Korean J Lab Med.  2011 Oct;31(4):244-249. 10.3343/kjlm.2011.31.4.244.

Gonadotropin-releasing Hormone Stimulation Test for Precocious Puberty

• Kim HK
• Kee SJ
• Seo JY
• Yang EM
• Chae HJ
• Kim CJ

• KMID: 1781687
• DOI: http://doi.org/10.3343/kjlm.2011.31.4.244

Abstract

BACKGROUND
Gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard to identify central precocious puberty (CPP). This test requires multiple blood samples at different time points to measure gonadotropin levels, and is therefore expensive, time-consuming, and uncomfortable for patients. We aimed to simplify the GnRH stimulation test to require fewer blood samples.
METHODS
A study of 166 girls with precocious puberty was undertaken. Blood samples were obtained at 0, 15, 30, 45, 60, 90, and 120 min after GnRH administration, and the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured. For each parameter, the sensitivities and specificities were estimated and ROC curves were constructed.
RESULTS
One hundred and twenty-eight patients (77.1%) were diagnosed for CPP. Peak LH levels were achieved 30 min after GnRH stimulation in patients with CPP. Further, 98.4% of the 45-min samples were diagnostic for CPP, and the cumulative frequency of LH values of > or =5 IU/L was 100% at 45 min. Using this cut-off value for LH, the ROC curve for LH at 45 min showed the highest sensitivity (98.4%) and specificity (100%) in the diagnosis of CPP.
CONCLUSIONS
Values of LH measured from a single blood sample obtained at 45 min in the GnRH stimulation test may be adequate for the diagnosis of CPP. Two samples, taken at 30 and 45 min after stimulation, were able to accurately diagnose CPP in 100% of the patients in this study.

Keyword

Luteinizing hormone; Sexual precocity; Premature thelarche

MeSH Terms

Child
Female
Follicle Stimulating Hormone/blood
Gonadotropin-Releasing Hormone/*diagnostic use
Humans
Luteinizing Hormone/blood
Puberty, Precocious/blood/*diagnosis
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Time Factors

Figure

• 

  Fig. 1 Comparison of basal (A) and peak (B) LH concentrations following GnRH stimulation, between CPP patients (N=128) and PT patients (N=38). Box-plots show the median, interquartile range, outliers, and extreme cases.Abbreviations: LH, luteinizing hormone; GnRH, gonadotropin releasing hormone; CPP, central precocious puberty; PT, premature thelarche.

• 

  Fig. 2 Comparison of (A) LH and (B) FSH concentrations, and (C) LH/FSH ratio, versus time after GnRH stimulation, between CPP and PT patients. Data are presented as median and 95% CI.Abbreviations: LH, luteinizing hormone; FSH, follicle-stimulating hormone; GnRH, gonadotropin releasing hormone; CPP, central precocious puberty; PT, premature thelarche; CI, confidence intervals.

• 

  Fig. 3 ROC curves of LH at different time points (30, 45, and 60 min) after stimulation in all patients.Abbreviations: LH, luteinizing hormone; AUC, area under curve; ROC, receiver operating characteristic.

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