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Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty
Dong-Min Lee1,2, In-Hyuk Chung2
1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Insights
Morning unstimulated luteinizing hormone (mLH) effectively screens for central precocious puberty (CPP). This simpler test is a reliable alternative to the lengthy gonadotropin releasing hormone stimulation test (GnRHST).
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Clinical Diagnostics
Background:
- Central precocious puberty (CPP) diagnosis relies on the gonadotropin releasing hormone stimulation test (GnRHST).
- GnRHST is time-consuming and requires multiple samples, posing inconvenience for pediatric patients.
- Exploring alternative, less invasive screening methods for CPP is crucial.
Purpose of the Study:
- To evaluate the reliability of morning unstimulated luteinizing hormone (mLH) levels for screening central precocious puberty (CPP).
- To assess the influence of diurnal variation on mLH levels in early puberty.
- To determine the prognostic value of a single mLH measurement for CPP diagnosis.
Main Methods:
- Retrospective evaluation of 160 girls under 8 years with early puberty signs (SMR 2).
- Classification into CPP or non-CPP groups based on standard GnRHST results.
- Analysis of auxological, biochemical, and hormonal data, focusing on mLH and morning unstimulated follicular stimulating hormone (mFSH) levels.
Main Results:
- A significant difference in the mLH/mFSH ratio was observed between CPP and non-CPP groups (P<0.001).
- mLH levels showed a significant correlation with GnRHST variables (r=0.532, P<0.001).
- An mLH cutoff of 0.22 IU/L demonstrated 69.4% sensitivity and 82.1% specificity for CPP screening. Bone age and BMI were not significant predictors.
Conclusions:
- Single morning unstimulated luteinizing hormone (mLH) measurement is clinically effective for screening central precocious puberty (CPP).
- The mLH cutoff of 0.22 IU/L provides a reliable indicator for CPP screening.
- Bone age advancement and body mass index were not found to be useful predictors in this CPP screening study.
Purpose:
The standard method used to diagnose central precocious puberty (CPP) is the gonadotropin releasing hormone stimulation test (GnRHST). However, this test is inconvenient for children because it is time-consuming and requires multiple samples. This study aimed to determine the reliability of morning unstimulated luteinizing hormone (mLH) level when screening for CPP, with an emphasis on the influence of diurnal variation.
Methods:
This study included 160 girls with signs of early puberty (SMR 2) under 8 years of age. They were classified as CPP or non-CPP based on their standard GnRHST. The auxological, biochemical, and hormonal characteristics of subjects were retrospectively evaluated. The prognostic value of single morning unstimulated gonadotropin level was examined for use in CPP screening.
Results:
Of 160 patients, 121 (75.6%) presented with CPP, and 39 (24.4%) were determined to be prepubertal. The mLH/mFSH (morning unstimulated follicular stimulating hormone) ratio showed significant differences between the 2 groups (P<0.001). The mLH was correlated with GnRHST variables (r=0.532, P<0.001). The mLH cutoff point when screening for CPP was 0.22 IU/L, which had sensitivity and specificity of 69.4% and 82.1%, respectively. In regression analysis, bone age (BA) (odds ratio [OR], 1.018; 95% confidence interval [CI], 0.967-1.071; P=0.506) and body mass index (BMI) (OR, 0.874; 95% CI, 0.583-1.310; P=0.515) were not significant predictors. The mLH≥0.22 IU/L group (OR, 9.596; 95% CI, 3.853-23.900; P<0.001) was highly suggestive of CPP.
Conclusion:
In this study, single morning unstimulated luteinizing hormone had clinical efficacy for CPP screening, but BA advanced over chronological age and BMI was not useful for CPP screening.
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