The Efficacy of Modified Puberty Suppression Score by Single Blood Sample for Evaluation of GnRH Agonist Treatment in Central Precocious Puberty

Lee, Seung Gue; Choi, Woo Jin; Kim, Me Jin; Kim, Young Ho; Jung, Ji Ah; Hwang, Il Tae; Yang, Seung; Lee, Hae Ran

Abstract

PURPOSE
GnRH stimulation test is golden standard for the diagnosis of central precocious puberty as well as evaluation of treatment, however, it is more expensive and inconvenient. This is the reason why many other tests have been suggested. We studied the efficacy of modified puberty suppression score by single blood sample for evaluation of GnRH agonist treatment in central precocious puberty.
METHODS
Twenty-four girls (age, 9.56+/-1.56 years) diagnosed with early puberty or precocious puberty at Kangdong Sacred Heart Hospital from March 2002 to May 2005 were included in this study. All of patients were treated with leuprorelin acetate (83.66-115.12 microgram/kg). Total 24 patients including 11 suppression and 13 non-suppression cases were analyzed. The serum levels of LH, FSH, estradiol and progesterone were measured before and 8 weeks after treatment. The height, weight, bone age and Tanner stage of breast development in each patient were also measured before and 12 weeks after treatment. We modified puberty suppression score by Mul et al. in 1999. We defined scores based on statistical significance - estradiol, 2 points (>=1.36 ng/dL), progesterone, 2 points (>=0.31 ng/dL), LH, 1 point (>=2.0 IU/L), delta BA/delta CA, 1 point (>=0), delta HtSDS, 1 point (>=0.25/6 mo). Total score is 7 points and we defined suppression is less than 3 points.
RESULTS
The serum levels of estradiol (<1.36 ng/dL, P=0.000) and progesterone (<0.31 ng/dL, P= 0.003) are significantly lower in suppression group than nonsuppression group. If the score according to modified puberty suppression score (MPSS) is less than 3 points, which is considered as a successful suppression by GnRH agonist. The sensitivity, specificity, positive predictive value and negative predictive value of MPSS are 100%, 92.8%, 90.9% and 100% respectively.
CONCLUSION
Single blood sample is simpler and easier than GnRH stimulation test for the evaluation and monitoring of GnRH agonist treatment in central precocious puberty and MPSS by single blood sample may be useful in outpatient clinic.