Application of urinary luteinizing hormone in the prediction of central precocious puberty in girls

  • Jinfang YUAN ,
  • Xinli WANG ,
  • Yunpu CUI ,
  • Xuemei WANG
Expand
  • Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China
WANG Xinli, e-mail, dobesity530@126.com

Received date: 2021-06-24

  Online published: 2024-10-16

Copyright

, 2024, All rights reserved, without authorization

Abstract

Objective: To evaluate the level of first morning voided (FMV) urinary luteinizing hormone (LH) in girls with breast development, and to determine the value of FMV urine LH in the evaluation of central precocious puberty (CPP). Methods: From September 2018 to April 2021, among the patients who were admitted to the Department of Pediatrics of Peking University Third Hospital for "precocious puberty" and underwent gonadotropin-releasing hormone (GnRH) stimulation test, a total of 108 girls were enrolled. According to CPP diagnostic criteria, they were divided into CPP group (n=45) and non-CPP group (n=63). The clinical characteristics and hormone levels of the two groups were compared. Receiver operating characteristic (ROC) curve was used to analyze the cut-off value of FMV urinary LH in the diagnosis of CPP in girls. Further analyses were done to evaluate the value of FMV urinary LH in the diagnosis of CPP using correlation analysis between urinary LH level and common clinical cha-racteristics. Results: ROC curve analysis showed that FMV urine LH level was significant for the diagnosis of CPP. The cut-off value of FMV urine LH was 0.69 IU/L (specificity 56.9%, sensitivity 85.0%, area under curve 0.804, P < 0.001). The basic clinical characteristics without GnRH stimulation test were analyzed by binary Logistic regression analysis, indicating that the level of FMV urine LH, uterine volume, ovarian volume and advanced T-bone age had predictive significance for CPP diagnosis in girls (OR values were 2.125, 1.961, 1.564 and 2.672, respectively). The prediction model was established and the area under the ROC curve was 0.904, P < 0.001. The level of FMV urine LH was positively correlated with the levels of serum LH, FSH and estrogen before GnRH stimulation test, the peak value of blood LH after GnRH stimulation test, T bone age and uterine volume, with r values of 0.462, 0.373, 0.242, 0.360, 0.373 and 0.263, respectively, and P values were < 0.001, < 0.001, 0.013, < 0.001, < 0.001 and 0.007, respectively. Conclusion: FMV urine LH can provide a good indication for the diagnosis of CPP. Combining with bone age advanced level and pelvic ultrasound measurement, the predictive value of FMV urine LH can be further improved for the diagnosis of CPP in girls.

Cite this article

Jinfang YUAN , Xinli WANG , Yunpu CUI , Xuemei WANG . Application of urinary luteinizing hormone in the prediction of central precocious puberty in girls[J]. Journal of Peking University(Health Sciences), 2024 , 56(5) : 788 -793 . DOI: 10.19723/j.issn.1671-167X.2024.05.006

References

1 中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 中枢性性早熟诊断与治疗专家共识(2022)[J]. 中华儿科杂志, 2023, 61 (1): 16- 22.
2 Bradley SH , Lawrence N , Steele C , et al. Precocious puberty[J]. BMJ, 2020, 368, l6597.
3 Latronico AC , Brito VN , Carel JC . Causes, diagnosis, and treatment of central precocious puberty[J]. Lancet Diabetes Endocrinol, 2016, 4 (3): 265- 274.
4 Teilmann G , Pedersen CB , Jensen TK , et al. Prevalence and incidence of precocious pubertal development in Denmark: An epidemiologic study based on national registries[J]. Pediatrics, 2005, 116 (6): 1323- 1328.
5 Demir A , Voutilainen R , Juul A , et al. Increase in first morning voided urinary luteinizing hormone levels precedes the physical onset of puberty[J]. J Clin Endocrinol Metab, 1996, 81 (8): 2963- 2967.
6 中华医学会儿科学分会内分泌遗传代谢学组, 《中华儿科杂志》编辑委员会. 中枢性性早熟诊断与治疗共识(2015)[J]. 中华儿科杂志, 2015, 53 (6): 412- 418.
7 Girard J , Hadziselimovic F . Relevance of urinary gonadotrophins[J]. Eur J Pediatr, 1987, 146 (Suppl 2)): S18- S20.
8 Kulin HE , Santner SJ . Timed urinary gonadotropin measurements in normal infants, children, and adults, and in patients with disorders of sexual maturation[J]. J Pediatr, 1977, 90 (5): 760- 765.
9 Wood CL , Lane LC , Cheetham T . Puberty: Normal physiology (brief overview)[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33 (3): 101265.
10 Abreu AP , Kaiser UB . Pubertal development and regulation[J]. Lancet Diabetes Endocrinol, 2016, 4 (3): 254- 264.
11 Cantas-Orsdemir S , Eugster EA . Update on central precocious puberty: From etiologies to outcomes[J]. Expert Rev Endocrinol Metab, 2019, 14 (2): 123- 130.
12 Swerdloff RS , Odell WD . Hormonal mechanisms in the onset of puberty[J]. Postgrad Med J, 1975, 51 (594): 200- 208.
13 Apter D , Cacciatore B , Alfthan H , et al. Serum luteinizing hormone concentrations increase 100-fold in females from 7 years to adulthood, as measured by time-resolved immunofluorometric assay[J]. J Clin Endocrinol Metab, 1989, 68 (1): 53- 57.
14 Rosenfield RL , Bordini B , Yu C . Comparison of detection of normal puberty in girls by a hormonal sleep test and a gonadotropin-releasing hormone agonist test[J]. J Clin Endocrinol Metab, 2013, 98 (4): 1591- 1601.
15 McNeilly JD , Mason A , Khanna S , et al. Urinary gonadotrophins: A useful non-invasive marker of activation of the hypothalamic pituitary-gonadal axis[J]. Int J Pediatr Endocrinol, 2012, 2012 (1): 10.
16 Kolby N , Busch AS , Aksglaede L , et al. Nocturnal urinary excretion of FSH and LH in children and adolescents with normal and early puberty[J]. J Clin Endocrinol Metab, 2017, 102 (10): 3830- 3838.
17 Demir A , Voutilainen R , Stenman UH , et al. First morning voided urinary gonadotropin measurements as an alternative to the GnRH test[J]. Horm Res Paediatr, 2016, 85 (5): 301- 308.
18 Shim YS , An SH , Lee HJ , et al. Random urinary gonadotropins as a useful initial test for girls with central precocious puberty[J]. Endocr J, 2019, 66 (10): 891- 903.
19 Lee SY , Kim JM , Kim YM , et al. Single random measurement of urinary gonadotropin concentration for screening and monitoring of girls with central precocious puberty[J]. Ann Pediatr Endocrinol Metab, 2021, 26 (3): 178- 184.
20 Zung A , Burundukov E , Ulman M , et al. The diagnostic value of first-voided urinary LH compared with GnRH-stimulated gonadotropins in differentiating slowly progressive from rapidly progressive precocious puberty in girls[J]. Eur J Endocrinol, 2014, 170 (5): 749- 758.
21 Soriano-Guillen L , Argente J . Central precocious puberty, functional and tumor-related[J]. Best Pract Res Clin Endocrinol Metab, 2019, 33 (3): 101262.
22 Xu YQ , Li GM , Li Y . Advanced bone age as an indicator facilitates the diagnosis of precocious puberty[J]. J Pediatr (Rio J), 2018, 94 (1): 69- 75.
23 de Vries L , Horev G , Schwartz M , et al. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche[J]. Eur J Endocrinol, 2006, 154 (6): 891- 898.
24 Eksioglu AS , Yilmaz S , Cetinkaya S , et al. Value of pelvic sono-graphy in the diagnosis of various forms of precocious puberty in girls[J]. J Clin Ultrasound, 2013, 41 (2): 84- 93.
25 Lee SH , Joo EY , Lee JE , et al. The diagnostic value of pelvic ultrasound in girls with central precocious puberty[J]. Chonnam Med J, 2016, 52 (1): 70- 74.
26 Yuan B , Pi YL , Zhang YN , et al. A diagnostic model of idiopa-thic central precocious puberty based on transrectal pelvic ultrasound and basal gonadotropin levels[J]. J Int Med Res, 2020, 48 (8): 300060520935278.
27 Yu HK , Liu X , Chen JK , et al. Pelvic ultrasound in diagnosing and evaluating the efficacy of gonadotropin-releasing hormone agonist therapy in girls with idiopathic central precocious puberty[J]. Front Pharmacol, 2019, 10, 104.
Outlines

/