J Korean Med Sci.  2012 Feb;27(2):194-199. 10.3346/jkms.2012.27.2.194.

Factors to Predict Positive Results of Gonadotropin Releasing Hormone Stimulation Test in Girls with Suspected Precocious Puberty

• Nam HK
• Rhie YJ
• Son CS
• Park SH
• Lee KH

• KMID: 1120158
• DOI: http://doi.org/10.3346/jkms.2012.27.2.194

Abstract

Sometimes, the clinical findings and the results of the gonadotropin-releasing hormone (GnRH) stimulation test are inconsistent in girls with early breast development and bone age advancement. We aimed to investigate the factors predicting positive results of the GnRH stimulation test in girls with suspected central precocious puberty (CPP). We reviewed the records of 574 girls who developed breast budding before the age of 8 yr and underwent the GnRH stimulation test under the age of 9 yr. Positive results of the GnRH stimulated peak luteinizing hormone (LH) level were defined as 5 IU/L and over. Girls with the initial positive results (n = 375) showed accelerated growth, advanced bone age and higher serum basal LH, follicle-stimulating hormone, and estradiol levels, compared to those with the initial negative results (n = 199). Girls with the follow-up positive results (n = 64) showed accelerated growth and advanced bone age, compared to those with the follow-up negative results. In the binary logistic regression, the growth velocity ratio was the most significant predictive factor of positive results. We suggest that the rapid growth velocity is the most useful predictive factor for positive results in the GnRH stimulation test in girls with suspected precocious puberty.

Keyword

Precocious Puberty; Growth Velocity; Gonadotropin-Releasing Hormone Stimulation Test

MeSH Terms

Age Determination by Skeleton
Breast/growth & development
Child
Estradiol/blood
Female
Follicle Stimulating Hormone/blood
Follow-Up Studies
Gonadotropin-Releasing Hormone/*analysis
Humans
Logistic Models
Luteinizing Hormone/blood
Predictive Value of Tests
Puberty, Precocious/*diagnosis
ROC Curve
Retrospective Studies

Figure

• 

  Fig. 1 Receiver operating characteristic curve for the growth velocity of girls with suspected precocious puberty. It shows the optimal cut point to predict the positive result of the GnRH stimulation test. The small closed circle indicates the growth velocity of 3.8 cm over 6 months (sensitivity 37%, specificity 90%).

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