A single sample GnRHa stimulation test in the diagnosis of precocious puberty

Parvin Yazdani,Yuezhen Lin,Morey Haymond,Vandana Raman

doi:10.1186/1687-9856-2012-23

Abstract

ContextGonadotropin-releasing hormone (GnRH) has been the standard test for diagnosing central precocious puberty. Because GnRH is no longer available, GnRH analogues (GnRHa) are now used. Random LH concentration, measured by the third-generation immunochemiluminometric assay, is a useful screening tool for central precocious puberty. However, GnRHa stimulation test should be considered, when a basal LH measurement is inconclusive. However optimal sampling times for luteinizing hormone (LH) have yet to be established.PurposeTo determine the appropriate sampling time for LH post leuprolide challenge.MethodsA retrospective analysis of multi-sample GnRHa stimulation tests performed in 155 children (aged 1–9 years) referred for precocious puberty to Texas Children’s Hospital.After 20 mcg/kg of SQ leuprolide acetate, samples were obtained at 0, 1, 3, and 6 hours.ResultsOf 71 children with clinical evidence of central precocious puberty, fifty nine children had a peak LH >5 mIU/mL. 52 (88%) of these responders had positive responses at 1 hour (95% CI is 80–96%), whereas all 59 children (100%) had a peak LH response >5 mIU/mL at 3 hours (95% CI is 94-100%), P = 0.005.ConclusionsA single serum LH sample collected 3 hours post GnRHa challenge is the optimal sample to establish the diagnosis of central precocious puberty.

Highlights

Central precocious puberty is the early onset of pubertal development as a result of gonadotropin release by the pituitary gland
A single serum luteinizing hormone (LH) sample collected 3 hours post Gonadotropin-releasing hormone analogue (GnRHa) challenge is the optimal sample to establish the diagnosis of central precocious puberty
Gonadotropin-releasing hormone (GnRH)-stimulated plasma LH concentrations have been the mainstay for establishing the diagnosis of precocious puberty, but it is no longer available in the United States

Summary

Introduction

Central precocious puberty is the early onset of pubertal development as a result of gonadotropin release by the pituitary gland. Precocious puberty in a child can be associated with adverse consequences including compromised final adult height and psychosocial problems. Establishing the diagnosis of central precocious puberty requires documenting pubertal physical findings and measuring luteinizing hormone (LH) concentration, which is the key biochemical assessment of pubertal status. Gonadotropin-releasing hormone (GnRH)-stimulated plasma LH concentrations have been the mainstay for establishing the diagnosis of precocious puberty, but it is no longer available in the United States. GnRH analogue (leuprolide acetate) administered subcutaneously is a suitable substitute for GnRH in the diagnosis of central precocious puberty [1,2,3,4,5].

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Conclusion