Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK.
Post-graduate School of Paediatrics, Departments of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena & Reggio Emilia, Paediatric Unit, Modena, Italy.
J Pediatr Endocrinol Metab. 2020 Nov 26;33(11):1373-1381. doi: 10.1515/jpem-2020-0170.
Background Girls with Turner syndrome (TS) are at an increased risk of primary ovarian insufficiency (POI). Good correlation between serum and urinary gonadotrophins exists in children assessed for disorders of puberty, but there is little evidence of their reliability in hypergonadotropic states. Objectives To determine whether there was a correlation between serum and urinary Luteinising Hormone (uLH) and Follicle-Stimulating Hormone (uFSH) in hypergonadotrophic states, and whether uFSH could suggest an ovarian failure in TS as Anti-Mullerian Hormone (AMH). Patients and Methods Retrospective cohort study of 37 TS girls attending the paediatric TS clinic in Glasgow between February 2015 and January 2019, in whom 96 non-timed spot urine samples were available with a median age at time of sample of 12.89 years (3.07-20.2 years). uLH and uFSH were measured by chemiluminescent microparticle immunoassay. Simultaneous serum gonadotrophins and AMH were available in 30 and 26 girls, respectively. AMH <4 pmol/L was considered indicative of ovarian failure. Results A strong correlation was found between serum LH and uLH (r 0.860, P<0.001) and serum FSH and uFSH (r 0.905, p<0.001). Among patients≥10 years not on oestrogen replacement, ROC curve identified uFSH as a reasonable marker for AMH<4 pmol/L uFSH of >10.85 U/L indicates an AMH <4 pmol/L with 75% sensitivity and 100 % specificity (AUC 0.875)with similar ability as serum FSH (AUC 0.906). Conclusion uLH and uFSH are non-invasive, useful and reliable markers of ovarian activity in hypergonadotropic states as TS. uFSH could provide an alternative to AMH (in centres which are limited by availability or cost) in revealing ovarian failure and requirement for oestrogen replacement in pubertal induction.
背景 特纳综合征（TS）女孩发生原发性卵巢功能不全（POI）的风险增加。在评估青春期障碍的儿童中，血清和尿促性腺激素之间存在良好的相关性，但在高促性腺激素状态下，其可靠性的证据很少。 目的 确定高促性腺激素状态下血清和尿黄体生成素（uLH）和卵泡刺激素（uFSH）之间是否存在相关性，以及 uFSH 是否可以像抗苗勒管激素（AMH）一样提示 TS 中的卵巢衰竭。 患者和方法 这是一项回顾性队列研究，纳入了 2015 年 2 月至 2019 年 1 月期间在格拉斯哥儿科 TS 诊所就诊的 37 名 TS 女孩，其中有 96 份非定时随机尿样，中位年龄为 12.89 岁（3.07-20.2 岁）。uLH 和 uFSH 采用化学发光微粒子免疫分析法测定。同时有 30 名和 26 名女孩分别获得了血清促性腺激素和 AMH。AMH<4pmol/L 被认为是卵巢衰竭的指标。 结果 发现血清 LH 和 uLH（r=0.860，P<0.001）以及血清 FSH 和 uFSH（r=0.905，p<0.001）之间存在很强的相关性。在未接受雌激素替代治疗的≥10 岁患者中，ROC 曲线确定 uFSH 是 AMH<4pmol/L 的合理标志物，uFSH>10.85U/L 提示 AMH<4pmol/L 的灵敏度为 75%，特异性为 100%（AUC 0.875），与血清 FSH 相似（AUC 0.906）。 结论 uLH 和 uFSH 是高促性腺激素状态下 TS 卵巢活性的非侵入性、有用且可靠的标志物。uFSH 可以替代 AMH（在可用性或成本受限的中心），以揭示卵巢衰竭和青春期诱导中雌激素替代的需求。
