Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls?
2
조회
0
다운로드
5
인용
0
참고문헌
키워드
초록
Purpose: A gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP). The aim of this study was to investigate the diagnostic accuracy of basal gonadotropin levels for girls with suspected precocious puberty and to evaluate the factors affecting positive results of the GnRHST. Methods: Korean girls with early pubertal development who visited the clinic during 2010–2012 were included. Auxological and biochemical tests were evaluated and a standard GnRHST was performed. A peak luteinizing hormone (LH) level of ≥5 IU/L was considered a positive response during the GnRHST. Results: A total of 336 girls were included. The positive responses were observed in 241 girls (71.7%), and negative responses were found in 95 girls (28.3%). In the logistic regression analysis, the coefficient of the basal LH and basal LH/follicular stimulating hormone (FSH) ratio was 4.23 (P ＜0.001) and 21.28 (P ＜0.001), respectively. Receiver operating characteristic analysis showed that the basal LH/FSH ratio is a better predictor of the pubertal result after the GnRHST than the basal LH (area under the curve was 0.745 and 0.740, respectively; P =0.027). Among 189 girls with a basal LH of ＜0.1 IU/L, 105 (55.6%) had positive responses. Conclusion: An elevated level of the basal LH and basal LH/FSH ratio was a significant predicting factor of positive responses during the GnRHST. However a GnRHST was still necessary for diagnostic confirmation of CPP because more than half of the girls with a basal LH level below the detection limit revealed to have CPP.
Abstract
Purpose: A gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP). The aim of this study was to investigate the diagnostic accuracy of basal gonadotropin levels for girls with suspected precocious puberty and to evaluate the factors affecting positive results of the GnRHST. Methods: Korean girls with early pubertal development who visited the clinic during 2010–2012 were included. Auxological and biochemical tests were evaluated and a standard GnRHST was performed. A peak luteinizing hormone (LH) level of ≥5 IU/L was considered a positive response during the GnRHST. Results: A total of 336 girls were included. The positive responses were observed in 241 girls (71.7%), and negative responses were found in 95 girls (28.3%). In the logistic regression analysis, the coefficient of the basal LH and basal LH/follicular stimulating hormone (FSH) ratio was 4.23 (P ＜0.001) and 21.28 (P ＜0.001), respectively. Receiver operating characteristic analysis showed that the basal LH/FSH ratio is a better predictor of the pubertal result after the GnRHST than the basal LH (area under the curve was 0.745 and 0.740, respectively; P =0.027). Among 189 girls with a basal LH of ＜0.1 IU/L, 105 (55.6%) had positive responses. Conclusion: An elevated level of the basal LH and basal LH/FSH ratio was a significant predicting factor of positive responses during the GnRHST. However a GnRHST was still necessary for diagnostic confirmation of CPP because more than half of the girls with a basal LH level below the detection limit revealed to have CPP.
참고문헌 (25)
- Parent AS, "The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration", Endocr Rev, 24, pp.668~693 (2003)
- Lee PA., "Central precocious puberty: an overview of diagnosis, treatment, and outcome", Endocrinol Metab Clin North Am, 28, pp.901~918 (1999)
- Carel JC, "Clinical practice: precocious puberty", N Engl J Med, 358, pp.2366~2377 (2008)
- Brauner R, "Adult height in girls with idiopathic true precocious puberty", J Clin Endocrinol Metab, 79, pp.415~420 (1994)
- Mrug S, "Positive parenting and early puberty in girls: protective effects against aggressive behavior. Arch Pediatr Adolesc Med 2008;162:781-6. 6. Lee PA. Laboratory monitoring of children with precocious puberty", Arch Pediatr Adolesc Med, 148, pp.369~376 (1994)
- Resende EA, "Assessment of basal and gonadotropinreleasing hormone-stimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children", J Clin Endocrinol Metab, 92, pp.1424~1429 (2007)
- Brito VN, "Diagnostic value of fluorometric assays in the evaluation of precocious puberty", J Clin Endocrinol Metab, 84, pp.3539~3544 (1999)
- Neely EK, "Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty", J Pediatr, 127, pp.47~52 (1995)
- Houk CP, "Adequacy of a single unstimulated luteinizing hormone level to diagnose central precocious puberty in girls", Pediatrics, 123, pp.e1059~e1063 (2009)
- Ibáñez L, "Use of leuprolide acetate response patterns in the early diagnosis of pubertal disorders: comparison with the gonadotropin-releasing hormone test", J Clin Endocrinol Metab, 78, pp.30~35 (1994)
- Freire AV, "High diagnostic accuracy of subcutaneous Triptorelin test compared with GnRH test for diagnosing central precocious puberty in girls", Clin Endocrinol (Oxf), 78, pp.398~404 (2013)
- 문진수, "2007 한국 소아 청소년 성장도표 : 개발 과정과 전망", Korean Journal of Pediatrics, 51(1), pp.1~25 (2008), 대한소아과학회
- Greulich WW, "Radiologic atlas of skeletal development of the hand and wrist" (1959), Stanford University Press
- Carel JC, "Consensus statement on the use of gonadotropin-releasing hormone analogs in children", Pediatrics, 123, pp.e752~e762 (2009)
- Akobeng AK, "Understanding diagnostic tests 3: receiver operating characteristic curves", Acta Paediatr, 96, pp.644~647 (2007)
- Youden WJ, "Index for rating diagnostic tests", Cancer, 3, pp.32~35 (1950)
- 김한결, "Gonadotropin-releasing Hormone Stimulation Test for Precocious Puberty", Annals of Laboratory Medicine, 31(4), pp.244~249 (2011), 대한진단검사의학회
- Lee HS, "Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls", Horm Metab Res, 44, pp.851~854 (2012)
- 남효경, "Factors to Predict Positive Results of Gonadotropin Releasing Hormone Stimulation Test in Girls with Suspected Precocious Puberty", Journal of Korean Medical Science, 27(2), pp.194~199 (2012), 대한의학회
- Bidlingmaier M, "Measurement of human growth hormone by immunoassays: current status, unsolved problems and clinical consequences", Growth Horm IGF Res, 20, pp.19~25 (2010)
- Pasternak Y, "The utility of basal serum LH in prediction of central precocious puberty in girls", Eur J Endocrinol, 166, pp.295~299 (2012)
- Cavallo A, "A simplified gonadotrophin-releasing hormone test for precocious puberty", Clin Endocrinol (Oxf), 42, pp.641~646 (1995)
- Cavallo A, "LHRH test in the assessment of puberty in normal children", Horm Res, 41, pp.10~15 (1994)
- Eckert KL, "A single-sample, subcutaneous gonadotropin-releasing hormone test for central precocious puberty", Pediatrics, 97, pp.517~519 (1996)
- Brito VN, "A single luteinizing hormone determination 2 hours after depot leuprolide is useful for therapy monitoring of gonadotropin-dependent precocious puberty in girls", J Clin Endocrinol Metab, 89, pp.4338~4342 (2004)