Evaluation of gonadotropin-releasing hormone stimulation test results used in the differential diagnosis of precocious puberty
Abstract
Aim: The purpose of this study was to evaluate the results of gonadotropin-releasing hormone (GnRH) stimulation tests administered to girls presenting with breast development before the age of eight.
Materials and Methods: Forty-nine cases (19 true precocious puberty and 30 premature thelarche) administered GnRH tests due to breast development were included in the study. Patient data were obtained through a retrospective examination of file records. Cases’ age at diagnosis, bone age (BA), and basal and gonadotropin levels hormone levels were recorded.
Results: A peak luteinizing hormone (LH) threshold of 4.58 IU/L was 84% sensitive and 90% specific in differentiating of two groups, while a peak LH/ follicle-stimulating hormone (FSH) threshold >0.27 exhibited 74% sensitivity and 80% specificity, and a BA- calendar age difference of 1.13 exhibited 63% sensitivity and 80% specificity.
Conclusion: Peak LH ≥ 4.58 IU/L and peak LH/FSH ≥0.27 threshold values can differentiate true precocious puberty and premature thelarche in girls presenting with early breast development.
References
- Brito VN, Spinola-Castro AM, Kochi C, Kopacek C, Silva PC, Guerra-Júnior G. Central precocious puberty: revisiting the diagnosis and therapeutic management. Arch Endocrinol Metab. 2016;60(2):163-72.
- Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003; 24(5):668-93.
- Partsch CJ, Sippell WG. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol Metab. 2002;16(1):165-89.
- Antoniazzi F, Zamboni G. Central precocious puberty: current treatment options. Paediatr Drugs. 2004;6(4):211-31.
- Chiabotto P, Costante L, de Sanctis C. Premature thelarche and environmental pollutants. Minerva Med. 2006;97(3):277-85.
- Volta C, Bernasconi S, Cisternino M, et al. Isolated premature thelarche and thelarche variant: clinical and auxological follow-up of 119 girls. J Endocrinol Invest. 1998;21(3):180-83.
- Lee CT, Tung YC, Tsai WY. Premature thelarche in Taiwanese girls. J Pediatr Endocrinol Metab. 2010;23(9):879-84.
- Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr. 1995;127(1):47-52.
- Lee HS, Park HK, Ko JH, Kim YJ, Hwang JS. Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls. Horm Metab Res. 2012;44(11):851-54.
- Pasternak Y, Friger M, Loewenthal N, Haim A, Hershkovitz E. The utility of basal serum LH in prediction of central precocious puberty in girls. Eur J Endocrinol. 2012;166(2):295-99.
- Lee DS, Ryoo NY, Lee SH, Kim S, Kim JH. Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls? Ann Pediatr Endocrinol Metab. 2013;18(4):196-201.
- Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. California:Stanford University Press;1959.
- Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303.
- Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752-e762.
- Della Manna T, Setian N, Damiani D, Kuperman H, Dichtchekenian V. Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty. Rev Hosp Clin Fac Med Sao Paulo. 2002;57(2):49-54.
- Battaglia C, Mancini F, Regnani G, Persico N, Iughetti L, De Aloysio D. Pelvic ultrasound and color Doppler findings in different isosexual precocities. Ultrasound Obstet Gynecol 2003;22(3):277-83.
- Vurallı D, Gönç EN, Özön ZA, Alikaşifoğlu A. Adequacy of basal luteinizing hormone levels in the diagnosis of central precocious puberty. Turk Pediatri Ars. 2020;55(2):131-38.
- Kandemir N, Demirbilek H, Özön ZA, Gönç N, Alikaşifoğlu A. GnRH stimulation test in precocious puberty: single sample is adequate for diagnosis and dose adjustment. J Clin Res Pediatr Endocrinol. 2011;3(1):12-7.
- Yazdani P, Lin Y, Raman V, Haymond M. A single sample GnRHa stimulation test in the diagnosis of precocious puberty. Int J Pediatr Endocrinol. 2012;2012(1):23.
- Çatlı G, Erdem P, Anık A, Abacı A, Böber E. Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche. Turk Pediatri Ars. 2015;50(1):20-6.
- Mogensen SS, Aksglaede L, Mouritsen A, et al. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab. 2011;96(5):1393-401.
Erken puberte ayırıcı tanısında kullanılan gonadotropin salgılatıcı hormon uyarı test sonuçlarının değerlendirilmesi
Abstract
Amaç: Bu çalışmada 8 yaşından önce meme gelişimi ile çocuk endokrin polikliniğine başvuran kız çocuklarına uygulanan gonadotropin salgılatıcı hormon (GnRH) uyarı test sonuçlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Hasta verileri dosya kayıtlarının geriye yönelik incelenmesi sonucu elde edilen bu çalışmada meme gelişimi nedeniyle GnRH uyarı testi yapılmış 49 kız olgu (19 gerçek erken puberte, 30 prematür telarş) alındı. Olguların tanı yaşı, antropometrik ölçümleri, kemik yaşı (KY), bazal ve uyarılmış gonadotropin düzeyleri kaydedildi.
Bulgular: İki grubu ayırt etmek için zirve luteinizan hormon (LH) sınır değeri 4,58 IU/L alındığında duyarlılık %84 ve özgüllük %90, zirve LH/folikül stimüle edici hormon (FSH) sınır değeri >0,27 alındığında duyarlılık %74 ve özgüllük %80, KY-takvim yaşı farkı 1,13 alındığında duyarlılık %63 ve özgüllük %80 saptandı.
Sonuç: Erken meme gelişimi ile başvuran kız çocuklarında zirve LH ≥ 4,58 IU/L ve zirve LH/FSH ≥0,27 sınır değerleri gerçek erken puberteyi prematür telarştan ayırt edebilir.
References
- Brito VN, Spinola-Castro AM, Kochi C, Kopacek C, Silva PC, Guerra-Júnior G. Central precocious puberty: revisiting the diagnosis and therapeutic management. Arch Endocrinol Metab. 2016;60(2):163-72.
- Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003; 24(5):668-93.
- Partsch CJ, Sippell WG. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol Metab. 2002;16(1):165-89.
- Antoniazzi F, Zamboni G. Central precocious puberty: current treatment options. Paediatr Drugs. 2004;6(4):211-31.
- Chiabotto P, Costante L, de Sanctis C. Premature thelarche and environmental pollutants. Minerva Med. 2006;97(3):277-85.
- Volta C, Bernasconi S, Cisternino M, et al. Isolated premature thelarche and thelarche variant: clinical and auxological follow-up of 119 girls. J Endocrinol Invest. 1998;21(3):180-83.
- Lee CT, Tung YC, Tsai WY. Premature thelarche in Taiwanese girls. J Pediatr Endocrinol Metab. 2010;23(9):879-84.
- Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr. 1995;127(1):47-52.
- Lee HS, Park HK, Ko JH, Kim YJ, Hwang JS. Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls. Horm Metab Res. 2012;44(11):851-54.
- Pasternak Y, Friger M, Loewenthal N, Haim A, Hershkovitz E. The utility of basal serum LH in prediction of central precocious puberty in girls. Eur J Endocrinol. 2012;166(2):295-99.
- Lee DS, Ryoo NY, Lee SH, Kim S, Kim JH. Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls? Ann Pediatr Endocrinol Metab. 2013;18(4):196-201.
- Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. 2nd ed. California:Stanford University Press;1959.
- Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44(235):291-303.
- Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752-e762.
- Della Manna T, Setian N, Damiani D, Kuperman H, Dichtchekenian V. Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty. Rev Hosp Clin Fac Med Sao Paulo. 2002;57(2):49-54.
- Battaglia C, Mancini F, Regnani G, Persico N, Iughetti L, De Aloysio D. Pelvic ultrasound and color Doppler findings in different isosexual precocities. Ultrasound Obstet Gynecol 2003;22(3):277-83.
- Vurallı D, Gönç EN, Özön ZA, Alikaşifoğlu A. Adequacy of basal luteinizing hormone levels in the diagnosis of central precocious puberty. Turk Pediatri Ars. 2020;55(2):131-38.
- Kandemir N, Demirbilek H, Özön ZA, Gönç N, Alikaşifoğlu A. GnRH stimulation test in precocious puberty: single sample is adequate for diagnosis and dose adjustment. J Clin Res Pediatr Endocrinol. 2011;3(1):12-7.
- Yazdani P, Lin Y, Raman V, Haymond M. A single sample GnRHa stimulation test in the diagnosis of precocious puberty. Int J Pediatr Endocrinol. 2012;2012(1):23.
- Çatlı G, Erdem P, Anık A, Abacı A, Böber E. Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche. Turk Pediatri Ars. 2015;50(1):20-6.
- Mogensen SS, Aksglaede L, Mouritsen A, et al. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab. 2011;96(5):1393-401.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Article |
| Authors | |
| Publication Date | April 23, 2021 |
| Submission Date | January 16, 2021 |
| Acceptance Date | March 30, 2021 |
| Published in Issue | Year 2021 Volume: 7 Issue: 1 |
