Abstract
The aim of this study was to determine reliable cut-off levels of basal gonadotropin and to assess the correlation of obstetric ultrasound parameters with the GnRH stimulation test. The GnRH stimulation test was performed in a cohort of young female patients who presented at our hospital for the evaluation of early signs of puberty. Using receiver operating curves (ROCs), the sensitivity and specificity of basal luteinising hormone (LH), follicle stimulating hormone (FSH), basal and stimulated LH/FSH ratio, oestradiol levels and ultrasonographic parameters were evaluated at each level, and the area under curve (AUC) was measured. One hundred female children were assessed. We found that LH levels, peak LH/FSH ratio, fundal/cervical ratio, uterus length, and ovarian volume were reliable predictors of central precocious puberty (CPP). Cut-off levels of basal LH and the peak LH/FSH ratio had high specificity in our cohort. In addition, obstetric ultrasound parameters represent reliable predictors for the diagnosis of CPP.
Acknowledgments
The English in the original article has been checked by at least two professional editors, both native speakers of English. For a certificate, please see http://www.textcheck.com/certificate/qAZuAO; http://www.textcheck.com/certificate/56lo1Q.
References
1. Lee PA. Central precocious puberty, an overview of diagnosis, treatment and outcome. Endrocrinol Met Clin N Am 1999;28:901–11.10.1016/S0889-8529(05)70108-0Search in Google Scholar
2. Merke DP, Cutler GB Jr. Evaluation and management of precocious puberty. Arch Dis Child 1996;75:269–71.10.1136/adc.75.4.269Search in Google Scholar PubMed PubMed Central
3. Pasternak Y, Friger M, Loewenthal N, Haim A, Hershkovitz E. The utility of basal serum LH in prediction of central precocious puberty in girls. Eur J Endocrinol 2012;166:295–9.10.1530/EJE-11-0720Search in Google Scholar PubMed
4. Houk CP, Kunselman AR, Lee PA. Adequacy of a single unstimulated luteinizing hormone level to diagnose central precocious puberty in girls. Pediatrics 2009;123:1059–63.10.1542/peds.2008-1180Search in Google Scholar PubMed
5. Martins WP, Nastri CO. Ultrasonographic measurement of ovarian volume in the diagnosis of central precocious puberty. Ultrasound Obstet Gynecol 2009;34:484–5.10.1002/uog.7355Search in Google Scholar PubMed
6. Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752–62.10.1542/peds.2008-1783Search in Google Scholar PubMed
7. Neyzi O, Furman A, Bundak R, Gunoz H, Darendeliler F, et al. Growth references for Turkish children aged 6 to 18 years. Acta Paediatr 2006;95:1635–41.10.1080/08035250600652013Search in Google Scholar PubMed
8. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, et al. Body mass index references for Turkish children. Acta Paediatr 2006;95:194–8.10.1080/08035250500334738Search in Google Scholar PubMed
9. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303.10.1136/adc.44.235.291Search in Google Scholar PubMed PubMed Central
10. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Stanford, CA: Stanford University Press, 1966.Search in Google Scholar
11. Pescovitz OH, Hench KD, Barnes KM, Loriaux DI, Cutler GB Jr. Premature telarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab 1988;67:474–9.10.1210/jcem-67-3-474Search in Google Scholar PubMed
12. Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontanous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr 1995;127:47–52.10.1016/S0022-3476(95)70255-5Search in Google Scholar
13. Haber HP, Mayer EI. Ultrasound evaluation of uterine and ovarian size from birth to puberty. Pediatr Radiol 1994;24:11–3.10.1007/BF02017650Search in Google Scholar PubMed
14. Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clinical Chem 1993;39:561–77.10.1093/clinchem/39.4.561Search in Google Scholar
15. Prété G, Couto-Silva AC, Trivin C, Brauner R. Idiopathic central precocious puberty in girls: presentation factors. BMC Pediatr 2008;8:27.10.1186/1471-2431-8-27Search in Google Scholar PubMed PubMed Central
16. Kim D, Cho SY, Maeng SH, Yi ES, Jung YJ, et al. Diagnosis and constitutional and laboratory features of Korean girls referred for precocious puberty. Korean J Pediatr 2012;55:481–6.10.3345/kjp.2012.55.12.481Search in Google Scholar PubMed PubMed Central
17. Badouraki M, Christoforidis A, Economou I, Dimitriadis AS, Katzos G. Evaluation of pelvic ultrasonography in the diagnosis and differentiation of various forms of sexual precocity in girls. Ultrasound Obstet Gynecol 2008;32:819–27.10.1002/uog.6148Search in Google Scholar PubMed
18. Biro FM, Lucky AW, Simbartl LA, Barton BA, Daniels SR, et al. Pubertal maturation in girls and the relationship to anthropometric changes: pathways through puberty. J Pediatr 2003;142:643–6.10.1067/mpd.2003.244Search in Google Scholar PubMed
19. Park YJ, Moon CM, Yoo HJ. A study of factors influencing advanced puberty. Korean J Pediatr 2010;53:146–51.10.3345/kjp.2010.53.2.146Search in Google Scholar
20. Klein KO, Larmore KA, de Lancey E, Brown JM, Considine RV, et al. Effect of obesity on estradiol level, and its relationship to leptin, bone maturation, and bone mineral density in children. J Clin Endocrinol Metab 1998;83:3469–75.10.1210/jcem.83.10.5204Search in Google Scholar PubMed
21. Kılıç A, Durmuş MS, Ünüvar E, Yıldız I, Aydın BK, et al. Clinical and laboratory characteristics of children referred for early puberty: preponderance in 7–8 years of age. J Clin Res Pediatr Endocrinol 2012;4:208–12.10.4274/Jcrpe.736Search in Google Scholar
22. Kim HK, Kee SJ, Seo JY, Yang EM, Chae HJ, et al. Gonadotropin-releasing hormone stimulation test for precocious puberty. Korean J Lab Med 2011;31:244–9.10.3343/kjlm.2011.31.4.244Search in Google Scholar PubMed PubMed Central
23. Nam HK, Rhie YJ, Son CS, Park SH, Lee KH. Factors to predict positive results of gonadotropin releasing hormone stimulation test in girls with suspected precocious puberty. J Korean Med Sci 2012;27:194–9.10.3346/jkms.2012.27.2.194Search in Google Scholar PubMed PubMed Central
24. Lee HS, Park HK, Ko JH, Kim YJ, Hwang JS. Utility of Basal luteinizing hormone levels for detecting central precocious puberty in girls. Horm Metab Res 2012;44:851–4.10.1055/s-0032-1321905Search in Google Scholar PubMed
25. Kandemir N, Demirbilek H, Özön ZA, Gönç N, Alikaşifoğlu A. GnRH stimulation test in precocious puberty: single sample is adequate for diagnosis and dose adjustment. J Clin Res Pediatr Endocrinol 2011;3:12–7.10.4274/jcrpe.v3i1.03Search in Google Scholar PubMed PubMed Central
26. Oerter KE, Uriarte MM, Rose SR, Barnes KM, Cutler GB Jr. Gonadotropin secretory dynamics during puberty in normal girls and boys. J Clin Endocrinol Metab 1990;71:1251–8.10.1210/jcem-71-5-1251Search in Google Scholar PubMed
27. Wacharasindhu S, Srivuthana S, Aroonparkmongkol S, Shotelersuk V. A cost-benefit of GnRH stimulation test in diagnosis of central precocious puberty (CPP). J Med Assoc Thai 2000;83:1105–11.Search in Google Scholar
28. Haber HP, Wollmann HA, Ranke MB. Pelvic ultrasonography: early differentiation between isolated premature thelarche and central precocious puberty. Eur J Pediatr 1995;154:182–6.10.1007/BF01954267Search in Google Scholar PubMed
29. de Vries L, Phillip M. Role of pelvic ultrasound in girls with precocious puberty. Horm Res Paediatr 2011;75:148–52.10.1159/000323361Search in Google Scholar PubMed
30. Buzi F, Pilotta A, Dordoni D, Lombardi A, Zaglio S, et al. Pelvic ultrasonography in normal girls and in girls with pubertal precocity. Acta Paediatr 1998;87:1138–45.10.1111/j.1651-2227.1998.tb00921.xSearch in Google Scholar
31. de Vries L, Horev G, Schwartz M, Phillip M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol 2006;154:891–8.10.1530/eje.1.02151Search in Google Scholar PubMed
32. Herter LD, Golendziner E, Flores JA, Moretto M, Di Domenico K, et al. Ovarian and uterine findings in pelvic sonography: comparison between prepubertal girls, girls with isolated thelarche, and girls with central precocious puberty. J Ultrasound Med 2002;21:1237–46.10.7863/jum.2002.21.11.1237Search in Google Scholar PubMed
33. Lipple BM, Sample WF. Pelvic ultrasonography in pediatric and endocrine adolescent disorders. J Pediatr 1978;92:819–22.Search in Google Scholar
34. Bridges NA, Cooke A, Healy MJ, Hindmarsh PC, Brook CG. Growth of the uterus. Arch Dis Child 1996;75:330–1.10.1136/adc.75.4.330Search in Google Scholar PubMed PubMed Central
35. Stanhope R, Adams J, Jacobs HS, Brook CG. Ovarian ultrasound assessment in normal children, idiopathic precocious puberty, and during low dose pulsatile gonadotrophin releasing hormone treatment of hypogonadotrophic hypogonadism. Arch Dis Child 1985;60:116–9.10.1136/adc.60.2.116Search in Google Scholar PubMed PubMed Central
36. Griffin IJ, Cole TJ, Duncan KA, Hollman AS, Donaldson MD. Pelvic ultrasound measurements in normal girls. Acta Paediatr 1995;84:536–43.10.1111/j.1651-2227.1995.tb13689.xSearch in Google Scholar PubMed
©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
- Highlight: Cushing syndrome
- Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
- Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
- Cushing’s disease presenting as cholestatic hepatitis
- How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
- Review article
- Subclinical hypothyroidism in childhood and adolescense
- Original articles
- Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
- Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
- Measures of pituitary gland and stalk: from neonate to adolescence
- Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
- Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
- Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
- A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
- Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
- Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
- Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
- Long-term outcomes of pediatric Graves’ disease
- Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
- Vitamin D, parathormone, and insulin resistance in children born large for gestational age
- Prevalence of vitamin D deficiency in apparently healthy children in north India
- Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
- Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
- Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
- Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
- Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
- The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
- The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
- Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
- Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
- Patient reports
- Hereditary vitamin D rickets: a case series in a family
- Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
- Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
- Acquired hypothyroidism due to iodine deficiency in an American child
- Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
- Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
- Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
- Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
- Short communications
- Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
- Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
- Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
- Letter to the Editor
- And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?
Articles in the same Issue
- Frontmatter
- Highlight: Cushing syndrome
- Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
- Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
- Cushing’s disease presenting as cholestatic hepatitis
- How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
- Review article
- Subclinical hypothyroidism in childhood and adolescense
- Original articles
- Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
- Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
- Measures of pituitary gland and stalk: from neonate to adolescence
- Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
- Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
- Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
- A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
- Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
- Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
- Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
- Long-term outcomes of pediatric Graves’ disease
- Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
- Vitamin D, parathormone, and insulin resistance in children born large for gestational age
- Prevalence of vitamin D deficiency in apparently healthy children in north India
- Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
- Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
- Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
- Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
- Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
- Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
- The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
- The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
- Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
- Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
- Patient reports
- Hereditary vitamin D rickets: a case series in a family
- Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
- Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
- Acquired hypothyroidism due to iodine deficiency in an American child
- Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
- Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
- Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
- Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
- Short communications
- Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
- Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
- Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
- Letter to the Editor
- And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?