Ann Pediatr Endocrinol Metab.  2013 Dec;18(4):202-207. 10.6065/apem.2013.18.4.202.

Factors that predict a positive response on gonadotropin-releasing hormone stimulation test for diagnosing central precocious puberty in girls

• Suh J
• Choi MH
• Kwon AR
• Kim YJ
• Jeong JW
• Ahn JM
• Chae HW
• Kim DH
• Kim HS

• KMID: 2266356
• DOI: http://doi.org/10.6065/apem.2013.18.4.202

Abstract

PURPOSE
The rapid increase in the incidence of precocious puberty in Korea has clinical and social significance. Gonadotropin-releasing hormone (GnRH) stimulation test is required to diagnose central precocious puberty (CPP), however this test is expensive and time-consuming. This study aimed to identify factors that can predict a positive response to the GnRH stimulation test.
METHODS
Clinical and laboratory parameters, including basal serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2), were measured in 540 girls with clinical signs of CPP.
RESULTS
Two hundred twenty-nine of 540 girls with suspected CPP had a peak serum LH level higher than 5 IU/L (the CPP group). The CPP group had advanced bone age (P<0.001), accelerated yearly growth rate (P<0.001), increased basal levels of LH (P=0.02), FSH (P<0.001), E2 (P=0.001), and insulin-like growth factor-I levels (P<0.001) compared to the non-CPP group. In contrast, body weight (P<0.001) and body mass index (P<0.001) were lower in the CPP group. Although basal LH was significantly elevated in the CPP group compared to the non-CPP group, there was considerable overlap between the 2 groups. Cutoff values of basal LH (0.22 IU/L) detected CPP with 87.8% sensitivity and 20.9% specificity.
CONCLUSION
No single parameter can predict a positive response on the GnRH stimulation test with both high sensitivity and specificity. Therefore, multiple factors should be considered in evaluation of sexual precocity when deciding the timing of the GnRH stimulation test.

Keyword

Precocious puberty; Diagnosis; Gonadotropin-releasing hormone; Forecasting; Female

MeSH Terms

Body Mass Index
Body Weight
Diagnosis
Estradiol
Female*
Follicle Stimulating Hormone
Forecasting
Gonadotropin-Releasing Hormone*
Humans
Incidence
Korea
Luteinizing Hormone
Puberty, Precocious*
Estradiol
Follicle Stimulating Hormone
Gonadotropin-Releasing Hormone
Luteinizing Hormone

Figure

• 

  Fig. 1 Results show considerable overlap between the 2 groups. CPP, central precocious puberty; LH, luteinizing hormone.

• 

  Fig. 2 The statistically optimal cutoff value of basal luteinizing hormone was 0.22 IU/L, with a sensitivity of 87.8% and a specificity of 20.9% (area under the receiver operating characteristic curve, 0.529).

• 

  Fig. 3 The cutoff value of basal follicle-stimulating hormone was 2.30 IU/L, with a sensitivity of 76.4% and a specificity of 65.9% (area under the receiver operating characteristic curve, 0.780).

• 

  Fig. 4 The cutoff value of basal estradiol was 8.30 pg/mL, with a sensitivity of 53.3% and a specificity of 65.6% (area under the receiver operating characteristic curve, 0.615).

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