LH Dynamics in Overweight Girls with Premature Adrenarche and Slowly Progressive Sexual Precocity

Brian Bordini,Robert L Rosenfield,Elizabeth Littlejohn

doi:10.1155/2010/724696

Brian Bordini, Robert L Rosenfield + Show 1 more

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https://doi.org/10.1155/2010/724696

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Abstract

Background. Excess adiposity and premature adrenarche (PA) are risk factors for the development of polycystic ovary syndrome (PCOS). Methods. Girls with slowly progressive precocious breast development, who were overweight and had PA (SPPOPA, 6.2–8.2 years, n = 5), overweight PA (6.6–10.8 years, n = 7), and overweight premenarcheal controls (OW-PUB, 10.6–12.8 years, n = 8) underwent hormonal sleep testing and GnRH agonist (GnRHag) and ACTH tests. Results. Despite an insignificant sleep-related increase in LH and prepubertal baseline hormone levels, SPPOPA peak LH and estradiol responses to GnRHag were intermediate between those of PA and OW-PUB, the LH being significantly different from both. Conclusions. GnRHag tests indicate that SPPOPA is a slowly progressive form of true puberty with blunted LH dynamics. These results argue against the prepubertal hyperandrogenism of excess adiposity or PA enhancing LH secretion or causing ovarian hyperandrogenism prior to menarche. Excess adiposity may contribute to both the early onset and slow progression of puberty.

Highlights

We have characterized a variant group of sexually precocious girls who presented diagnostic challenges that provided an opportunity to test hypotheses about pubertal pathophysiology
Baseline body mass index (BMI) percentile and pubic hair stage were similar in the three study groups; SPPOPA and OW-PUB girls had similar breast stage and bone age (Table 2)
We demonstrate that sleep-related gonadotropin production and LH responses to GnRH agonist testing are blunted in girls with slowly progressive sexual precocity who are overweight and have premature adrenarche

Summary

Introduction

We have characterized a variant group of sexually precocious girls who presented diagnostic challenges that provided an opportunity to test hypotheses about pubertal pathophysiology They met current criteria for sexual precocity, with breast and pubic hair development before 8 years of age [1,2,3]. They differed from girls with typical central precocious puberty ( termed complete, true, or gonadotropin-dependent premature puberty) because they had slowly progressive precocious breast development [4,5,6], were overweight, and had premature adrenarche (SPPOPA). GnRHag tests indicate that SPPOPA is a slowly progressive form of true puberty with blunted LH dynamics These results argue against the prepubertal hyperandrogenism of excess adiposity or PA enhancing LH secretion or causing ovarian hyperandrogenism prior to menarche. Excess adiposity may contribute to both the early onset and slow progression of puberty

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Results

Discussion

Conclusion