Basal serum luteinizing hormone value as the screening biomarker in female central precocious puberty
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
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.
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.
참고문헌 (23)
- Partsch CJ, "Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens", Hum Reprod Update, 7, pp.292~302 (2001)
- Teilmann G, "Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries", Pediatrics, 116, pp.1323~1328 (2005)
- Sørensen K, "Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty", Horm Res Paediatr, 77, pp.137~145 (2012)
- Aksglaede L, "Recent decline in age at breast development: the Copenhagen Puberty Study", Pediatrics, 123, pp.e932~e939 (2009)
- Willemsen RH, "Pros and cons of GnRHa treatment for early puberty in girls", Nat Rev Endocrinol, 10, pp.352~363 (2014)
- Lakshman R, "Early age at menarche associated with cardiovascular disease and mortality", J Clin Endocrinol Metab, 94, pp.4953~4960 (2009)
- Prentice P, "Pubertal timing and adult obesity and cardiometabolic risk in women and men: a systematic review and meta-analysis", Int J Obes (Lond), 37, pp.1036~1043 (2013)
- Pescovitz OH, "Premature thelarche and central precocious puberty:the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone", J Clin Endocrinol Metab, 67, pp.474~479 (1988)
- 김한결, "Gonadotropin-releasing Hormone Stimulation Test for Precocious Puberty", Annals of Laboratory Medicine, 31(4), pp.244~249 (2011), 대한진단검사의학회
- 이동성, "Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls?", Annals of Pediatric Endocrinology & Metabolism, 18(4), pp.196~201 (2013), 대한소아내분비학회
- Lee HS, "Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls", Horm Metab Res, 44, pp.851~854 (2012)
- Pasternak Y, "The utility of basal serum LH in prediction of central precocious puberty in girls", Eur J Endocrinol, 166, pp.295~299 (2012)
- Çatlı G, "Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche", Turk Pediatri Ars, 50, pp.20~26 (2015)
- 최정윤, "Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls", Clinical and Experimental Pediatrics, 58(8), pp.294~300 (2015), 대한소아청소년과학회
- 이상헌, "The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty", 전남의대학술지, 52(1), pp.70~74 (2016), 의과학연구소[DOI]
- de Vries L, "Ultrasono-graphic and clinical parameters for early differentiation between precocious puberty and premature thelarche", Eur J Endocrinol, 154, pp.891~898 (2006)
- Neely EK, "Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty", J Pediatr, 127, pp.47~52 (1995)
- Lee PA, "Laboratory monitoring of children with precocious puberty", Arch Pediatr Adolesc Med, 148, pp.369~376 (1994)
- 서정환, "Factors that predict a positive response on gonadotropin-releasing hormone stimulation test for diagnosing central precocious puberty in girls", Annals of Pediatric Endocrinology & Metabolism, 18(4), pp.202~207 (2013), 대한소아내분비학회
- Supornsilchai V, "Basal luteinizing hormone", follicle stimulating hormone ratio in diagnosis of central precocious puberty, 2003, pp.86(Suppl 2), S145~S151
- Fu JF, "Impact of BMI on gonadorelin-stimulated LH peak in premenarcheal girls with idiopathic central precocious puberty", Obesity (Silver Spring), 23, pp.637~643 (2015)
- Lee HS, "Impact of body mass index on luteinizing hormone secretion in gonadotropin-releasing hormone stimulation tests of boys experiencing precocious puberty", Neuroendocrinology, 97, pp.225~231 (2013)
- Lee HS, "Luteinizing hormone secretion during gonadotropin-releasing hormone stimulation tests in obese girls with central precocious puberty", J Clin Res Pediatr Endocrinol, 8, pp.392~398 (2016)