Humans ; Puberty, Precocious ; diagnosis ; therapy

Child ; Humans ; Puberty, Precocious ; diagnosis ; therapy

PURPOSE: The aim of this study was to evaluate the effects of treatment with GnRH agonists on final height(FH) and the influencing factors on height gains. METHODS: Twenty-five girls and five boys with true precocious puberty, who were treated with GnRH agonists for more than one year and had attained final height, were evaluated retrospectively. We analysed auxological parameters at diagnosis, at the end of treatment, and at the attainment of final height, and calculated height gains. RESULTS: FH SDS was significantly higher than predicted adult height(PAH) SDS at diagnosis (-0.91+/-1.32, vs. -1.80+/-1.39, P<0.01). A group of initial PAH below the range of target height(TH) attained significantly more height gains and increments of height SDS than those in a group of initial PAH within the range of TH(8.37+/-2.56 cm vs. 1.38+/-6.42 cm, P<0.01; 1.30+/-0.74 vs. 0.35+/-1.28, P<0.05). Height gains were positively correlated with bone age advancement at diagnosis and height velocity during the first year of treatment(r=0.528, P<0.01 and r=0.454, P<0.05), while height gains were negatively correlated with initial PAH and bone age increments during treatment(r=-0.485, P< 0.05 and r=-0.613, P<0.01). CONCLUSION: This study suggests that GnRH agonist therapy for children with true precocious puberty improves the final height, and height gains are positively affected by bone age advancement at diagnosis and growth velocity during the first year of therapy, and negatively affected by PAH at diagnosis and degree of bone maturation during therapy.
Adolescent ; Adult ; Child ; Diagnosis ; Female ; Gonadotropin-Releasing Hormone* ; Humans ; Puberty ; Puberty, Precocious* ; Retrospective Studies

The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for differentiating central precocious puberty (CPP) from exaggerated thelarche (ET). Because of this test's limitations, previous studies have clarified the clinical and laboratory factors that predict CPP. The present study investigated the early diagnostic significance of pelvic ultrasound in girls with CPP. The GnRH stimulation test and pelvic ultrasound were performed between March 2007 and February 2015 in 192 girls (aged <8 years) with signs of early puberty and advanced bone age. Ninety-three of 192 patients (48.4%) were diagnosed as having CPP and the others (51.6%) as having ET. The CPP group had higher uterine volumes (4.31+/-2.79 mL) than did the ET group (3.05+/-1.97 mL, p=0.03). No significant differences were found in other ultrasonographic parameters. By use of receiver operating characteristic curve analysis, the most predictive parameter for CPP was a uterine volume of least 3.30 mL, with an area under the curve of 0.659 (95% confidence interval: 0.576-0.736). The CPP group had significantly higher uterine volumes than did the ET group, but there were no reliable cutoff values in pelvic ultrasound for differentiating between CPP and ET. Pelvic ultrasound should be combined with clinical and laboratory tests to maximize its diagnostic value for CPP.
Adolescent ; Diagnosis ; Female ; Gonadotropin-Releasing Hormone ; Humans ; Pelvis ; Puberty ; Puberty, Precocious ; ROC Curve ; Ultrasonography

Central Nervous System Diseases ; diagnosis ; therapy ; Humans ; Practice Guidelines as Topic ; Puberty, Precocious ; diagnosis ; therapy

OBJECTIVES: To study the value of basal luteinizing hormone (LH) level combined with uterine volume measurement in the early diagnosis of central precocious puberty (CPP) in girls with different Tanner stages. METHODS: A retrospective analysis was performed on the girls who presented with breast development before the age of 8 years and attended the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2022. According to the results of gonadotropin-releasing hormone (GnRH) agonist test, the girls with peak LH ≥5.0 IU/L and peak LH/follicle stimulating hormone ≥0.6 were enrolled as the positive group, and the other girls were enrolled as the negative group. The two groups were compared in terms of the basal LH level and uterine volume. The receiver operating characteristic (ROC) curve was used to analyze their value in the early diagnosis of CPP. RESULTS: For the girls with Tanner B2 and B3 stages, the positive group had significantly higher basal LH level and uterine volume than the negative group (P<0.05). The basal LH level had an optimal cut-off value of 0.325 IU/L and 0.505 IU/L respectively in the diagnosis of Tanner stage B2/B3 CPP, while uterine volume had an optimal cut-off value of 1.639 mL and 2.158 mL respectively. Basal LH level combined with uterine volume measurement had a significantly larger area under the ROC curve than uterine volume measurement alone (P<0.001), but with no significant difference compared with that of basal LH level measurement alone (P>0.05). CONCLUSIONS Basal LH level combined with uterine volume measurement is valuable in the early diagnosis of CPP in girls with different Tanner stages, which provides a basis and guiding significance for clinical diagnosis of CPP.
Child ; Female ; Humans ; Early Diagnosis ; Luteinizing Hormone/chemistry* ; Puberty, Precocious/diagnosis* ; Retrospective Studies ; Uterus/pathology*

PURPOSE: This study aimed to investigate the influence of gonadotropin releasing hormone agonist (GnRHa) treatment on the weight and body mass index (BMI) of girls who were diagnosed with idiopathic central precocious puberty (CPP) or early puberty (EP). METHODS: Patients who were younger than 8 years of age at diagnosis were classified as CPP and patients aged between 8 and 9 years at diagnosis were classified as EP. Of 129 patients, 34 were diagnosed with CPP and 95 were diagnosed with EP. The patients were divided according to pretreatment weight status into normal weight group, an overweight group, or an obese group. RESULTS: No significant changes were observed with respect to the weight standard deviation score (SDS) before and after 1 year, 2 years of treatment, respectively (P>0.05, P>0.05) in all patient groups. No significant changes were observed in relation to the BMI SDS before and after 1 year, 2 years of treatment, respectively (P>0.05, P>0.05) in all patient group. Depending on the degree of obesity, differences with respect to the weight SDS and BMI SDS were observed. CONCLUSION: BMI SDS increased in the GnRHa-treated patients as a whole group, but was not statistically significant. But BMI SDS increased significantly in the normal weight group after 2 years of GnRHa treatment. So, GnRHa treatment may affect the change of BMI SDS depending on degree of obesity.
Adolescent ; Body Mass Index* ; Body Weight* ; Diagnosis ; Female* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Humans ; Obesity ; Overweight ; Puberty* ; Puberty, Precocious*

PURPOSE: GnRH stimulation test is golden standard for the diagnosis of central precocious puberty as well as evaluation of treatment, however, it is more expensive and inconvenient. This is the reason why many other tests have been suggested. We studied the efficacy of modified puberty suppression score by single blood sample for evaluation of GnRH agonist treatment in central precocious puberty. METHODS: Twenty-four girls (age, 9.56+/-1.56 years) diagnosed with early puberty or precocious puberty at Kangdong Sacred Heart Hospital from March 2002 to May 2005 were included in this study. All of patients were treated with leuprorelin acetate (83.66-115.12 microgram/kg). Total 24 patients including 11 suppression and 13 non-suppression cases were analyzed. The serum levels of LH, FSH, estradiol and progesterone were measured before and 8 weeks after treatment. The height, weight, bone age and Tanner stage of breast development in each patient were also measured before and 12 weeks after treatment. We modified puberty suppression score by Mul et al. in 1999. We defined scores based on statistical significance - estradiol, 2 points (>=1.36 ng/dL), progesterone, 2 points (>=0.31 ng/dL), LH, 1 point (>=2.0 IU/L), delta BA/delta CA, 1 point (>=0), delta HtSDS, 1 point (>=0.25/6 mo). Total score is 7 points and we defined suppression is less than 3 points. RESULTS: The serum levels of estradiol (<1.36 ng/dL, P=0.000) and progesterone (<0.31 ng/dL, P= 0.003) are significantly lower in suppression group than nonsuppression group. If the score according to modified puberty suppression score (MPSS) is less than 3 points, which is considered as a successful suppression by GnRH agonist. The sensitivity, specificity, positive predictive value and negative predictive value of MPSS are 100%, 92.8%, 90.9% and 100% respectively. CONCLUSION: Single blood sample is simpler and easier than GnRH stimulation test for the evaluation and monitoring of GnRH agonist treatment in central precocious puberty and MPSS by single blood sample may be useful in outpatient clinic.
Adolescent ; Ambulatory Care Facilities ; Breast ; Diagnosis ; Estradiol ; Female ; Gonadotropin-Releasing Hormone* ; Heart ; Humans ; Leuprolide ; Progesterone ; Puberty* ; Puberty, Precocious* ; Sensitivity and Specificity

PURPOSE: Gonadotropin releasing hormone agonist (GnRHa) treatment is widely used in precocious puberty to delay rapid pubertal growth and increase final height. But, girls who enter puberty 8 to 9 years also have same course with precocious puberty in many cases. Therefore GnRHa treatment is used in girls with early puberty, but the effects are controversial. We analyzed growth velocity and sex hormone concentrations in early puberty during and after GnRHa treatment. METHODS: The subjects were included 77 girls who had sexual development during 8 to 9 years, and they were treated with GnRHa over 6 months. We analyzed chronologic age (CA), bone age (BA), predicted adult height (PAH), breast development and serum LH, FSH, E2 levels during and after treatment. Additionally we analyzed height and growth velocity of 17 subjects who were treated with GnRHa plus GH. RESULTS: CA was 8.7+/-1.1 yrs and BA was 10.3+/-1.7 yrs at diagnosis. Growth velocity was decreased from 7.4+/-2.0 cm/yr to 4.9+/-1.1 cm/yr during treatment, but they were increased to 7.9+/-1.7 cm/yr in 6 months off treatment. PAH SDS was increased from -1.9+/-1.6 to -1.5+/-1.5 during treatment. Serum E2 levels were decreased from 16.1+/-8.7 ng/dL to 9.4+/-2.4 ng/dL in 3 months after treatment and maintained in low level during treatment. But they began to increase at 3 months off treatment (P=0.059). Breast development was decreased in 3 months after treatment, however it began to increase in 3 months off treatment. Growth velocities were increased from 4.7 cm/yr to 6.6 cm/yr in 3months after combination treatment of GnRHa plus GH. PAH SDS was significantly increased in GnRHa plus GH treatment compared to GnRHa treatment only. CONCLUSION: GnRHa treatment suppressed rapid progress of early puberty effectively from start of treatment. It could be useful to relieve psychosocial problems in early puberty. PAH SDS was increased during GnRHa treatment, but it was increased more in GnRHa plus GH treatment. GH combination treatment should be considered if growth velocity was decreased seriously.
Adolescent ; Adult ; Breast ; Diagnosis ; Female* ; Gonadotropin-Releasing Hormone* ; Gonadotropins* ; Growth Hormone ; Humans ; Puberty* ; Puberty, Precocious ; Sexual Development

PURPOSE: Differential diagnosis of sexual precocity is important. Sexual precocity, defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys, was studied to evaluate the sex incidence and etiology of sexual precocity. METHODS: We reviewed the etiology and age incidence of precocious puberty in 14 boys and 89 girls examined between 1994. 11. 1-2002. 7. 31 at Samsung Seoul Hospital. All underwent standard anthropometric measures. They were assigned to diagnostic categories on the basis of clinical assessment, endocrine evaluation, radiologic imaging, and pelvic ultrasonography. RESULTS: In 89 girls, 27 had idiopathic precocious puberty, 3 had precocious puberty with organic brain lesion, 12 had gonadotropin-independent precocious puberty, 44 had premature thelarche, 2 had premature menarche, 1 had premature adrenarche. The majority of idiopathic precocious puberty girls(78%) were aged between 7-7.9 years. In 14 boys, 2 had idiopathic precocious puberty, 3 had precocious puberty with organic brain lesion, 6 had gonadotropin-independent precocious puberty, 3 had gynecomastia. CONCLUSION: Sexual precocity occurs more frequently in girls than boys. Premature thelarche is the most common form of sexual precosity. In boys, majority of central precocious puberty had organic brain lesion, so brain imaging study should be performed. In girls, majority of idiopathic precocious puberty were aged between 7-7.9 years. Reexamination of the age limit for defining when puberty should be considered precocious in Korean girls is necessary.
Adolescent ; Adrenarche ; Brain ; Diagnosis, Differential ; Female ; Gynecomastia ; Humans ; Incidence* ; Male ; Menarche ; Neuroimaging ; Puberty ; Puberty, Precocious* ; Seoul ; Ultrasonography