Responsivity of Pituitary Gonadotropes to Luteinizing Hormone-releasing Factor in Idiopathic Precocious Puberty, Precocious Thelarche, Precocious Adrenarche, and in Patients Treated with Medroxyprogesterone Acetate

Reiter, Edward O.; Kaplan, Selna L.; Conte, Felix A.; Grumbach, Melvin M.

doi:10.1203/00006450-197509020-00011

Cited by 9 publications

(12 citation statements)

References 17 publications

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“…With this test, children with precocious puberty have significantly higher peak serum concentrations of LH than children with premature thelarche [10,13]. However, as shown in this and in other studies [12], diagnostically useful differences appear only in advanced central precocious puberty, whereas in the early stages of the disorder, LH and FSH levels often do not differ from those of children with isolated premature thelarche.…”

Section: Discussionmentioning

confidence: 61%

“…These reports have examined basal serum concentrations of oestrogens [6], basal serum concentrations of LH and FSH [8,10] and serum concentrations of LH and FSH after stimulation with LHRH [9,13]; nocturnal gonadotropin serum profiles [15], breast thermography [2], and ultrasonography of the uterus and ovaries [11,14]. In these studies the exact clinical pubertal stage (breast and pubic hair development) of the children was not reported, or only children in an advanced stage of precocious puberty according to clinical criteria were examined [6,8,13]. By dividing our patients with precocious puberty into an early and an advanced group we were able to show that ultrasonography of the uterus offers a noninvasive method for the early detection of central precocious puberty with a sensitivity of 100% and a specificity of 100%.…”

Section: Discussionmentioning

confidence: 99%

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Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty

1995

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We examined 55 girls with isolated premature thelarche between the ages of 0.3 and 7.4 years (group A), 20 children with central precocious puberty between 2.1 and 7.7 years of age and 101 age-matched controls. The children with precocious puberty were divided according to distribution of pubic hair into group B (Tanner stages PH1, B2-3; n = 11), representing an early stage of the disorder, and group C (stages PH2-3, B3-4; n = 9), representing an advanced stage. Uterine and ovarian volumes were measured sonographically, peak serum levels of luteinizing hormone and follicle-stimulating hormone were determined after intravenous administration of luteinizing hormone-releasing hormone. The mean uterine and ovarian volumes were significantly greater in children with precocious puberty than in controls (group B: uterine volume: 3.8 +/- 2.0 ml vs 0.9 +/- 0.3 ml for controls, P < 0.001; ovarian volume: 2.2 +/- 1.3 ml vs 0.6 +/- 0.2 ml for controls, P < 0.01; group C: uterine volume: 8.0 +/- 4.4 ml vs 1.0 +/- 0.3 ml for controls, P < 0.01; ovarian volume; 2.6 +/- 1.3 ml vs 0.4 +/- 0.1 ml, P < 0.01). No significant differences were found between children with premature thelarche and the control group. As a diagnostic method for the early detection of central precocious puberty, ultrasound measurement of uterine volume had a sensitivity and specificity of 100% (cut-off value, 1.8 ml), while ultrasound determination of ovarian volume had a sensitivity of 82% and a specificity of 95% (cut-off value, 1.2 ml).(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty

1995

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“…The FSH predominance might be a result of a larger readily releasable pool of pituitary FSH in comparison with a smaller pool of releasable LH in prepubertal girls 15 . This girl presented some features of puberty at the time of diagnosis, but the pubertal signs regressed with L-T4 treatment.…”

Section: Discussionmentioning

confidence: 98%

Severe Hypothyroidism Due to Autoimmune Atrophic Thyroiditis - Predicted Target Height and a Plausible Mechanism for Sexual Precocity

Niedziela¹,

Korman²

2001

Journal of Pediatric Endocrinology and Metabolism

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Autoimmune thyroiditis, the most frequent cause of acquired hypothyroidism in childhood and adolescents, is characterized by raised levels of the specific antibodies to thyroperoxidase (TPOAb) and thyroglobulin (TgAb). We report a girl aged 10 years and 9 months who presented with arrested growth and breast development (thelarche). She also exhibited myxedema of the face and legs, prominent striae on the thighs, dry, cold skin, and hypertrichosis on her back. There was no goiter, no history of thyroid pain and no family history of thyroid disease. She complained occasionally of a transient headache. The patient's height was below the 3rd percentile, while her body weight was at the 50th percentile and bone age was normal. Laboratory tests proved severe hypothyroidism (fT4 0 ng/dl, fT3 0.99 pg/ml, TSH >100 microIU/ml plus an increased titer of TPOAb). Thyroid ultrasound supported the diagnosis of thyroiditis. Pituitary PRL and FSH levels and peripheral estradiol were all elevated. L-Thyroxine therapy, instituted following diagnosis, improved the growth velocity to 11 cm/year and the FSH and E2 levels were normalized to prepubertal values. Complete regression of the breast development was observed within 4 months. However, 4 months later a true (central), isosexual LHRH-dependent puberty started. The pubertal features at the time of the original diagnosis might be explained by: 1. the direct action of elevated TRH on gonadotropes to stimulate gonadotropin secretion and on lactotrophes to stimulate PRL secretion, and 2. TSH action on LH and mostly FSH receptors (homologous to TSH receptors) in the ovary, stimulating the secretion of estradiol.

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“…Moreover, children with precocious adrenarche have been found to have prepubertal levels of gonadotrophins [13]. The relatively high levels of basal plasma gonadotrophins and exaggerated response to LH-RH can be interpreted as an expression of either true precocious puberty or primary gonadal failure.…”

Section: Discussionmentioning

confidence: 99%

Primary gonadal failure and precocious adrenarche in a boy with Prader-Labhart-Willi syndrome

Shuper

Mimouni

et al. 1982

Eur J Pediatr

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A 7-year-old boy with Prader-Labhart-Willi syndrome who had precocious adrenarche was found to have primary gonadal failure, as evidenced by appropriate laboratory investigations: elevated basal levels of plasma FSH and LH with exaggerated responses to LH-RH stimulation and unresponsiveness of plasma testosterone to repeated hCG stimulations. The elevated values of plasma DHEA which were found indicate an early activation of the adrenal gland. This patient demonstrates the variability of pubertal development in the Prader-Labhart-Willi syndrome, with the unusual association of primary gonadal failure and precocious adrenarche.

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Responsivity of Pituitary Gonadotropes to Luteinizing Hormone-releasing Factor in Idiopathic Precocious Puberty, Precocious Thelarche, Precocious Adrenarche, and in Patients Treated with Medroxyprogesterone Acetate

Cited by 9 publications

References 17 publications

Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty

Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty

Severe Hypothyroidism Due to Autoimmune Atrophic Thyroiditis - Predicted Target Height and a Plausible Mechanism for Sexual Precocity

Primary gonadal failure and precocious adrenarche in a boy with Prader-Labhart-Willi syndrome

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