Triptorelin stimulated luteinizing hormone concentrations for diagnosing central precocious puberty: study of diagnostic accuracy

Vuković, Rade; Milenković, Tatjana; Soldatović, Ivan; Pekić, Sandra; Mitrovic, Katarina; Todorović, Sladjana

doi:10.1007/s12020-021-02947-z

Cited by 8 publications

(12 citation statements)

References 37 publications

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“…The previous study also used a simple leuprolide stimulation test with a single 30-min post-stimulation LH sample, which has been supported in several studies (36,37). In contrast, we used the 90-min multi-sample gonadorelin stimulation test recommended as the reference standard test for CPP in other studies (38,39). Of course, a global consensus on GnRH stimulation test and cutoff level for the diagnosis of CPP has not yet been established.…”

Section: Discussionmentioning

confidence: 99%

Impact of 6-month triptorelin formulation on predicted adult height and basal gonadotropin levels in patients with central precocious puberty

Yoo

Kim²,

Jung³

et al. 2023

Front. Endocrinol.

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BackgroundTriptorelin, a long-acting gonadotropin-releasing hormone (GnRH) agonist, is available in 1-, 3-, and 6-month formulations to treat central precocious puberty (CPP). The triptorelin pamoate 22.5-mg 6-month formulation recently approved for CPP offers greater convenience to children by reducing the injection frequency. However, worldwide research on using the 6-month formulation to treat CPP is scarce. This study aimed to determine the impact of the 6-month formulation on predicted adult height (PAH), changes in gonadotropin levels, and related variables.MethodsWe included 42 patients (33 girls and nine boys) with idiopathic CPP treated with a 6-month triptorelin (6-mo TP) formulation for over 12 months. Auxological parameters, including chronological age, bone age, height (cm and standard deviation score [SDS]), weight (kg and SDS), target height (TH), and Tanner stage, were evaluated at baseline, and after 6, 12, and 18 months of treatment. Hormonal parameters, including serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol for girls or testosterone for boys, were analyzed concurrently.ResultsThe mean age at treatment initiation was 8.6 ± 0.83 (8.3 ± 0.62 for girls, 9.6 ± 0.68 for boys). The peak LH level following intravenous GnRH stimulation at diagnosis was 15.47 ± 9.94 IU/L. No progression of the modified Tanner stage was observed during treatment. Compared to baseline, LH, FSH, estradiol, and testosterone were significantly reduced. In particular, the basal LH levels were well suppressed to less than l.0 IU/L, and the LH/FSH ratio was less than 0.66. The bone age/chronological age ratio remained stable with a decreasing trend (1.15 at the start of treatment, 1.13 at 12 months, 1.11 at 18 months). PAH SDS increased during treatment (0.77 ± 0.79 at baseline, 0.87 ± 0.84 at the start of treatment, 1.01 ± 0.93 at six months, and 0.91 ± 0.79 at 12 months). No adverse effects were observed during treatment.ConclusionThe 6-mo TP suppressed the pituitary-gonadal axis stably and improved the PAH during treatment. Considering its convenience and effectiveness, a significant shift to long-acting formulations can be expected.

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Section: Discussionmentioning

confidence: 99%

Impact of 6-month triptorelin formulation on predicted adult height and basal gonadotropin levels in patients with central precocious puberty

Yoo

Kim²,

Jung³

et al. 2023

Front. Endocrinol.

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“…However, the reported optimal duration of stimulation test differs among studies. Some reports state that analysis of an LH sample 30 minutes after triptorelin injection is sufficient, and some state that continuation until 180 minutes after triptorelin injection gives a higher accuracy [ 20 , 21 ]. Our study evaluated the efficacy of the triptorelin stimulation test and appropriate length of study time.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the triptorelin stimulation test compared with the classic gonadotropin-releasing hormone stimulation test in diagnosing central precocious puberty in girls

Kim,

Hwangbo,

Park

et al. 2024

Ann Pediatr Endocrinol Metab

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Purpose: The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for diagnosing central precocious puberty (CPP). Gonadorelin (Relefact) is used for the test but is not always readily available; triptorelin is used as an alternative. The purpose of this study was to evaluate the diagnostic validity of the triptorelin test compared with the GnRH test in the diagnosis of CPP in girls.Methods: This retrospective study included 100 girls with premature thelarche (PT) who underwent a hypothalamic-pituitary-gonadal axis evaluation. In the overall group, 50 girls were tested with intravenous gonadorelin (Relefact) and 50 girls were tested with subcutaneous triptorelin acetate (Decapeptyl). Luteinizing hormone (LH) and follicle-stimulating hormone levels were measured at baseline and 30, 45, 60, and 90 minutes after gonadorelin injection or 30, 60, 90, and 120 minutes after triptorelin injection.Results: Clinical characteristics of age, height, weight, body mass index, and bone age were similar between the 2 groups. The highest LH level was reached 60 minutes after stimulation in both groups. Approximately 20% of the gonadorelin group and 24% of the triptorelin group were diagnosed with CPP (<i>P</i>=0.52). Among those diagnosed with CPP, the mean peak LH concentrations were 8.15 mIU/mL and 9.73 mIU/mL in the gonadorelin and triptorelin groups, respectively.Conclusion: The triptorelin test showed similar trends of LH elevation and diagnostic rate compared with the traditional GnRH test for diagnosing CPP. This suggests that the triptorelin test may be a valid alternative to the GnRH test for differentiating CPP from self-limiting PT. Our study also demonstrated that a triptorelin stimulation test for up to 120 minutes was sufficient to diagnose CPP.

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“…Vukovic et al [12] evaluated the diagnostic accuracy of the triptorelin test in girls with CPP and PT using blood samples drawn at 0, 30, 60, 90, 120, and 180 min after injection. The highest median LH level (25th-75th percentile) was reached at 180 min.…”

Section: Discussionmentioning

confidence: 99%

“…Although the gonadorelin test is considered the gold standard for diagnosing CPP, the triptorelin test provides an alternative when gonadorelin is not readily available. The diagnostic value of triptorelin has been adequately substantiated in previous studies, but there is no consensus regarding the appropriate blood sampling intervals [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Before the COVID-19 pandemic, gonadorelin (Relefact®) was commonly used in the GnRH stimulation test; during the pandemic, however, it became in short supply and an alternative was needed. Several previous studies have suggested that triptorelin acetate (Decapeptyl 0.1 mg®) could be a reliable alternative to the gold standard GnRH test because its diagnostic accuracy is comparable to that of gonadorelin [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Application of the subcutaneous triptorelin stimulation test for the diagnosis of central precocious puberty

Ahn,

Lee,

Gim

et al. 2023

Preprint

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Background The gonadotropin-releasing hormone (GnRH) stimulation test using intravenously injected gonadorelin is the gold standard for diagnosis of central precocious puberty (CPP). However, gonadorelin is not always readily available. Objective This study investigated the diagnostic efficacy of the subcutaneous triptorelin test and the appropriate blood sampling time for diagnosis of CPP. Methods We compared clinical data of patients with CPP (n = 74) and premature thelarche (PT) (n = 75) who had been diagnosed with the triptorelin stimulation test (n = 146) versus patients with CPP (n = 3) and PT (n = 37) who had been diagnosed with the gonadorelin stimulation test (n = 74). In the triptorelin test, the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels were measured 0, 30, 60, 120, and 180 min (triptorelin 180 min test) and 0, 30, 60, 90, and 120 min (triptorelin 120 min test) after subcutaneous triptorelin injection. In the gonadorelin test, the LH and FSH levels were measured 0, 30, 45, 60, and 90 min after intravenous gonadorelin injection. The clinical parameters of CPP and PT were compared according to the type of stimulant and diagnostic method. Results In the triptorelin test group, girls with CPP had a more advanced bone age and higher mean Tanner stage for breast development than girls with PT, whereas in the gonadorelin test group, girls with CPP and PT were not significantly different. In addition, the triptorelin 120 min test group had higher height standard deviation scores than the gonadorelin test group. In the gonadorelin test group, all girls with CPP exhibited a peak LH response at 30 to 60 min after intravenous gonadorelin injection. In the triptorelin test group, most girls with CPP exhibited a peak LH response at > 120 min (n = 38). Among girls with PT, those in the triptorelin 120 min test group had a higher mean Tanner stage for breast development than those in the triptorelin 180 min test group. Conclusion The diagnostic efficacy of the triptorelin test is as high as that of the gonadorelin test in diagnosis of CPP. Because of the slower LH response in the triptorelin test, the LH level should be measured over a longer period of time in patients with suspected CPP.

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Triptorelin stimulated luteinizing hormone concentrations for diagnosing central precocious puberty: study of diagnostic accuracy

Cited by 8 publications

References 37 publications

Impact of 6-month triptorelin formulation on predicted adult height and basal gonadotropin levels in patients with central precocious puberty

Impact of 6-month triptorelin formulation on predicted adult height and basal gonadotropin levels in patients with central precocious puberty

Effectiveness of the triptorelin stimulation test compared with the classic gonadotropin-releasing hormone stimulation test in diagnosing central precocious puberty in girls

Application of the subcutaneous triptorelin stimulation test for the diagnosis of central precocious puberty

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