Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA.
Horm Res Paediatr. 2020;93(11-12):651-655. doi: 10.1159/000513934. Epub 2021 Mar 25.
A random ultrasensitive luteinizing hormone (LH) (LH-ICMA) ≥0.3 mIU/L is highly accurate in confirming a diagnosis of central precocious puberty (CPP). However, a prepubertal value does not exclude the diagnosis. The clinical differences between patients with CPP who have a pubertal versus prepubertal LH-ICMA have not been clearly defined. Furthermore, there is minimal information regarding the utility of this test in boys with CPP. The objective of this study was to analyze differences between patients diagnosed with CPP who had a pubertal versus prepubertal LH-ICMA, including a cohort of boys.
A retrospective chart review of children diagnosed with CPP within the last 10 years who had a baseline LH-ICMA obtained was performed. Variables analyzed included sex, age, ethnicity, bone age, BMI, etiology, Tanner stage (TS), testicular volume, and menarchal status.
Of 27 boys and 126 girls who qualified for the study, the LH-ICMA was pubertal in 87% and prepubertal in 13%. Girls with a pubertal LH-ICMA had higher baseline estradiol concentrations (p < 0.001) and more advanced breast development (p = 0.015) compared to girls with a prepubertal LH-ICMA. Of girls with a prepubertal LH-ICMA, 74% had at least TS 3 breast development and 1 was post-menarchal. The LH-ICMA was pubertal in 96% of the boys with CPP in this study.
The LH-ICMA can be prepubertal even in girls with advanced development. To our knowledge, ours is the largest cohort of boys in whom the accuracy of a random LH-ICMA has been reported.
随机超敏黄体生成素（LH）（LH-ICMA）≥0.3mIU/L 高度准确地确认中枢性性早熟（CPP）的诊断。然而，青春期前的值不能排除诊断。具有青春期前和青春期 LH-ICMA 的 CPP 患者之间的临床差异尚未明确界定。此外，关于该测试在 CPP 男孩中的应用几乎没有信息。本研究的目的是分析具有青春期前和青春期 LH-ICMA 的 CPP 患者之间的差异，包括男孩队列。
对过去 10 年内诊断为 CPP 且获得基础 LH-ICMA 的儿童进行回顾性图表审查。分析的变量包括性别、年龄、种族、骨龄、BMI、病因、Tanner 分期（TS）、睾丸体积和初潮状态。
在符合研究条件的 27 名男孩和 126 名女孩中，LH-ICMA 为青春期的占 87%，青春期前的占 13%。LH-ICMA 为青春期的女孩基础雌二醇浓度更高（p<0.001），乳房发育更先进（p=0.015），而 LH-ICMA 为青春期前的女孩。在具有青春期前 LH-ICMA 的女孩中，74%的人至少有 TS3 期乳房发育，1 人已初潮。本研究中 CPP 的男孩中，LH-ICMA 为青春期的占 96%。
即使在乳房发育先进的女孩中，LH-ICMA 也可能处于青春期前。据我们所知，这是报道最大的 CPP 男孩中随机 LH-ICMA 准确性的队列。
