Chotipakornkul Nuntika, Onsoi Witchuwan, Numsriskulrat Nattakarn, Aroonparkmongkol Suphab, Supornsilchai Vichit, Srilanchakon Khomsak
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand.
Ann Pediatr Endocrinol Metab. 2023 Jun;28(2):138-143. doi: 10.6065/apem.2346072.036. Epub 2023 Jun 30.
Intravenous gonadotropin-releasing hormone (IV GnRH) testing is the gold standard for confirming a central precocious puberty (CPP) diagnosis. However, this test is not widely available commercially. Therefore, our study aim was to establish cutoff values for basal gonadotropin level and gonadotrophin responses to a 100-μg subcutaneous IV GnRH test that can distinguish between CPP and premature thelarche (PT) to discover a simple method to detect CPP.
Girls between the ages of 6 and 8 years who attended the pediatric endocrinology outpatient clinic at our tertiary hospital between 2019 and 2022 were included in this study. They were evaluated for breast development, and a subcutaneous 100-μg GnRH test was administered by measuring the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in blood samples at baseline and then 30, 60, 90, and 120 minutes after injection. CPP is characterized by increased height velocity, advanced bone age, and progression of breast development. The cutoff value for diagnosis of CPP was determined using a receiver operating characteristic (ROC) analysis.
In 86 Thai girls (56 with CPP and 30 with PT), the ROC analysis showed 71.4% and 100% sensitivity and specificity, respectively, for basal LH (cutoff ≥ 0.2 IU/L) plus the basal LH/FSH ratio (cutoff ≥ 0.1). The optimal cutoff values for peak LH (cutoff ≥ 7 IU/L) demonstrated a sensitivity of 94.6% and a specificity of 100%, whereas the LH value at 30 and 60 minutes after injection (cutoff ≥ 6 IU/L) demonstrated sensitivities of 92.9% and 94.6% and a specificity of 100%, respectively.
Combining the basal LH (cutoff: 0.2 IU/L) and the basal LH/FSH ratio (cutoff: 0.1) can easily and cost-effectively diagnose CPP in a girl in breast Tanner stage II.
静脉注射促性腺激素释放激素（IV GnRH）检测是确诊中枢性性早熟（CPP）的金标准。然而，该检测在商业上并不广泛可用。因此，我们的研究目的是确定基础促性腺激素水平以及对100μg皮下注射IV GnRH检测的促性腺激素反应的临界值，以区分CPP和乳房过早发育（PT），从而找到一种检测CPP的简单方法。
纳入2019年至2022年在我们三级医院儿科内分泌门诊就诊的6至8岁女孩。对她们进行乳房发育评估，并通过测量基线时以及注射后30、60、90和120分钟血样中的黄体生成素（LH）和卵泡刺激素（FSH）水平，进行100μg皮下GnRH检测。CPP的特征是身高增长速度加快、骨龄提前和乳房发育进展。使用受试者工作特征（ROC）分析确定CPP诊断的临界值。
在86名泰国女孩（56名患有CPP，30名患有PT）中，ROC分析显示基础LH（临界值≥0.2 IU/L）加上基础LH/FSH比值（临界值≥0.1）的敏感性和特异性分别为71.4%和100%。LH峰值的最佳临界值（临界值≥7 IU/L）显示敏感性为94.6%，特异性为100%，而注射后30和60分钟时的LH值（临界值≥6 IU/L）的敏感性分别为92.9%和94.6%，特异性为100%。
结合基础LH（临界值：0.2 IU/L）和基础LH/FSH比值（临界值：0.1）可以轻松且经济高效地诊断处于坦纳乳房分期II期的女孩的CPP。
