Basal serum luteinizing hormone value as the screening biomarker in female central precocious puberty

Abstract

PurposePrecocious puberty refers to the development of secondary sex characteristics before ages 8 and 9 years in girls and boys, respectively. Central precocious puberty (CPP) is caused by premature activation of the hypothalamus-pituitary-gonadal (HPG) axis and causes thelarche in girls before the age of 8. A gonadotropin-releasing hormone (GnRH) stimulation test is the standard diagnostic modality for diagnosing CPP. However, the test cannot always be used for screening because it is expensive and time-consuming. This study aimed to find alternative reliable screening parameters to identify HPG axis activation in girls <8 years old (CPP) and for girls 8–9 years old (early puberty, EP).MethodsFrom January 2013 to June 2015, medical records from 196 girls younger than 9 years old with onset of breast development were reviewed, including 126 girls who had a bone age (BA) 1 year above their chronological age. All patients underwent a GnRH stimulation test, and 117 underwent pelvic sonography. The girls were divided into 4 groups based on age and whether the GnRH stimulation test showed evidence of central puberty. Subanalyses were also conducted within each group based on peak luteinizing hormone (LH) level quartiles.ResultsBasal serum LH level was the most sensitive marker for screening CPP and EP. The cutoff values were 0.245 IU/L for CPP under 8 years old (P=0.049, area under the curve [AUC]=0.764, 88% sensitivity, 48% specificity) and 0.275 IU/L for EP between 8–9 years old (P=0.005, AUC=0.813, 79% sensitivity, 77% specificity). Peak LH level decreased as BMI z-score among subgroups increased when there was no difference in BA; however, higher BA eliminated this effect.ConclusionsBasal serum LH level is a useful screening parameter for diagnosing CPP and EP in girls. Peak LH levels were lower with increasing BMI z-score, although older BA eliminated this effect.

Diagnostic evaluation of central precocious puberty in girls

“…Heo et al revealed that a basal serum LH level of 0.245 IU/L produced better sensitivity (88%) but much lower specificity (44%) for CPP. 25 We deduced that this disparity was because of the different stimulated peak LH value of ! 5 IU/L used in their study.…”

“…This finding is consistent with previous studies that reported the basal FSH level and LH/ FSH ratio had less efficient predictive value. 12,25 Because the basal serum LH did not provide satisfactory prediction capacity in differentiating positive from negative GnRH stimulation test results, we developed a practical scoring system to improve our prediction. Therefore, study revealed that growth velocity was the most significant predictive factor for positive GnRH test results.…”

Study on the Mechanism of Sarsasapogenin in Treating Precocious Puberty by Regulating the HPG Axis

“…Premature estrogen secretion can accelerate bone maturation, shorten growth cycle, and reduce the final height of adults [ 43 ]. Serum hormone is the most intuitive indicator of clinical efficacy [ 44 – 46 ]. Our results showed that sarsasapogenin could significantly reduce serum hormone levels, and from the numerical point of view, the inhibitory effect of sarsasapogenin on serum hormone is better than that of leuprolide.…”

Study on the mechanism of sarsasapogenin in treating precocious puberty by regulating HPG axis

“…Premature estrogen secretion can accelerate bone maturation, shorten growth cycle and reduce the final height of adults [42] . Serum hormone is the most intuitive indicator of clinical efficacy [43][44][45] . Our results showed that sarsasapogenin could significantly reduce serum hormone levels, and from the numerical point of view, the inhibitory effect of sarsasapogenin on serum hormone is better than that of leuprolide.…”