Ann Pediatr Endocrinol Metab.  2021 Sep;26(3):178-184. 10.6065/apem.2040208.104.

Single random measurement of urinary gonadotropin concentration for screening and monitoring girls with central precocious puberty

• Lee SY
• Kim JM
• Kim YM
• Lim HH

• KMID: 2520510
• DOI: http://doi.org/10.6065/apem.2040208.104

Abstract

Purpose
The gold standard for assessing pubertal activation is the gonadotropinreleasing hormone (GnRH) stimulation test (GnRHST), which is invasive, timeconsuming, and inconvenient. This study evaluated whether a single random measurement of urinary luteinizing hormone (LH) concentration could substitute for the GnRHST in diagnosing and monitoring central precocious puberty (CPP) in girls.
Methods
Fifty-five girls with breast buds before 8 years of age were assessed by both the GnRHST and urinary gonadotropin assays. Based on the GnRHST results, 29 girls were assigned to the CPP group (peak LH≥5 IU/L), and 26 were placed in the premature thelarche (PT) group (peak LH<5 IU/L). Auxological data and urine and serum samples were collected at baseline and after treatment with a GnRH agonist for 12 and 24 weeks.
Results
Although the auxological data did not differ between the 2 groups, the serum levels of insulin-like growth factor-1, basal LH, follicle-stimulating hormone (FSH), estradiol, and peak LH; urinary LH; and peak serum LH/FSH and urinary LH/FSH ratios were higher in the CPP group than in the PT group. Pearson correlation analysis showed a positive correlation between the urinary and serum LH concentrations (r=0.660, P<0.001). Receiver-operating characteristic curve analyses showed that a urinary LH concentration of 0.725 IU/L was a cutoff that significantly predicted positivity on the GnRHST. Urinary LH and FSH concentrations declined significantly during GnRH agonist treatment.
Conclusion
A single, random measurement of urinary gonadotropin concentration could be a reliable tool for initial screening and therapeutic monitoring of CPP in girls.

Keyword

Precocious puberty; Gonadotropins; Urine; Gonadotropin-releasing hormone

Figure

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  Fig. 1. ROC curves for a positive GnRH stimulation test. ROC, receiver-operating characteristics; GnRH: gonadotropin-releasing hormone; LH, luteinizing hormone; FSH, follicle-stimulating hormone.

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  Fig. 2. Changes in serum and urinary gonadotropin levels in girls with CPP before and after treatment with GnRHa. (A1) Urinary LH level, (A2) urinary FSH level. (B1) serum LH level, and (B2) serum FSH level. Values are presented as mean±standard deviation. CPP, central precocious puberty, GnRHa: gonadotropin-releasing hormone agonist; LH, luteinizing hormone; FSH, follicle-stimulating hormone.

Reference

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