Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatrics, Saint Paul's Hospital, Taoyuan City, Taiwan.
Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine Nursing and Management, New Taipei City, Taiwan.
Pediatr Neonatol. 2021 Mar;62(2):187-194. doi: 10.1016/j.pedneo.2020.12.001. Epub 2020 Dec 11.
The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for confirming the activation of the hypothalamic-pituitary-gonadal axis in central precocious puberty (CPP). However, it is time-consuming and costly. Our aim was to search for a simpler diagnostic modality for CPP by 1) evaluating the performance of basal serum luteinizing hormone (LH), 2) constructing a practical scoring system, and 3) determining the optimal single sampling time for serum LH in the GnRH stimulation test.
Data of girls aged between 3 and 9 years at the time of the GnRH stimulation test, who attended our endocrine clinic at the MacKay Children's Hospital for signs of puberty between July 2014 and June 2019, were analyzed retrospectively. We recorded patients' age, height, weight, breast Tanner stage (BS), bone age, serum LH, and follicle-stimulating hormone (FSH). Receiver operating characteristic (ROC) curves and the Youden index were used to obtain the optimal basal serum LH level. Binary logistic regression was employed to construct a practical scoring system. Cross-sectional, cumulative frequency, and ROC curves were used to simplify the GnRH stimulation test.
Overall, 381 sets of GnRH stimulation tests were performed in 313 patients. Basal serum LH ≥ 0.2 IU/L demonstrated 70% sensitivity and 70% specificity for predicting positive GnRH stimulation test results. The practical scoring system (3 × BS + 3 × LH + 4 × FSH) showed 76% sensitivity and 72% specificity. The serum LH level at 30 min after intravenous gonadorelin exhibited 99% sensitivity and 100% specificity.
Single sampling of serum LH at 30th minute post-injection of GnRH demonstrated a diagnostic performance equivalent to the traditional GnRH stimulation test in diagnosing CPP. Therefore, this approach could become the simplest diagnostic modality.
促性腺激素释放激素（GnRH）刺激试验是确认中枢性性早熟（CPP）下丘脑-垂体-性腺轴激活的金标准。然而，它既耗时又昂贵。我们的目的是通过 1）评估基础血清黄体生成素（LH）的表现，2）构建实用的评分系统，以及 3）确定 GnRH 刺激试验中血清 LH 的最佳单次采样时间，来寻找一种更简单的 CPP 诊断方法。
回顾性分析了 2014 年 7 月至 2019 年 6 月期间，因青春期迹象在麦凯儿童医院内分泌科就诊的年龄在 3 至 9 岁的女孩 GnRH 刺激试验的数据。我们记录了患者的年龄、身高、体重、乳房 Tanner 分期（BS）、骨龄、血清 LH 和卵泡刺激素（FSH）。使用受试者工作特征（ROC）曲线和 Youden 指数获得最佳基础血清 LH 水平。采用二元逻辑回归构建实用评分系统。采用横断面、累积频率和 ROC 曲线简化 GnRH 刺激试验。
总体而言，对 313 例患者进行了 381 次 GnRH 刺激试验。基础血清 LH≥0.2IU/L 预测 GnRH 刺激试验阳性结果的敏感性和特异性均为 70%。实用评分系统（3×BS+3×LH+4×FSH）的敏感性和特异性分别为 76%和 72%。静脉注射促性腺激素释放激素后 30 分钟的血清 LH 水平具有 99%的敏感性和 100%的特异性。
GnRH 刺激试验后 30 分钟单次采血检测血清 LH 的诊断性能与传统 GnRH 刺激试验相当，可作为诊断 CPP 的最简单方法。
