Ann Pediatr Endocrinol Metab.  2019 Mar;24(1):27-33. 10.6065/apem.2019.24.1.27.

Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty

• Lee DM
• Chung IH

• KMID: 2447373
• DOI: http://doi.org/10.6065/apem.2019.24.1.27

Abstract

PURPOSE
The standard method used to diagnose central precocious puberty (CPP) is the gonadotropin releasing hormone stimulation test (GnRHST). However, this test is inconvenient for children because it is time-consuming and requires multiple samples. This study aimed to determine the reliability of morning unstimulated luteinizing hormone (mLH) level when screening for CPP, with an emphasis on the influence of diurnal variation.
METHODS
This study included 160 girls with signs of early puberty (SMR 2) under 8 years of age. They were classified as CPP or non-CPP based on their standard GnRHST. The auxological, biochemical, and hormonal characteristics of subjects were retrospectively evaluated. The prognostic value of single morning unstimulated gonadotropin level was examined for use in CPP screening.
RESULTS
Of 160 patients, 121 (75.6%) presented with CPP, and 39 (24.4%) were determined to be prepubertal. The mLH/mFSH (morning unstimulated follicular stimulating hormone) ratio showed significant differences between the 2 groups (P<0.001). The mLH was correlated with GnRHST variables (r=0.532, P<0.001). The mLH cutoff point when screening for CPP was 0.22 IU/L, which had sensitivity and specificity of 69.4% and 82.1%, respectively. In regression analysis, bone age (BA) (odds ratio [OR], 1.018; 95% confidence interval [CI], 0.967-1.071; P=0.506) and body mass index (BMI) (OR, 0.874; 95% CI, 0.583-1.310; P=0.515) were not significant predictors. The mLH≥0.22 IU/L group (OR, 9.596; 95% CI, 3.853-23.900; P<0.001) was highly suggestive of CPP.
CONCLUSIONS
In this study, single morning unstimulated luteinizing hormone had clinical efficacy for CPP screening, but BA advanced over chronological age and BMI was not useful for CPP screening.

Keyword

Precocious puberty; Gonadotropin-releasing hormone stimulation test; Gonadotropin-releasing hormone; Luteinizing hormone; Bone age

MeSH Terms

Adolescent
Body Mass Index
Child
Female
Gonadotropin-Releasing Hormone
Gonadotropins
Humans
Lutein*
Luteinizing Hormone*
Mass Screening*
Methods
Puberty
Puberty, Precocious*
Retrospective Studies
Sensitivity and Specificity
Treatment Outcome
Gonadotropin-Releasing Hormone
Gonadotropins
Lutein
Luteinizing Hormone

Figure

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  Fig. 1. Receiver operator characteristic curve of various thresholds for morning unstimulated luteinizing hormone levels (area under the curve, 0.757; 95% confidence interval, 0.684–0.831) for predicting central precocious puberty. mLH, morning unstimulated luteinizing hormone.

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  Fig. 2. Probability of positive response after gonadotropin-releasing hormone stimulation according to morning unstimulated luteinizing hormone and morning unstimulated follicular stimulating hormone. mLH, morning unstimulated luteinizing hormone; mFSH, morning unstimulated follicular stimulating hormone.

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  Fig. 3. Probability of positive response after gonadotropin-releasing hormone stimulation according to morning unstimulated luteinizing hormone and difference between chronological age (CA) and bone age (BA). mLH, morning unstimulated luteinizing hormone.

Reference

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