Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. e1059-e1063 (doi:10.1542/peds.2008-1180)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Google Scholar
Right arrow Articles by Houk, C. P.
Right arrow Articles by Lee, P. A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Houk, C. P.
Right arrow Articles by Lee, P. A.
Related Collections
Right arrow Endocrinology
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Adequacy of a Single Unstimulated Luteinizing Hormone Level to Diagnose Central Precocious Puberty in Girls

Christopher P. Houk, MDa, Allen R. Kunselman, MAb and Peter A. Lee, MD, PhDc,d

a Department of Pediatrics, Medical College of Georgia, Augusta, Georgia
b Departments of Public Health Sciences
c Pediatrics, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
d Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana

OBJECTIVE. Using basal specimens from original gonadotropin radioimmunoassays, it was not possible to differentiate prepuberty from puberty hence gonadotropin-releasing hormone or gonadotropin-releasing hormone analog (GnRHa) testing was required to make this distinction. Third-generation gonadotropin assays have far greater specificity and sensitivity. Using a group of patients who had the diagnosis of central precocious puberty (CPP) verified or excluded by using GnRHa and traditional diagnostic criteria, the objective of this study was to determine if a single basal gonadotropin measurement was adequate to verify the diagnosis of CPP by using 2 third-generation gonadotropin assays.

METHODS. Girls referred for assessment of early puberty had previously been evaluated for central precocious puberty including gonadotropin-releasing hormone analog stimulation testing with gonadotropin measurements by 2 different chemiluminescent third-generation immunoassays. Diagnosis of central precocious puberty was made on the basis of the response to the gonadotropin-releasing hormone analog, and clinical criteria. Girls with central precocious puberty had luteinizing hormone responses ranging from 9.1 to 67.6 U/L, the prepubertal luteinizing hormone response range was 0.2 to 5.0 U/L. Basal serum luteinizing hormone and follicle-stimulating hormone concentrations from these girls have been assessed to determine the utility of using such a single sample to diagnose central precocious puberty.

RESULTS. Basal luteinizing hormone levels using the 2 third-generation gonadotropin assays were sufficient to diagnose central precocious puberty in >90% of the girls. Luteinizing hormone values were undetectable in both assays with different lower limits of detection (<0.15 and <0.20 U/L) in 29 of 34 prepubertal girls; the detectible values in 5 girls ranged from 0.20 to 0.66 U/L. All girls with central precocious puberty had values of >0.83 U/L, except a single value of 0.46 U/L. The basal follicle-stimulating hormone failed to differentiate prepubertal girls from those with central precocious puberty, whereas luteinizing hormone/follicle-stimulating hormone ratios would seem to have limited discernment.

CONCLUSION. A single basal luteinizing hormone measurement is adequate to document a pubertal hypothalamic-pituitary-ovarian axis in most but not all girls with central precocious puberty.

Key Words: hormonal control • precocious puberty • pubertal disorders • early onset puberty

Abbreviations: LH—luteinizing hormone • FSH—follicle-stimulating hormone • GnRH—gonadotropin-releasing hormone • GnRHa—gonadotropin-releasing hormone analog • CPP—central precocious puberty • HPG—hypothalamic-pituitary-gonadal • CCC—concordance correlation coefficient • ROC—receiver operating characteristic • CI—confidence interval

Accepted Jan 30, 2009.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?