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Time Points for Gonadotropin-Releasing Hormone Stimulation Test Results in Korean Children
Rihwa Choi1,2, Aerin Kwon2, Youngju Oh2
1Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
Insights
Diagnosing central precocious puberty in Korean children can be streamlined. Optimal luteinizing hormone (LH) measurements after gonadotropin-releasing hormone (GnRH) stimulation occur at 45 and 60 minutes, improving diagnostic efficiency.
Area of Science:
- Pediatric Endocrinology
- Clinical Diagnostics
- Hormone Assays
Background:
- Central precocious puberty diagnosis relies on luteinizing hormone (LH) measurement post-gonadotropin-releasing hormone (GnRH) stimulation.
- Optimizing the timing of sample collection is crucial for accurate and efficient laboratory diagnosis.
Purpose of the Study:
- To investigate optimal time points for LH measurement following GnRH stimulation in Korean children.
- To evaluate the diagnostic accuracy of different sampling times for identifying central precocious puberty.
Main Methods:
- Analysis of 19,990 GnRH stimulation tests from 1958 Korean children (1841 females, 117 males).
- Samples collected at basal (0) and 15, 30, 45, 60, 90, 120 minutes post-stimulation.
- Receiver operating characteristic (ROC) curve analysis to determine optimal time points based on area under the curve (AUC).
Main Results:
- Peak LH concentration ≥5 IU/L and ≥2x basal rise defined pubertal response.
- Optimal diagnostic time points identified: 45 minutes for males (AUC 0.982) and 60 minutes for females (AUC 0.975).
- Combined 45 and 60-minute sampling yielded the highest AUC (0.996) with 99.1% sensitivity and 100% specificity.
Conclusions:
- A reduced sampling strategy at 45 and 60 minutes post-GnRH stimulation can efficiently diagnose central precocious puberty in Korean children.
- This optimized approach enhances diagnostic accuracy and potentially reduces testing time and resources.
Abstract:
The gold standard for the laboratory diagnosis of central precocious puberty is based on the measurement of luteinizing hormone (LH) after gonadotropin-releasing hormone (GnRH) stimulation. We sought to investigate the laboratory data for GnRH stimulation testing using samples collected from Korean children at different time points. Sampling times were at the basal time point (0) and 15, 30, 45, 60, 90, and 120 min after GnRH stimulation. Pubertal response was defined as occurring when the peak LH concentration was 5 IU/L or more and rose to at least 2 times the basal LH concentration after GnRH stimulation. During the study period, 19,990 test results from 1958 Korean children (1841 females aged 1.3-8.9 years and 117 males aged 7.3-9.9 years) were obtained. Among the 1958 children, 1232 (62.9%) showed pubertal responses. The receiver operating characteristic curve that demonstrated the greatest area under the curve (AUC) among all examined time points was 45 min after GnRH stimulation in males (AUC 0.982, 95% CI 0.938-0.998) and 60 min in females (AUC 0.975, 95% CI 0.967-0.981). The combination of 45 min and 60 min showed the greatest AUC (0.996, 95% confidence interval 0.991-0.998), with a sensitivity level of 99.1% and a specificity of 100% for all children. The results of this study provide a possibility for a reduction in sampling time points (45 min and 60 min) to identify the presence of a pubertal response after GnRH stimulation in Korean children.
