Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty

Lee, Dong-Min; Chung, In Hyuk

doi:10.6065/apem.2019.24.1.27

Cited by 15 publications

(19 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pubertal development and body growth should be examined every 3 to 6 months, and repeated blood tests are not necessary if the uLH or uLH-to-uFSH ratio is not elevated ( 27 ). By no means should clinical manifestations of pubertal regression or arrest be given priority over hormonal tests because the probability of a positive GnRHST response after GnRHST increases with the increasing difference between bone age and chronological age ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

Zhan

Xiao-dong

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

Context Although gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP), it is invasive, expensive, and time-consuming, requiring multiple blood samples to measure gonadotropin levels. Objective We evaluated whether urinary hormones could be potential biomarkers for pre- or post- puberty, aiming to simplify the current diagnosis and prognosis procedure. Design, Setting, and Participants We performed a cross-sectional study of a total of 355 girls with CPP in National Clinical Research Center for Child Health in China, including 258 girls with positive and 97 girls with negative results from GnRHST. Twenty patients received GnRH analogue (GnRHa) treatment and completed a six-month follow up. Main Outcome Measures We measured luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, progesterone, testosterone, and human chorionic gonadotropin in the first morning voided urine samples. Results Their urinary LH levels and the ratios of LH: FSH increased significantly with the advancement in Tanner Stages. uLH levels were positively associated with basal and peak LH levels in the serum after GnRH stimulation. A cut-off value of 1.74 IU/L for uLH reached a sensitivity of 69.4% and a specificity of 75.3% in predicting a positive GnRHST result. For the combined threshold (uLH≥1.74+uLH: uFSH ratio >0.4), the specificity reached 86.6%. After 3 months of GnRHa therapy, the uLH and uFSH levels decreased accordingly. Conclusions uLH could be a reliable biomarker for the initial CPP diagnosis and screening; uLH also could be an effective marker for evaluating the efficacy of clinical treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

Zhan

Xiao-dong

et al. 2021

The Journal of Clinical Endocrinology &Amp; Metabolism

View full text Add to dashboard Cite

show abstract

“…Attempts have been made to find a more acceptable and widely available alternative to the GnRH-stimulation test. Some researchers have proposed LH > 0.2–0.3 mIU/L from a random blood sample as a reliable screening cut-off for CPP ( 6 , 23 , 24 ). The present study also assessed the diagnostic utility of basal LH levels and found that the cut-off point was 0.255 mIU/L (sensitivity 68.9%, specificity 86.0%), which is similar to the cut-off points found in previous reports ( 1 , 9 ).…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Utility of the Basal Luteinizing Hormone Level and Single 60-Minute Post GnRH Agonist Stimulation Test for Idiopathic Central Precocious Puberty in Girls

Cao

Liu

et al. 2021

Front. Endocrinol.

View full text Add to dashboard Cite

ObjectiveThe present study aimed to assess the diagnostic utility of the Luteinizing hormone (LH) levels and single 60-minute post gonadotropin-releasing hormone (GnRH) agonist stimulation test for idiopathic central precocious puberty (CPP) in girls.MethodsData from 1,492 girls diagnosed with precocious puberty who underwent GnRH agonist stimulation testing between January 1, 2016, and October 8, 2020, were retrospectively reviewed. LH levels and LH/follicle-stimulating hormone (FSH) ratios were measured by immuno-chemiluminescence assay before and at several timepoints after GnRH analogue stimulation testing. Mann–Whitney U test, Spearman’s correlation, χ2 test, and receiver operating characteristic (ROC) analyses were performed to determine the diagnostic utility of these hormone levels.ResultsThe 1,492 subjects were split into two groups: an idiopathic CPP group (n = 518) and a non-CPP group (n = 974). Basal LH levels and LH/FSH ratios were significantly different between the two groups at 30, 60, 90, and 120 minutes after GnRH analogue stimulation testing. Spearman’s correlation analysis showed the strongest correlation between peak LH and LH levels at 60 minutes after GnRH agonist stimulation (r = 0.986, P < 0.001). ROC curve analysis revealed that the 60-minute LH/FSH ratio yielded the highest consistency, with an area under the ROC curve (AUC) of 0.988 (95% confidence interval [CI], 0.982–0.993) and a cut-off point of 0.603 mIU/L (sensitivity 97.3%, specificity 93.0%). The cut-off points of basal LH and LH/FSH were 0.255 mIU/L (sensitivity 68.9%, specificity 86.0%) and 0.07 (sensitivity 73.2%, specificity 89.5%), respectively, with AUCs of 0.823 (95% CI, 0.799–0.847) and 0.843 (95% CI, 0.819–0.867), respectively.ConclusionsA basal LH value greater than 0.535 mIU/L can be used to diagnose CPP without a GnRH agonist stimulation test. A single 60-minute post-stimulus gonadotropin result of LH and LH/FSH can be used instead of a GnRH agonist stimulation test, or samples can be taken only at 0, 30, and 60 minutes after a GnRH agonist stimulation test. This reduces the number of blood draws required compared with the traditional stimulation test, while still achieving a high level of diagnostic accuracy.

show abstract

“…In fact, there were no significant differences in weight, height, BMI, and growth velocity between both groups; only advanced bone age emerged as a significant predictor of CPP in this age group, although with limited discriminatory capacity (positive predictive value: 69.5%). Therefore, an exclusive measurement of the auxological characteristics would not be sufficient to diagnose or exclude CPP in girls with breast budding in this age range ( 18 ). In addition, it should be noted that the prognosis of adult height of the CPP girls, which at the time of diagnosis is usually overvalued by clinical and auxological conditions ( 19 ), did not differ from that calculated for the PT girls.…”

Section: Discussionmentioning

confidence: 99%

Clinical data and basal gonadotropins in the diagnosis of central precocious puberty in girls

Durá-Travé

Gallinas-Victoriano

Malumbres-Chacón

et al. 2021

Endocrine Connections

View full text Add to dashboard Cite

Objective. The objective of this study was to analyze whether some auxological characteristics or a single basal gonadotropin measurement will be sufficient to distinguish the prepubertal from pubertal status. Methods. Auxologycal characteristics were recorded and serum LH and FSH were measured by immunochemiluminescence assays before and after GnRH stimulation test in a sample of 241 Caucasian girls with breast budding between 6- to 8- years old. Peak LH levels higher than 5 IU/L were considered a pubertal response. Area under the curve, cut-off points, sensitivity, and specificity for auxologycal variables and basal gonadotropins levels were determined by receiver operating curves. Results. There were no significant differences in age at onset, weight, height, BMI and height velocity between both groups. Bone age was significantly higher in pubertal girls (p<0.05), although with limited discriminatory capacity. The sensitivity and specificity for the basal LH levels were 89% and 82% respectively, for a cut off point of 0.1 IU/L. All girls in the pubertal group had a basal LH higher than 1.0 IU/L (positive predictive value of 100%). There was a wide overlap of basal FSH and LH/FSH ratio between prepubertal and pubertal girls. Conclusions. Auxologycal characteristics should not be used only in the differential diagnosis between prepubertal from pubertal status in 6- to 8-year-old girls. We found a high specificity of a single basal LH sample and it would be useful for establishing the diagnosis of puberty in this age group, eliminating the need for GnRH stimulation testing.

show abstract

Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty

Cited by 15 publications

References 41 publications

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

The Diagnostic Utility of the Basal Luteinizing Hormone Level and Single 60-Minute Post GnRH Agonist Stimulation Test for Idiopathic Central Precocious Puberty in Girls

Clinical data and basal gonadotropins in the diagnosis of central precocious puberty in girls

Contact Info

Product

Resources

About