Ann Pediatr Endocrinol Metab.  2017 Sep;22(3):183-188. 10.6065/apem.2017.22.3.183.

Diurnal variation of gonadotropin levels in girls with early stages of puberty

Affiliations
  • 1Department of Pediatrics, CHA Gumi Medical Center, CHA University, Gumi, Korea.
  • 2Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea. pedyoo@cha.ac.kr
  • 3Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea.

Abstract

PURPOSE
Pubertal gonadotropin secretion shows circadian pattern and the luteinizing hormone (LH) levels tend to rise in later stages of puberty in girls. We studied the usefulness of basal LH in the evaluation of central precocious puberty with emphasis on the influence of sampling time.
METHODS
Medical records of 334 girls that underwent gonadotropin-releasing hormone stimulation test (GnRHST) were reviewed. Auxological and laboratory data were compared between those with early morning (EM, before 10 AM) and late morning/afternoon (LM/A, after 10 AM) basal samples.
RESULTS
Among those in sexual maturity rating (SMR) 2, EM samples showed higher basal LH (P=0.004) compare to LM/A samples, whereas those in SMR 3 showed no difference in LH levels between EM and LM/A samples. Among girls with pubertal response, EM group showed higher basal LH (P=0.031) and follicular stimulating hormone (P=0.008) than LM/A group. The EM basal LH was more closely related with the peak stimulated LH than the LM/A basal LH did (rs=0.871 vs. rs=0.524). The optimal basal LH cutoffs to predict a pubertal response to GnRHST were 0.11 IU/L with a sensitivity of 66.7% and a specificity of 78.7% in EM group, and 0.07 IU/L with a sensitivity of 60.0% and a specificity of 78.9% in LM/A group, respectively.
CONCLUSION
In girls with early stages of puberty, EM basal LH is a more sensitive screening tool than the LM/A basal LH. Diurnal variation should be considered in evaluating children with precocious puberty.

Keyword

Precocious puberty; Luteinizing hormone; Gonadotropin-releasing hormone

MeSH Terms

Adolescent
Child
Female*
Gonadotropin-Releasing Hormone
Gonadotropins*
Humans
Luteinizing Hormone
Mass Screening
Medical Records
Puberty*
Puberty, Precocious
Sensitivity and Specificity
Gonadotropin-Releasing Hormone
Gonadotropins
Luteinizing Hormone

Figure

  • Fig. 1. Comparison of gonadotropin and estradiol levels in early morning (EM) vs. late morning/afternoon (LM/A) basal samples of the 16 girls in the subgroup analysis. LH, luteinizing hormone; FSH, follicular stimulating hormone; E2, estradiol.

  • Fig. 2. Subgroup analysis showing correlations between basal LH and peak stimulated LH in early morning (EM) vs. late morning/afternoon (LM/A) samples. LH, luteinizing hormone; FSH, follicular stimulating hormone.

  • Fig. 3. Receiver operating characteristic curves for the optimal cutoff of basal serum LH levels for predicting pubertal response in early morning sample group (EM: area under the curve [AUC], 0.773; 95% confidence interval [CI], 0.704– 0.841) and late morning/afternoon sample group (LM/A: AUC, 0.732; 95% CI, 0.641–0.823). EM, early morning; LM/A, late morning/afternoon; LH, luteinizing hormone.


Cited by  2 articles

Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty
Dong-Min Lee, In-Hyuk Chung
Ann Pediatr Endocrinol Metab. 2019;24(1):27-33.    doi: 10.6065/apem.2019.24.1.27.

Gonadotropin-releasing hormone stimulation test and diagnostic cutoff in precocious puberty: a mini review
Siti Nadirah Ab Rahim, Julia Omar, Tuan Salwani Tuan Ismail
Ann Pediatr Endocrinol Metab. 2020;25(3):152-155.    doi: 10.6065/apem.2040004.002.


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