75 mg LA.RESULTS:Eleven girls showed improvement in all clinical parameters, and their effectiveness tests were compared to those of the other patients to calculate the cut-off values, which were ≤3.64 IU/L (p=0.004*) for LH after 1 h and ≤6.10 IU/L (p<0.001*) for LH after 2 h.CONCLUSION:The LH response after the LA stimulation test, associated with clinical data and within a context of CPP, constitutes a reliable and feasible resource and can assist in monitoring the effectiveness of treatment.

Assessment of Gonadotropin Concentrations Stimulated by Gonadotropin-Releasing Hormone Analog by Electrochemiluminescence in Girls with Precocious Puberty and Premature Thelarche

“…Such differences indicate the relevance of defining cutoff values according to the laboratory dosage method. Furthermore, most of the children had an LH peak at 60 min as suggested by Fujita et al [31], exempting the child from prolonged waiting and stress.…”

Triptorelin stimulated luteinizing hormone concentrations for diagnosing central precocious puberty: study of diagnostic accuracy

“…Thus, the GnRH stimulation test continues to be the gold standard for discriminating IPT vs CPP in girls with premature thelarche [9][10][11][12][13]. Due to frequent unavailability of intravenous GnRH in many countries, stimulation testing with a widely available GnRH analog such as triptorelin, shown to induce comparable peaks of LH secretion, has been proposed as an alternative test for diagnosing CPP [3,11,12,[16][17][18][19][20]. In the present study, the potency of triptorelin to stimulate LH secretion has been confirmed by a significant strong correlation of peak LH responses after triptorelin injection compared to peak GnRH-stimulated LH concentrations (Fig.…”

“…However, we must always have in mind that not everyone in the world has access to the same level of medical care, including the medications available for both diagnostic and therapeutic purposes. That is exactly the case with the intravenous GnRH preparation that is often unavailable in countries such as India, Brazil, Thailand, or Serbia [11,12,[16][17][18][19]. Also, with the widespread drug shortages seen during the current COVID-19 crisis and the global disruption of supply chains, the availability of the intravenous GnRH preparation may become affected even in wealthier countries worldwide [35,36].…”

“…Ultrasensitive chemiluminescence assays are used in many centers to analyze LH, and a peak GnRH-stimulated LH concentration ≥5.0 IU/L is commonly used to define HPG activation in girls with premature thelarche [3,14,15]. However, intravenous GnRH preparation is not always readily available, in contrast to GnRH analogs such as triptorelin [11,12,[16][17][18][19]. Stimulation of the HPG axis with GnRH analogs has been proposed as an alternative to the gold standard GnRH test [3,11,12,20].…”

Effectiveness of the triptorelin stimulation test compared with the classic gonadotropin-releasing hormone stimulation test in diagnosing central precocious puberty in girls

“…Gonadotropin-dependent precocious puberty, or central precocious puberty (CPP), is caused by premature activation of the HPG axis and can be treated with GnRH agonists. Patient history, physical examination, basal gonadotropin levels, and laboratory tests can be used to diagnose CPP [ 4 , 5 ] The GnRH stimulation test is considered the gold standard for detecting activation of the HPG axis [ 6 , 7 ]. CPP is diagnosed when bone age is more than 1 year higher than chronological age and when the peak luteinizing hormone (LH) level is above 5 mIU/mL during the GnRH stimulation test.…”