Factors to Predict Positive Results of Gonadotropin Releasing Hormone Stimulation Test in Girls with Suspected Precocious Puberty

Abstract

Sometimes, the clinical findings and the results of the gonadotropin-releasing hormone (GnRH) stimulation test are inconsistent in girls with early breast development and bone age advancement. We aimed to investigate the factors predicting positive results of the GnRH stimulation test in girls with suspected central precocious puberty (CPP). We reviewed the records of 574 girls who developed breast budding before the age of 8 yr and underwent the GnRH stimulation test under the age of 9 yr. Positive results of the GnRH stimulated peak luteinizing hormone (LH) level were defined as 5 IU/L and over. Girls with the initial positive results (n = 375) showed accelerated growth, advanced bone age and higher serum basal LH, follicle-stimulating hormone, and estradiol levels, compared to those with the initial negative results (n = 199). Girls with the follow-up positive results (n = 64) showed accelerated growth and advanced bone age, compared to those with the follow-up negative results. In the binary logistic regression, the growth velocity ratio was the most significant predictive factor of positive results. We suggest that the rapid growth velocity is the most useful predictive factor for positive results in the GnRH stimulation test in girls with suspected precocious puberty.

Factors that predict a positive response on gonadotropin-releasing hormone stimulation test for diagnosing central precocious puberty in girls

“…This contradiction to the findings of previous studies may relate to the difference in subject numbers between studies. A previous study using a larger cohort16) also reported that a single basal LH measurement was not adequate to confirm CPP. Another large cohort study composed of 803 girls reported that a basal LH cutoff value of 1.1 IU/L had a sensitivity of 69.1% and a specificity of 50.5%17).…”

“…BA advancement and ratio of increase of BA to increase of CA also could not be used to diagnose CPP in our study because these parameters were observed in both groups to the same degree. Several studies have reported that serum IGF-I levels were elevated in girls with CPP, suggesting that serum IGF-I levels are related to CPP16,18). In our study, we analyzed IGF-I SDS to adjust the value according to sex and age using reference values from Korean children and adolescents11).…”

Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls?

“…However, the GnRHST is time-consuming, expensive and inconvenient for patients and labor-intensive for clinicians. Moreover, the GnRHST showed a negative response in 22.9% to 37.1% of subjects suspected to have precocious puberty18-20). To reduce the rate of negative responses, it is critical to select subjects who have a high possibility of showing positive results on the GnRHST.…”

Predictive Value of Dental Maturity for a Positive Gonadotropin-Releasing Hormone Stimulation Test Result in Girls with Precocious Puberty

“…The GnRHST could be inconvenient for both patients and clinicians because of repeated samples over 1 to 2 hours. Moreover, approximately 30% of individuals suspected with precocious puberty showed prepubertal response during the GnRHST (89). Therefore, it is important to accurately select patients who are expected to have a positive response during the GnRHST.…”