Factors that predict a positive response on gonadotropin-releasing hormone stimulation test for diagnosing central precocious puberty in girls
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Purpose: The rapid increase in the incidence of precocious puberty in Korea has clinical and social significance. Gonadotropin-releasing hormone (GnRH) stimulation test is required to diagnose central precocious puberty (CPP), however this test is expensive and time-consuming. This study aimed to identify factors that can predict a positive response to the GnRH stimulation test. Methods: Clinical and laboratory parameters, including basal serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2), were measured in 540 girls with clinical signs of CPP. Results: Two hundred twenty-nine of 540 girls with suspected CPP had a peak serum LH level higher than 5 IU/L (the CPP group). The CPP group had advanced bone age (P ＜0.001), accelerated yearly growth rate (P ＜0.001), increased basal levels of LH (P =0.02), FSH (P ＜0.001), E2 (P =0.001), and insulin-like growth factor-I levels (P ＜0.001)compared to the non-CPP group. In contrast, body weight (P ＜0.001) and body mass index (P ＜0.001) were lower in the CPP group. Although basal LH was significantly elevated in the CPP group compared to the non-CPP group, there was considerable overlap between the 2 groups. Cutoff values of basal LH (0.22 IU/L) detected CPP with 87.8% sensitivity and 20.9% specificity. Conclusion: No single parameter can predict a positive response on the GnRH stimulation test with both high sensitivity and specificity. Therefore, multiple factors should be considered in evaluation of sexual precocity when deciding the timing of the GnRH stimulation test.
Abstract
Purpose: The rapid increase in the incidence of precocious puberty in Korea has clinical and social significance. Gonadotropin-releasing hormone (GnRH) stimulation test is required to diagnose central precocious puberty (CPP), however this test is expensive and time-consuming. This study aimed to identify factors that can predict a positive response to the GnRH stimulation test. Methods: Clinical and laboratory parameters, including basal serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2), were measured in 540 girls with clinical signs of CPP. Results: Two hundred twenty-nine of 540 girls with suspected CPP had a peak serum LH level higher than 5 IU/L (the CPP group). The CPP group had advanced bone age (P ＜0.001), accelerated yearly growth rate (P ＜0.001), increased basal levels of LH (P =0.02), FSH (P ＜0.001), E2 (P =0.001), and insulin-like growth factor-I levels (P ＜0.001)compared to the non-CPP group. In contrast, body weight (P ＜0.001) and body mass index (P ＜0.001) were lower in the CPP group. Although basal LH was significantly elevated in the CPP group compared to the non-CPP group, there was considerable overlap between the 2 groups. Cutoff values of basal LH (0.22 IU/L) detected CPP with 87.8% sensitivity and 20.9% specificity. Conclusion: No single parameter can predict a positive response on the GnRH stimulation test with both high sensitivity and specificity. Therefore, multiple factors should be considered in evaluation of sexual precocity when deciding the timing of the GnRH stimulation test.
참고문헌 (21)
- Merke DP, "Evaluation and management of precocious puberty", Arch Dis Child, 75, pp.269~271 (1996)
- Cisternino M, "Etiology and age incidence of precocious puberty in girls: a multicentric study", J Pediatr Endocrinol Metab, 13(1), pp.695~701 (2000)
- Hur K, "Five year national trend of precocious puberty in Korean children, 2004-2008", Program and Abstracts, the 58th Annual Fall Meeting of the Korean Pediatric Society, 2009, pp.179~ (2009), Korean Pediatric Society
- Brauner R, "Adult height in girls with idiopathic true precocious puberty", J Clin Endocrinol Metab, 79, pp.415~420 (1994)
- Tremblay L, "Precocious puberty in adolescent girls: a biomarker of later psychosocial adjustment problems", Child Psychiatry Hum Dev, 36, pp.73~94 (2005)
- Berberoğlu M., "Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management", J Clin Res Pediatr Endocrinol, 1, pp.164~174 (2009)
- Lee PA, "Laboratory monitoring of children with precocious puberty", Arch Pediatr Adolesc Med, 148, pp.369~376 (1994)
- Marshall WA, "Variations in pattern of pubertal changes in girls", Arch Dis Child, 44, pp.291~303 (1969)
- Greulich WW, "Radiographic atlas of skeletal development of the hand and wrist" (1959), Stranford University Press
- 2007 Korean children and adolescents growth standard (commentary for the development of 2007 growth chart), "Korea Centers for Disease Control and Prevention, Division of Chronic Disease Surveillance, Committee for the Development of Growth Standard for Korean Children and Adolescents", Korea Centers for Disease Control and Prevention, Division of Chronic Disease Surveillance, ~ (2007)
- Hyun SE, "Reference values for serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Korean children and adolescents", Clin Biochem, 45, pp.16~21 (2012)
- 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)
- Pasternak Y, "The utility of basal serum LH in prediction of central precocious puberty in girls", Eur J Endocrinol, 166, pp.295~299 (2012)
- Supornsilchai V, "Basal luteinizing hormone", follicle stimulating hormone ratio in diagnosis of central precocious puberty, 2003, pp.86(2), S145~S151
- 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
- Lee HS, "Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls", Horm Metab Res, 44, pp.851~854 (2012)
- Sørensen K, "Serum IGF1 and insulin levels in girls with normal and precocious puberty", Eur J Endocrinol, 166, pp.903~910 (2012)
- Biro FM, "Pubertal maturation in girls and the relationship to anthropometric changes: pathways through puberty", J Pediatr, 142, pp.643~646 (2003)
- Burt Solorzano CM, "Obesity and the pubertal transition in girls and boys", Reproduction, 140, pp.399~410 (2010)
- Wang Y., "Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls", Pediatrics, 110, pp.903~910 (2002)