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Unstimulated luteinizing hormone levels sufficient to predict progression in precocious puberty
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Canadian Pediatric Endocrine Group
The gonadotropin-releasing hormone stimulation test is not needed to predict progression of precocious puberty, according to research presented at the annual scientific meeting of the Canadian Pediatric Endocrine Group.
“We wondered if there is a baseline (luteinizing hormone) value that we could use that would predict if the child will progress into puberty or not,” said Jill Hamilton, MD, FRCPC, study researcher and pediatric endocrinologist at the Hospital for Sick Children in Toronto and an associate professor at the University of Toronto.
With assays becoming more sensitive, such as the third-generation immunochemiluminescence assays, investigators can detect the identification of luteinizing hormone (LH) at lower levels, potentially avoiding the need for a gonadotropin-releasing hormone (GnRH) stimulation test, Hamilton said.
Hamilton and colleagues retrospectively compared data from 91 children, 75 girls and 16 boys, who were referred for evaluation of early signs of puberty. They had not been treated with GnRH analogues and had been followed for at least 6 months.
“We wanted to see how many children progressed in puberty, and if the (basal) LH level alone could predict who will progress as opposed to using the (GnRH) stimulated test,” Hamilton said.
They found that all patients with a basal LH level of at least 0.3 IU/L experienced subsequent pubertal progression, whereas 62 of 67 patients with a basal LH level of 0.2 IU/L or less did not progress to puberty, yielding 100% specificity and 82.2% sensitivity. In contrast, a stimulated LH level of 5 IU/L showed 96.6% sensitivity and 85.5% specificity.
The researchers concluded that a single basal LH level of 0.3 IU/L or more is sufficient to expect subsequent pubertal progression in patients presenting with signs of precocious puberty.
“The basal level was as good, and if not better, in predicting who was going to progress in puberty over the subsequent 6 months,” Hamilton said. “Normally, patients have to have two blood tests and undergo an injection. This saves time and costs associated with the GnRH stimulation test and reduces stress for the patients.”
The study was independently conducted.
For more information:
- Hamilton J. Abstract OA5. Presented at: the Canadian Pediatric Endocrine Group 2012 Scientific Meeting; Feb. 9-11, 2012; Winnipeg, MB, Canada.
Disclosure: Dr. Hamilton reports no relevant financial disclosures.
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