Effectiveness of basal LH in monitoring central precocious puberty treatment in girls
-
Valeria Calcaterra
,
Alberto Villani
Abstract
Objectives
Treatment of central precocious puberty (CPP) is based on administration of GnRH agonists in order to suppress hypothalamic-pituitary-gonadal axis and thus induce the stabilization or regression of pubertal development. Our aim was to determine whether the single basal serum LH and/or FSH concentration could be an effective tool to assess the efficacy of treatment to suppress activation of hypothalamic-pituitary axis.
Patients and methods
Serum LH and FSH were measured before and after the GnRH injection, as well as E2 basal levels in 60 girls with documented idiopathic CPP at diagnosis and 18 and 30 months after the beginning of therapy.
Results
At diagnosis, peaks of >5 IU/L of LH and of FSH were observed in 100 and 91.6% of girls, respectively, with basal LH values of <1 IU/L in 70% and basal FSH levels of <1 IU/L in 10%. E2 were <20 pg/mL in 36.6%. After 18 months, a suppressed peak (i.e. <3 IU/L) was recorded in 85% of girls (p<0.01) for LH and in 98.3% for FSH (p<0.01). Basal LH <1 IU/L was detected in 85% (p<0.01) and basal FSH ≤1 IU/L in 40% (p<0.01). Serum E2 ≤20 pg/mL was recorded in 61.6% (p<0.01). After 30 months, all patients showed LH suppressed peak (p<0.01) and 98.3% suppressed FSH peak (p<0.01). 100% showed basal LH concentrations <1 IU/L (p<0.01) and 38.3% FSH basal values <1 UI/mL (p<0.01). E2 ≤20 pg/mL was observed in 32.72% (p=NS).
Conclusions
Basal LH values are a reliable indicator of the efficacy of GnRHa therapy after 30 months of GnRHa therapy.
Acknowledgments
The authors are grateful to Dr. Sheila McVeigh, native-language lector at the University of Pavia, for the English revision of the manuscript.
Research funding: None declared.
Author contribution: VC and GDF conceptualized and designed the study, drafted the initial manuscript and approved the final manuscript as submitted. RA performed biochemical analysis, carried out analysis and interpretation of data and approved the final manuscript as submitted. DR and BM carried out analysis and interpretation of data, revised the literature and approved the final manuscript as submitted. CMM gave technical assistance, revised the literature and approved the final manuscript as submitted. EB, AV and MB designed the study, revised the manuscript, gave conceptual advice and approved the final manuscript as submitted.
Competing interest: Authors state no conflict of interest.
Ethical approval: The study was approved by the “Comitato Etico Area di Pavia”, the Ethics Committee of the Foundation IRCCS San Matteo Hospital, on May 17th, 2016 (reference number 20160005680) and was carried out according to the principles of the Declaration of Helsinki. Written assent was obtained from the children and written informed consent was obtained from their parents, in accordance with the study protocol.
References
1. Carel, JC, Léger, J. Clinical practice. Precocious puberty. N Engl J Med 2008;358:2366–77. https://doi.org/10.1056/nejmcp0800459.Search in Google Scholar
2. Herger, S, Muller, R, Ranke, M, Schwarz, P-H, Waldhauser, F, Partsch, C-J, et al.. Long-term GnRH agonist treatment for female CPP does not impair reproductive function. Mol Cell Endocrinol 2006;254–255:217–20.10.1016/j.mce.2006.04.012Search in Google Scholar PubMed
3. Lee, DS, Ryoo, NY, Lee, SH, Kim, S, Kim, JH. Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for the diagnosis of precocious puberty in girls? Ann Pediatr Endocrinol Metab 2013;18:196–201. https://doi.org/10.6065/apem.2013.18.4.196.Search in Google Scholar PubMed PubMed Central
4. Carel, J. C, Eugster, E. A, Rogol, A, Ghizzoni, L, Palmert, M. R. ESPE-LWPES GnRH Analogs Consensus Conference Group. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752. e762. https://doi.org/10.1542/peds.2008-1783.Search in Google Scholar PubMed
5. Kanthi Bangalore, K, Fuqua, JS, Rogol, AD, Klein, KO, Popovic, J, Houk, CP, et al.. Use of gonadotropin-releasing hormone analogs in children: update by an international consortium. Horm Res Paediatr 2019;91:357–72. https://doi.org/10.1159/000501336.Search in Google Scholar PubMed
6. Brito, VN, Batista, MC, Borges, MF, Latronico, AC, Kohek, MB, Thirone, AR, et al.. Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab 1999;84:3539–44. https://doi.org/10.1210/jc.84.10.3539.Search in Google Scholar
7. 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;166:295–99. https://doi.org/10.1530/eje-11-0720.Search in Google Scholar PubMed
8. Teilmann, G, Pedersen, CB, Jensen, TK, Skakkebaek, NE, Juul, A. Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries. Pediatrics 2005;116:1323–8. https://doi.org/10.1542/peds.2005-0012.Search in Google Scholar PubMed
9. Tanner, JM, Whitehouse, RH. Clinical longitudinal standards for height, weight height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976;51:170–9. https://doi.org/10.1136/adc.51.3.170.Search in Google Scholar PubMed PubMed Central
10. Cacciari, E, Milani, S, Balsamo, A, Spada, E, Bona, G, Cavallo, L, et al.. Italian cross-sectional growth charts for height, weight and BMI (2 to 20 yr). J Endocrinol Invest 2006;29:581–93. https://doi.org/10.1007/bf03344156.Search in Google Scholar
11. Greulich, WW, Pyle, SI. Radiographic atlas of skeletal development of the hand and wrist., 2nd ed. Stanford, USA: Stanford University Press; 1959.10.1097/00000441-195909000-00030Search in Google Scholar
12. Mogensen, S S, Aksglaede, L, Mouritsen, A, Soresen, K, Main, KM, Gideon, P, et al.. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab 2011;96:1393–401. https://doi.org/10.1210/jc.2010-2745.Search in Google Scholar PubMed
13. Zenaty, D, Blumberg, J, Liyanage, N, Jacqz-Aigrain, E, Lahlou, N, Carel, JC. A 6-month trial of the efficacy and safety of triptorelin pamoate (11.25 mg) every 3 Months in children with precocious puberty: a retrospective comparison with triptorelin acetate. Hormone Res Paediatr 2016;86:188–95. https://doi.org/10.1159/000448840.Search in Google Scholar PubMed
14. de Vries, L, Horev, G, Schwartz, M, Schwartz, M, Phillips, M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol 2006;154:891–8. https://doi.org/10.1530/eje.1.02151.Search in Google Scholar PubMed
15. Buzi, F, Pilotta, A, Dordoni, D, Lombardi, A, Zaglio, S, Adlard, P. Pelvic ultrasonography in normal girls and in girls with pubertal precocity. Acta Paediatr 1998;87:1138–45. https://doi.org/10.1080/080352598750031121.Search in Google Scholar PubMed
16. Menon, PSN. Precocious puberty, GnRH stimulation test and monitoring GnRH analog therapy. Indian J Pediatr 2015;82:980–2. https://doi.org/10.1007/s12098-015-1903-3.Search in Google Scholar PubMed
17. Lahlou, N, Carel, JC, Chaussain, JL, Roger, M. Pharmacokinetics and pharmacodynamics of GnRH agonists: clinical implications in pediatrics. J Pediatr Endocrinol Metab 2000;13:723–37. https://doi.org/10.1515/jpem.2000.13.s1.723.Search in Google Scholar PubMed
18. Nebesio, TD, Eugster, EA. Current concepts in normal and abnormal puberty. Curr Probl Pediatr Adolesc Health Care 2007;37:50–72. https://doi.org/10.1016/j.cppeds.2006.10.005.Search in Google Scholar PubMed
19. Neely, EK, Darrell, MW, Lee, PA, Stene, M, Hintz, RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr 1995;127:47–52. https://doi.org/10.1016/s0022-3476(95)70255-5.Search in Google Scholar PubMed
20. De Filippo, G, Rendina, D, Nazzaro, A, Lonardo, F, Bouvattier, C, Strazzullo, P. Baseline inhibin B levels for diagnosis of central precocious puberty in girls. Horm Res Paediatr 2013;80:207–12. https://doi.org/10.1159/000354682.Search in Google Scholar PubMed
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review Articles
- Association between muscle strength and risk factors for metabolic syndrome in children and adolescents: a systematic review
- Adverse effects of metabolic disorders in childhood on adult reproductive function and fertility in the male
- Original Articles
- Female adolescents and young women previously treated for pediatric malignancies: assessment of ovarian reserve and gonadotoxicity risk stratification for early identification of patients at increased infertility risk
- Anthropometric indices and cardiometabolic risk factors in a Ghanaian adolescent population
- Effectiveness of basal LH in monitoring central precocious puberty treatment in girls
- Combination of sleep duration, TV time and body mass index is associated with cardiometabolic risk moderated by age in youth
- Serum level of NPTX1 is independent of serum MKRN3 in central precocious puberty
- Training using a simulation-based workshop reduces inaccuracies in estimations of testicular volume
- Longitudinal 15-year follow-up of women with former early puberty: abnormal metabolic profiles not associated with earlier age at onset of puberty, but associated with obesity
- Prenatal smoke exposure is associated with increased anogenital distance in female infants: a prospective case–control study
- Evaluation of the efficiency of serum biotinidase activity as a newborn screening test in Turkey
- Characterization and outcome of 11 children with non-diabetic ketoacidosis
- Challenges of following patients with inherited metabolic diseases during the COVID-19 outbreak. A cross-sectional online survey study
- The utility of 68Ga-DOTATATE PET/CT in localizing primary/metastatic pheochromocytoma and paraganglioma in children and adolescents – a single-center experience
- Impact of sodium phenylbutyrate treatment in acute management of maple syrup urine disease attacks: a single-center experience
- Case Reports
- Delayed phenylketonuria diagnosis: a challenging case in child psychiatry
- Late diagnosis of 3β-Hydroxysteroid dehydrogenase deficiency: the pivotal role of gas chromatography-mass spectrometry urinary steroid metabolome analysis and a novel homozygous nonsense mutation in the HSD3B2 gene
- Differentiating syndrome of inappropriate ADH, reset osmostat, cerebral/renal salt wasting using fractional urate excretion
- Ectopic ACTH production by thymic and appendiceal neuroendocrine tumors – two case reports
- New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19
Articles in the same Issue
- Frontmatter
- Review Articles
- Association between muscle strength and risk factors for metabolic syndrome in children and adolescents: a systematic review
- Adverse effects of metabolic disorders in childhood on adult reproductive function and fertility in the male
- Original Articles
- Female adolescents and young women previously treated for pediatric malignancies: assessment of ovarian reserve and gonadotoxicity risk stratification for early identification of patients at increased infertility risk
- Anthropometric indices and cardiometabolic risk factors in a Ghanaian adolescent population
- Effectiveness of basal LH in monitoring central precocious puberty treatment in girls
- Combination of sleep duration, TV time and body mass index is associated with cardiometabolic risk moderated by age in youth
- Serum level of NPTX1 is independent of serum MKRN3 in central precocious puberty
- Training using a simulation-based workshop reduces inaccuracies in estimations of testicular volume
- Longitudinal 15-year follow-up of women with former early puberty: abnormal metabolic profiles not associated with earlier age at onset of puberty, but associated with obesity
- Prenatal smoke exposure is associated with increased anogenital distance in female infants: a prospective case–control study
- Evaluation of the efficiency of serum biotinidase activity as a newborn screening test in Turkey
- Characterization and outcome of 11 children with non-diabetic ketoacidosis
- Challenges of following patients with inherited metabolic diseases during the COVID-19 outbreak. A cross-sectional online survey study
- The utility of 68Ga-DOTATATE PET/CT in localizing primary/metastatic pheochromocytoma and paraganglioma in children and adolescents – a single-center experience
- Impact of sodium phenylbutyrate treatment in acute management of maple syrup urine disease attacks: a single-center experience
- Case Reports
- Delayed phenylketonuria diagnosis: a challenging case in child psychiatry
- Late diagnosis of 3β-Hydroxysteroid dehydrogenase deficiency: the pivotal role of gas chromatography-mass spectrometry urinary steroid metabolome analysis and a novel homozygous nonsense mutation in the HSD3B2 gene
- Differentiating syndrome of inappropriate ADH, reset osmostat, cerebral/renal salt wasting using fractional urate excretion
- Ectopic ACTH production by thymic and appendiceal neuroendocrine tumors – two case reports
- New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19
