Pescovitz O H, Hench K D, Barnes K M, Loriaux D L, Cutler G B
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892.
J Clin Endocrinol Metab. 1988 Sep;67(3):474-9. doi: 10.1210/jcem-67-3-474.
Premature thelarche is a benign condition that affects young girls. In contrast, central precocious puberty is considered a more serious disorder that causes progressive secondary sexual development, accelerated growth and skeletal maturation, early epiphyseal fusion, and short adult stature. Differentiation between these 2 conditions is important, but may be difficult on clinical grounds, since patients with both disorders may present initially as isolated breast development. To examine the potential usefulness of gonadotropin measurements in distinguishing early central precocious puberty from premature thelarche, we measured basal and LHRH-stimulated plasma gonadotropin levels in 58 girls with idiopathic premature breast development. The girls were divided into six clinically distinct groups, based on the severity of clinical presentation, ranging from isolated breast development (group A) to complete secondary sexual development and accelerated growth and skeletal maturation (group F). The mean basal plasma LH levels and the peak LH response to LHRH stimulation were significantly less in girls with isolated thelarche (group A) than in girls with complete sexual development (group F). The mean basal plasma FSH levels did not differ between these groups, but the peak FSH response to LHRH was greater in girls with isolated thelarche than in girls with complete sexual development. Thus, girls with isolated premature thelarche had a FSH-predominant response to LHRH [mean ratio of peak LH to peak FSH, 0.29 +/- 0.10 (+/- SD)], while girls with complete sexual development had a LH-predominant response (peak LH/FSH, 4.16 +/- 1.80). All girls with isolated thelarche had peak LH/FSH ratios less than 1, and all girls with complete sexual development had a ratio greater than 1. Girls with early or intermediate manifestations of central precocious puberty, who had features of puberty in addition to breast development but lacked all of the features of group F, comprised groups B-E. These girls also had intermediate peak LH/FSH ratios, ranging from 0.29 +/- 0.10 (group B) to 3.35 +/- 2.66 (group E). We conclude that girls with early central precocious puberty frequently have LH and FSH responses to LHRH that are indistinguishable from the FSH-predominant responses of girls with isolated thelarche. These data are consistent with the hypothesis that premature thelarche and central precocious puberty may represent different positions along a continuum of hypothalamic LHRH neuron activation.
单纯性乳房早发育是一种影响幼年女孩的良性病症。相比之下，中枢性性早熟被认为是一种更严重的疾病，会导致继发性性征进行性发育、生长加速和骨骼成熟、骨骺过早融合以及成年后身材矮小。区分这两种病症很重要，但基于临床依据可能存在困难，因为这两种疾病的患者最初都可能仅表现为乳房发育。为了研究促性腺激素测量在鉴别早期中枢性性早熟和单纯性乳房早发育方面的潜在作用，我们测量了58例特发性乳房过早发育女孩的基础及促性腺激素释放激素（LHRH）刺激后的血浆促性腺激素水平。根据临床表现的严重程度，将这些女孩分为六个临床特征不同的组，从单纯乳房发育（A组）到完全性征发育、生长加速和骨骼成熟（F组）。单纯乳房早发育组（A组）女孩的基础血浆促黄体生成素（LH）平均水平及LHRH刺激后的LH峰值反应明显低于完全性征发育组（F组）女孩。这两组的基础血浆促卵泡生成素（FSH）平均水平无差异，但单纯乳房早发育组女孩对LHRH刺激后的FSH峰值反应高于完全性征发育组女孩。因此，单纯性乳房早发育的女孩对LHRH的反应以FSH为主（LH峰值与FSH峰值的平均比值为0.29±0.10[±标准差]），而完全性征发育的女孩对LHRH的反应以LH为主（LH/FSH峰值为4.16±1.80）。所有单纯乳房早发育的女孩LH/FSH峰值比值均小于1，而所有完全性征发育的女孩该比值均大于1。具有中枢性性早熟早期或中期表现的女孩，除乳房发育外还有青春期特征，但缺乏F组的所有特征，这些女孩构成B - E组。这些女孩的LH/FSH峰值比值也处于中间水平，范围从0.29±0.10（B组）到3.35±2.66（E组）。我们得出结论，早期中枢性性早熟女孩对LHRH的LH和FSH反应常常与单纯乳房早发育女孩以FSH为主的反应难以区分。这些数据与以下假设一致，即单纯性乳房早发育和中枢性性早熟可能代表下丘脑LHRH神经元激活连续体上的不同位置。
