Aalborg University Hospital, Clinic of Pediatrics, Aalborg, Denmark
Aalborg University Hospital, Clinic of Clinical Biochemistry; Aalborg University, Department of Clinical Medicine, Aalborg, Denmark
J Clin Res Pediatr Endocrinol. 2021 Jun 2;13(2):204-211. doi: 10.4274/jcrpe.galenos.2020.2020.0210. Epub 2020 Dec 30.
A consensus on how to monitor girls with central precocious puberty (CPP) during gonadotropin-releasing hormone agonist (GnRHa) treatment is lacking. Increased, unstimulated basal luteinizing hormone (LH) concentrations have been suggested to indicate lack of suppression. The aim was to evaluate pre-injection basal LH concentrations during GnRHa (leuprorelin 3.75 mg) treatment every four weeks in girls with CPP.
Medical records were reviewed for girls with CPP treated at a single center from 2014-2019. Clinical characteristics and laboratory findings during treatment were systematically recorded.
A total of 587 GnRHa pre-injection basal LH concentrations were analyzed in 74 girls. Basal LH was pubertal (≥0.3 IU/L) in 53.5% of blood samples and 87.8% of all girls had a pubertal basal LH concentration at least once. A GnRH test (n=29) was repeated in 23 girls due to suspicion of clinical progression, elevated basal LH or recordable estradiol concentrations. None had a stimulated LH >3.1 IU/L. The predictability of treatment suppression (specificity) of basal LH concentrations was 12.0% when compared to repeated GnRH stimulation tests. Despite shortening the GnRHa injection interval to three weeks, basal LH concentrations remained pubertal in 85.7% girls. A significant reduction in height standard deviation score (p<0.001) and bone age advance (p<0.001) was observed during treatment.
Pre-injection basal LH remains at pubertal concentrations during treatment with leuprorelin 3.75 mg in girls with CPP. Clinical monitoring of pubertal progression is preferable to routine basal LH concentrations. Repeat GnRH stimulation testing should be regarded as the gold standard.
目前对于促性腺激素释放激素激动剂（GnRHa）治疗期间中枢性性早熟（CPP）女孩的监测方法尚未达成共识。有人提出，未受刺激的基础黄体生成素（LH）浓度升高表明抑制作用不足。本研究旨在评估 CPP 女孩接受 GnRHa（亮丙瑞林 3.75mg）治疗时每四周的基础 LH 浓度。
回顾了 2014 年至 2019 年在一家中心接受治疗的 CPP 女孩的病历。系统记录了治疗期间的临床特征和实验室发现。
共分析了 74 名女孩的 587 次 GnRHa 注射前基础 LH 浓度。53.5%的血样和 87.8%的女孩基础 LH 浓度达到青春期（≥0.3IU/L），至少有一次基础 LH 浓度达到青春期。由于怀疑临床进展、基础 LH 升高或可记录的雌二醇浓度，29 名女孩中有 23 名重复进行了 GnRH 试验。无一例女孩的 LH 刺激值>3.1IU/L。与重复 GnRH 刺激试验相比，基础 LH 浓度对治疗抑制（特异性）的预测率为 12.0%。尽管将 GnRHa 注射间隔缩短至 3 周，但仍有 85.7%的女孩基础 LH 浓度仍处于青春期。治疗期间观察到身高标准差评分（p<0.001）和骨龄进展（p<0.001）显著降低。
CPP 女孩接受亮丙瑞林 3.75mg 治疗时，注射前基础 LH 浓度仍处于青春期水平。临床监测青春期进展优于常规基础 LH 浓度。重复 GnRH 刺激试验应被视为金标准。
