Evaluation of GnRH analogue testing in diagnosis and management of children with pubertal disorders

Abstract

Context:Gonadotrophin releasing hormone (GnRH) stimulation test is pivotal in the assessment of children with pubertal disorders. However, lack of availability and high cost often result in the test falling into disfavor. We routinely use the GnRH analogue stimulation test as an alternative at our center.Aim:To present the data on children with endocrine disorders who underwent GnRH agonist stimulation test in pediatric endocrine clinic of a tertiary care referral hospital.Setting and Design:Pediatric endocrine clinic of a tertiary care referral hospital. Retrospective analysis of case records.Materials and Methods:The details pertaining to clinical and radiological parameters and hormonal tests were retrieved from case records of 15 children who underwent GnRH agonist stimulation test from May 2010 to April 2011.Results:Indications for testing with GnRH analogue were evaluation of delayed puberty, diagnosis of precocious puberty, assessment of hormonal suppression in treatment of precocious puberty and micropenis in two, nine, three and one cases, respectively. The results of the test and clinical and radiological parameters were in concordance. The test was also crucial in diagnosing the onset of central precocious puberty in two children with congenital adrenal hyperplasia.Conclusion:GnRH agonist test is a convenient, safe test that can be performed on an out-patient basis and can help the clinicians in the correct diagnosis and appropriate treatment of various puberty-related disorders.

Gonadotropin-releasing hormone stimulation test and diagnostic cutoff in precocious puberty: a mini review

“…Challenges arise in distinguishing between true pathological causes of CPP, isolated premature thelarche in girls (nonprogressive variants), and early phases of normal puberty [ 3 , 6 ].…”

“…Prepubertal basal level of serum estradiol can reach down to 1 pg/mL and that of serum testosterone to <10 ng/dL, measurable with a highly sensitive method (i.e., tandem mass spectrometry) [ 14 ]. Basal serum testosterone >25 ng/dL to >75 ng/dL in boys and estrogen level >10 pg/mL, >12 pg/mL, or >20 pg/mL in girls have been used as cutoff values for puberty [ 1 , 3 , 22 , 23 ]. With the GnRH test, peak values for both hormones are usually seen after 16 to 24 hours post-stimulation [ 1 , [ 3 ]].…”

“…Basal serum testosterone >25 ng/dL to >75 ng/dL in boys and estrogen level >10 pg/mL, >12 pg/mL, or >20 pg/mL in girls have been used as cutoff values for puberty [ 1 , 3 , 22 , 23 ]. With the GnRH test, peak values for both hormones are usually seen after 16 to 24 hours post-stimulation [ 1 , [ 3 ]]. In girls, both LH response and peak LH/FSH ratio post-GnRH stimulation can sometimes be low up until midpuberty, indicating the usefulness of correlation with an estradiol peak up to 50 pg/mL 20–24 hours after stimulation with leuprolide (a GnRHa) in identifying CPP [ 23 ].…”

“…Administering GnRH analogues (GnRHa), together with determination of serum basal and poststimulated gonadotropin levels, predicts pubertal responses at pubertal ages [ 1 , 2 ]. One concern is the lack of agreement on gonadotropin cutoffs used to diagnose central precocious puberty (CPP) [ 3 - 5 ]. The current review focuses on the clinical importance of GnRH testing in precocious puberty and different gonadotropin cutoffs utilized, along with limitations in testing.…”

A Diagnostic Scoring System to Distinguish Precocious Puberty from Premature Thelarche based on Clinical and Laboratory Findings

“…Furthermore, studies have reported different specificity, sensitivity and cutoff values for GnRH (3,4). Many factors, including the specificities of follicle stimulating hormone (FSH) and luteinizing hormone (LH) assays, influence GnRH test results (5). Estradiol measurements are less reliable indicators of the stage of puberty (2).…”