Ann Pediatr Endocrinol Metab.  2019 Sep;24(3):164-171. 10.6065/apem.2019.24.3.164.

Basal serum luteinizing hormone value as the screening biomarker in female central precocious puberty

• Heo S
• Lee YS
• Yu J

• KMID: 2460763
• DOI: http://doi.org/10.6065/apem.2019.24.3.164

Abstract

PURPOSE
Precocious puberty refers to the development of secondary sex characteristics before ages 8 and 9 years in girls and boys, respectively. Central precocious puberty (CPP) is caused by premature activation of the hypothalamus-pituitary-gonadal (HPG) axis and causes thelarche in girls before the age of 8. A gonadotropin-releasing hormone (GnRH) stimulation test is the standard diagnostic modality for diagnosing CPP. However, the test cannot always be used for screening because it is expensive and time-consuming. This study aimed to find alternative reliable screening parameters to identify HPG axis activation in girls <8 years old (CPP) and for girls 8-9 years old (early puberty, EP).
METHODS
From January 2013 to June 2015, medical records from 196 girls younger than 9 years old with onset of breast development were reviewed, including 126 girls who had a bone age (BA) 1 year above their chronological age. All patients underwent a GnRH stimulation test, and 117 underwent pelvic sonography. The girls were divided into 4 groups based on age and whether the GnRH stimulation test showed evidence of central puberty. Subanalyses were also conducted within each group based on peak luteinizing hormone (LH) level quartiles.
RESULTS
Basal serum LH level was the most sensitive marker for screening CPP and EP. The cutoff values were 0.245 IU/L for CPP under 8 years old (P=0.049, area under the curve [AUC]=0.764, 88% sensitivity, 48% specificity) and 0.275 IU/L for EP between 8-9 years old (P=0.005, AUC=0.813, 79% sensitivity, 77% specificity). Peak LH level decreased as BMI z-score among subgroups increased when there was no difference in BA; however, higher BA eliminated this effect.
CONCLUSION
Basal serum LH level is a useful screening parameter for diagnosing CPP and EP in girls. Peak LH levels were lower with increasing BMI z-score, although older BA eliminated this effect.

Keyword

Central precocious puberty; Thelarche; Luteinizing hormone

MeSH Terms

Adolescent
Breast
Female*
Gonadotropin-Releasing Hormone
Humans
Lutein*
Luteinizing Hormone*
Mass Screening*
Medical Records
Puberty
Puberty, Precocious*
Sex Characteristics
Gonadotropin-Releasing Hormone
Lutein
Luteinizing Hormone

Figure

• 

  Fig. 1. Study design. BA, bone age; CA, chronological age; GnRH, gonadotropin-releasing hormone; GnRHST, GnRH stimulation test; CPP, central precocious puberty; EP, early puberty.`

• 

  Fig. 2. Receiver operating characteristic (ROC) curve and cutoff value for CPP and EP screening. (A) ROC curve for CPP screening of patients <8 years. (B) ROC curve for EP screening of patients 8–9 years. (C) ROC curve for CPP+EP screening of patients <9 years. CPP, central precocious puberty; EP, early puberty; AUC, area under curve; Sn, sensitivity; Sp, specificity; PPV, positive predictive value; NPV, negative predictive value; J, Youden’s index. LH, luteinizing hormone; FSH, follicle-stimulating hormone.

• 

  Fig. 3. Analyses of pubertal group according to luteinizing hormone peak quartiles. Body mass index (BMI) z-score for each group. (A) BA for each group. (B) BA–CA for each group. BA, bone age; CA, chronological age. *P<0.05

Reference

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