Ann Pediatr Endocrinol Metab.  2023 Jun;28(2):138-143. 10.6065/apem.2346072.036.

The utilization of basal luteinizing hormone in combination with the basal luteinizing hormone and follicle-stimulating hormone ratio as a diagnostic tool for central precocious puberty in girls

• Chotipakornkul N
• Onsoi W
• Numsriskulrat N
• Aroonparkmongkol S
• Supornsilchai V
• Srilanchakon K

• KMID: 2543295
• DOI: http://doi.org/10.6065/apem.2346072.036

Abstract

Purpose
Intravenous gonadotropin-releasing hormone (IV GnRH) testing is the gold standard for confirming a central precocious puberty (CPP) diagnosis. However, this test is not widely available commercially. Therefore, our study aim was to establish cutoff values for basal gonadotropin level and gonadotrophin responses to a 100-μg subcutaneous IV GnRH test that can distinguish between CPP and premature thelarche (PT) to discover a simple method to detect CPP.
Methods
Girls between the ages of 6 and 8 years who attended the pediatric endocrinology outpatient clinic at our tertiary hospital between 2019 and 2022 were included in this study. They were evaluated for breast development, and a subcutaneous 100-μg GnRH test was administered by measuring the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in blood samples at baseline and then 30, 60, 90, and 120 minutes after injection. CPP is characterized by increased height velocity, advanced bone age, and progression of breast development. The cutoff value for diagnosis of CPP was determined using a receiver operating characteristic (ROC) analysis.
Results
In 86 Thai girls (56 with CPP and 30 with PT), the ROC analysis showed 71.4% and 100% sensitivity and specificity, respectively, for basal LH (cutoff ≥ 0.2 IU/L) plus the basal LH/FSH ratio (cutoff ≥ 0.1). The optimal cutoff values for peak LH (cutoff ≥ 7 IU/L) demonstrated a sensitivity of 94.6% and a specificity of 100%, whereas the LH value at 30 and 60 minutes after injection (cutoff ≥ 6 IU/L) demonstrated sensitivities of 92.9% and 94.6% and a specificity of 100%, respectively
Conclusion
Combining the basal LH (cutoff: 0.2 IU/L) and the basal LH/FSH ratio (cutoff: 0.1) can easily and cost-effectively diagnose CPP in a girl in breast Tanner stage II.

Keyword

Central precocious puberty; Premature thelarche; Luteinizing hormone; Follicle-stimulating hormone

Figure

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  Fig. 1. A comparison of the serum luteinizing hormone (LH) concentrations with the elapsed time after 100 mcg subcutaneous triptorelin injection between the central precocious puberty (CPP) and the premature thelarche (PT) patients. Data are presented as the median and 95% confidence interval.

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  Fig. 2. The area under the receiver operating characteristic (ROC) curve and the optimal cutoff point for the basal LH, peak LH, basal LH/FSH ratio, and peak LH/ FSH ratio to predict central precocious puberty. LH, luteinizing hormone; FSH, follicle-stimulating hormone.

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  Fig. 3. The area under the receiver operating characteristic (ROC) curve and the optimal cutoff point for a basal LH value >0.2 IU/L and a basal LH/FSH ratio ≥ 0.1 to predict central precocious puberty. LH, luteinizing hormone; FSH, folliclestimulating hormone.

Reference

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