Location: Children's Nutrition Research CenterTitle: A single sample GnRHa stimulation test in the diagnosis of precocious puberty) Author
Submitted to: International Journal of Pediatric Endocrinology
Publication Type: Review Article
Publication Acceptance Date: 6/23/2012
Publication Date: 7/18/2012
Citation: Yazndani, P., Lin, Y., Raman, V., Haymond, M.W. 2012. A single sample GnRHa stimulation test in the diagnosis of precocious puberty. International Journal of Pediatric Endocrinology. 23:1-6. Interpretive Summary: Early diagnosis of precocious puberty and appropriate management will prevent ultimate short stature and avoids many of the physical and psychological adversities associated with early puberty. Gonadotropin-releasing hormone (GnRH) has been a standard test for diagnosing children with early puberty. However optimal sampling times for the measurements of pituitary hormones following stimulation were yet to be established. We analyzed the results of such stimulation tests in 155 children (aged 1-9 years) referred for early development to Texas Children's Hospital. We found the diagnosis of a brain cause for early puberty. Such findings will be beneficial to the pediatric clinical community by providing a simple test to screen for true precocious puberty.
Technical Abstract: Gonadotropin-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. To determine the appropriate sampling time for LH post leuprolide challenge. A 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. Of 71 children with clinical evidence of central precocious puberty, 59 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. A single serum LH sample collected 3 hours post GnRHa challenge is the optimal sample to establish the diagnosis of central precocious puberty.