Adequacy of a Single Unstimulated Luteinizing Hormone Level to Diagnose Central Precocious Puberty in Girls

Houk, Christopher P.; Kunselman, Allen R.; Lee, Peter A.

doi:10.1542/peds.2008-1180

Cited by 127 publications

(98 citation statements)

References 12 publications

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“…The sensitivity of serum LH at baseline morning for diagnosis of CPP, mainly in girls, varies between 60 and 100%, depending on the cutoff value and laboratory methodology (16 Table 2 (27,28,(30)(31)(32)(33)(34)(35)(36)(37)(38). In girls, serum levels of E2 are not used to diagnose CPP, considering their low sensitivity and large overlap between normal prepubertal and pubertal children (26).…”

Section: Laboratory Diagnosis Hormonal Assessmentmentioning

confidence: 99%

Central precocious puberty: revisiting the diagnosis and therapeutic management

Brito

Spinola-Castro

Kochi

et al. 2016

Arch. Endocrinol. Metab.

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Clinical and laboratory diagnosis and treatment of central precocious puberty (CPP) remain challenging due to lack of standardization. The aim of this revision was to address the diagnostic and therapeutic features of CPP in Brazil based on relevant international literature and availability of the existing therapies in the country. The diagnosis of CPP is based mainly on clinical and biochemical parameters, and a period of follow-up is desirable to define the "progressive" form of sexual precocity. This occurs due to the broad spectrum of pubertal development, including isolated premature thelarche, constitutional growth and puberty acceleration, progressive and nonprogressive CPP, and early puberty. Measurement of basal and stimulated LH levels remains challenging, considering that the levels are not always in the pubertal range at baseline, short-acting GnRH is not readily available in Brazil, and the cutoff values differ according to the laboratory assay. When CPP is suspected but basal LH values are at prepubertal range, a stimulation test with short-acting or long-acting monthly GnRH is a diagnostic option. In Brazil, the treatment of choice for progressive CPP and early puberty is a long-acting GnRH analog (GnRHa) administered once a month or every 3 months. In Brazil, formulations of GnRHa (leuprorelin and triptorelin) are available and commonly administered, including 1-month depot leuprorelin 3.75 mg and 7.5 mg, 1-month depot triptorelin 3.75 mg, and 3-month depot leuprorelin 11.25 mg. Monthly or 3-month depot GnRHa are effective and safe to treat CPP. Arch Endocrinol Metab. 2016;60(2):163-72

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Section: Laboratory Diagnosis Hormonal Assessmentmentioning

confidence: 99%

Central precocious puberty: revisiting the diagnosis and therapeutic management

Brito

Spinola-Castro

Kochi

et al. 2016

Arch. Endocrinol. Metab.

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“…Basal LH has been recommended as a surrogate for peak LH in diagnosis of CPP [20, 21]; in this study basal LH correlated modestly with peak LH at diagnosis, although in some subjects the diagnostic peak LH was not associated with a clearly pubertal basal LH. Thus, basal LH has reasonable sensitivity as a screen and perhaps in most instances is adequate to diagnose CPP [22], while stimulation testing (now using aqueous leuprolide acetate) may sometimes be required and may help differentiate FSH-predominant nonprogressive premature thelarche from LH-predominant CPP.…”

Section: Discussionmentioning

confidence: 99%

Leuprolide Acetate 1-Month Depot for Central Precocious Puberty: Hormonal Suppression and Recovery

Neely

Lee

Bloch

et al. 2010

International Journal of Pediatric Endocrinology

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Methods. This prospective US multicenter trial of leuprolide acetate 1-month depot (7.5–15 mg) for central precocious puberty utilized an open-label treatment period, long-term follow-up, and adult callback. Forty-nine females <9 years old with Tanner breast stage ≥2 before 8 years and 6 males <10 years old with Tanner genital stage ≥2 before 9 years with stimulated LH ≥10 IU/L and bone age advance ≥1 year were enrolled. Results. Subjects were treated for 3.9 ± 2.0 years. Mean peak GnRH-stimulated LH and FSH were prepubertal after the first dose and remained suppressed throughout treatment. During treatment, mean estradiol decreased to the limit of detection and mean testosterone decreased but remained above prepubertal norms. During posttreatment follow-up (3.5 ± 2.2 years), all patients achieved a pubertal hormonal response within 1 year and menses were reported in all females ≥12 years old. No impairment of reproductive function was observed at adulthood (mean age: 24.8 years).

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“…The girls were divided into two groups according to the GnRH stimulation test results. Girls who had a peak LH values R5 IU/l were considered as having a pubertal activation of the HPG axis and therefore as having CPP (4,6). The girls who had lower values were considered prepubertal.…”

Section: Methodsmentioning

confidence: 99%

The utility of basal serum LH in prediction of central precocious puberty in girls

Pasternak

Friger

Loewenthal

et al. 2012

European Journal of Endocrinology

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Objective: The mainstay of distinction between prepubertal girls and girls who are suspected of having central precocious puberty (CPP) is based on gonadotropin measurements after a GnRH stimulation test to evaluate hypothalamic-pituitary-gonadal axis maturity. The objective of this study was to determine whether a single basal gonadotropin measurement carries a useful predictive value in verifying or refuting the diagnosis of CPP. Design and methods: Basal serum LH and FSH were measured by a chemiluminescent immunometric assay in a cohort of girls who had been evaluated for CPP before and after GnRH stimulation test. Peak LH levels higher than 5 IU/l were considered a pubertal response. Results: Eighty girls with suspected breast development before 8 years of age were enrolled to the study, out of whom 42 had CPP. Low basal serum LH (%0.1 IU/l) was sufficient to rule out the diagnosis of CPP in 94.7% of the 38 prepubertal girls; the sensitivity of basal LH levels for this purpose was only 64%. The basal FSH and the basal LH to FSH ratio achieved less efficient predictive value with 76 and 71% sensitivity and 73 and 86% specificity respectively. Conclusion: A single basal LH measurement may be adequate to confirm but not to refute the presence of CPP in most of the girls who are evaluated for early pubertal signs.

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Adequacy of a Single Unstimulated Luteinizing Hormone Level to Diagnose Central Precocious Puberty in Girls

Abstract: A single basal luteinizing hormone measurement is adequate to document a pubertal hypothalamic-pituitary-ovarian axis in most but not all girls with central precocious puberty.

Cited by 127 publications

References 12 publications

Central precocious puberty: revisiting the diagnosis and therapeutic management

Central precocious puberty: revisiting the diagnosis and therapeutic management

Leuprolide Acetate 1-Month Depot for Central Precocious Puberty: Hormonal Suppression and Recovery

The utility of basal serum LH in prediction of central precocious puberty in girls

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