OBJECTIVETo study the value of basal serum gonadotropin levels in the diagnosis of precocious puberty (PP) in girls.

METHODSA total of 77 girls with PP were divided into central PP (CPP) (n=45) and isolated premature thelarche (IPT) groups (n=32) based on the results of gonadotropin releasing hormone (GnRH) stimulation test, which was considered the gold standard for diagnosis of PP. The two groups were compared with respect to basal serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels and LH/FSH ratio. The receiver operating characteristic (ROC) curve was used to analyze the accuracy of basal LH and FSH levels and LH/FSH ratio in the diagnosis of PP.

RESULTSThe basal serum LH and FSH levels and LH/FSH ratio in the CPP group were significantly higher than in the IPT group (P<0.01). The basal serum LH level was positively correlated with peak LH level in the GnRH stimulation test in both groups. For diagnosis of CPP, the area under the ROC curve (AUC) for basal serum LH level was larger than for basal serum FSH level and LH/FSH ratio (P<0.05), and there was no significant difference in the AUC value between basal serum FSH level and LH/FSH ratio. When the basal serum LH level was 0.62 IU/L, there was a maximum Youden index (0.684), with 77.8% sensitivity and 90.6% specificity. When the basal serum LH level reached 1.5 IU/L, the sensitivity decreased to 31.1%, but with the highest specificity (100%).

CONCLUSIONSBasal serum LH level is superior to LH/FSH ratio and basal serum FSH level in the diagnosis of CPP, and can be used for preliminary diagnosis of PP in girls in the out-patient department, but there is some misdiagnosis and missed diagnosis. When basal serum LH level is higher than 1.5 IU/L the diagnosis of CPP can be confirmed in combination with clinical manifestation, without the need for an additional GnRH stimulation test.

Child ; Child, Preschool ; Female ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Puberty, Precocious ; blood ; diagnosis ; ROC Curve

OBJECTIVETo evaluate the diagnostic value of baseline serum luteinizing hormone (LH) level for central precocious puberty (CPP) in girls.

METHODSA total of 279 girls with precocious puberty were subjected to assessment of growth and development, bone age determination, baseline LH test, and follicle-stimulating hormone (FSH) test, gonadotropin-releasing hormone stimulation test, and other related examinations. Of the 279 patients, 175 were diagnosed with CPP and 104 with premature thelarche (PT). The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of baseline LH and FSH levels and their peak levels for CPP, and the correlation between the baseline LH level and the peak LH level was analyzed.

RESULTSThe CPP group had significantly higher bone age, baseline LH and FSH levels, peak LH and FSH levels, and ratio of peak LH level to peak FSH level than the PT group (P<0.01). The ROC curve proved that baseline LH level and peak LH level had good diagnostic values for CPP. Among the three bone age subgroups in the CPP group (7.0-9.0 years, 9.0-11.0 years, and >11.0 years), baseline LH level showed the best diagnostic value in the >11.0 years subgroup, with the largest area under the ROC curve. At a baseline LH level of 0.45 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 66.7% and 80% respectively, for the diagnosis of CPP. At a peak LH level of 9.935 IU/L, the Youden index reached the peak value, and the sensitivity and specificity were 74.8% and 100% respectively, for the diagnosis of CPP. The baseline LH level was positively correlated with the peak LH level (r=0.440, P<0.01).

CONCLUSIONSBaseline LH level can be used as an primary screening index for the diagnosis of CPP. It has a certain diagnostic value for CPP at different bone ages, and may be used as a monitoring index during the treatment and follow-uP.

Adolescent ; Age Determination by Skeleton ; Child ; Female ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Puberty, Precocious ; blood ; diagnosis ; ROC Curve

Central precocious puberty (CPP) is caused by premature activation of hypothalamic gonadotropin-releasing hormone (GnRH) secretion. Kisspeptin and G-protein coupled receptor-54 system is the essential gatekeeper of the reproductive system, playing a key role in the activation of the gonadotropic axis at puberty. We aimed to determine whether serum kisspeptin may function as a marker for CPP by investigating serum kisspeptin levels in Korean girls with CPP and their prepubertal controls. Serum kisspeptin levels of Korean girls with CPP (n = 30) and age-matched healthy prepubertal controls (n = 30) were measured with a competitive enzyme immunoassay. Serum kisspeptin levels were significantly higher in CPP group than in control group (4.61 +/- 1.78 vs 2.15 +/- 1.52 pM/L, P < 0.001). Serum kisspeptin was positively correlated with peak luteinizing hormone (LH), peak/basal LH ratio and peak LH/follicular-stimulating hormone (FSH) ratio during GnRH stimulation test. CPP is supposed to be triggered by premature increase of kisspeptin. Serum kisspeptin may be used as a marker of CPP. Further studies on KISS1 gene polymorphisms leading to higher risk of premature increase of kisspeptin and upstream regulator of kisspeptin are also needed.
Biological Markers/blood ; Child ; Female ; Follicle Stimulating Hormone/blood ; Humans ; Luteinizing Hormone/blood ; Puberty, Precocious/blood/*diagnosis ; Republic of Korea ; Tumor Suppressor Proteins/*blood

OBJECTIVETo study the value of follicle stimulating hormone (FSH), luteinizing hormone (LH) and LH/FSH ratio in the diagnosis of precocious puberty in girls by ROC curve analysis.

METHODSGonadotropin-releasing hormone (GnRH) stimulation test was performed on 220 girls with pseudo-sexual precocity and 61 girls with true sexual precocity. Blood LH and FSH levels were measured before and after 30 and 60 minutes of taking the GnRH test. The ratio of LH to FSH was calculated. Sensitivity and best point for the diagnosis of precocity according to LH, FSH and LH/FSH ratio were analyzed by ROC curve analysis.

RESULTSThe area under the ROC curve was 0.90 and 0.95 according to LH level and LH/FSH ratio respectively for the diagnosis of precocity. The best point for diagnosis by LH was 10.15 IU/L, with a sensitivity of 0.92 and specificity of 0.89. The best point for diagnosis by LH/FSH ratio was 0.60, with a missed diagnosis rate of 6.0% and specificity of 0.91. When true sexual precocity was diagnosed based on one index between LH>10.15 IU/L and LH/FSH ratio>0.60, sensitivity was 0.97 and specificity was 0.94. When the diagnosis of true sexual precocity was diagnosed based on both LH>10.15 IU/L and LH/FSH>0.60, sensitivity was 0.85 and specificity was 1.00.

CONCLUSIONSTrue sexual precocity can be diagnosed when both LH>10.15 IU/L and LH/FSH ratio>0.60. Only one of the two indexes for the diagnosis of true sexual precocity is presented, further observation is necessary to decrease missed diagnosis and misdiagnosis.

Diagnosis, Differential ; Female ; Follicle Stimulating Hormone ; blood ; Gonadotropin-Releasing Hormone ; pharmacology ; Humans ; Luteinizing Hormone ; blood ; Puberty, Precocious ; blood ; diagnosis ; ROC Curve

BACKGROUND: Gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard to identify central precocious puberty (CPP). This test requires multiple blood samples at different time points to measure gonadotropin levels, and is therefore expensive, time-consuming, and uncomfortable for patients. We aimed to simplify the GnRH stimulation test to require fewer blood samples. METHODS: A study of 166 girls with precocious puberty was undertaken. Blood samples were obtained at 0, 15, 30, 45, 60, 90, and 120 min after GnRH administration, and the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured. For each parameter, the sensitivities and specificities were estimated and ROC curves were constructed. RESULTS: One hundred and twenty-eight patients (77.1%) were diagnosed for CPP. Peak LH levels were achieved 30 min after GnRH stimulation in patients with CPP. Further, 98.4% of the 45-min samples were diagnostic for CPP, and the cumulative frequency of LH values of > or =5 IU/L was 100% at 45 min. Using this cut-off value for LH, the ROC curve for LH at 45 min showed the highest sensitivity (98.4%) and specificity (100%) in the diagnosis of CPP. CONCLUSIONS: Values of LH measured from a single blood sample obtained at 45 min in the GnRH stimulation test may be adequate for the diagnosis of CPP. Two samples, taken at 30 and 45 min after stimulation, were able to accurately diagnose CPP in 100% of the patients in this study.
Child ; Female ; Follicle Stimulating Hormone/blood ; Gonadotropin-Releasing Hormone/*diagnostic use ; Humans ; Luteinizing Hormone/blood ; Puberty, Precocious/blood/*diagnosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Time Factors

OBJECTIVETo assess the diagnostic value of the simplified gonadorelin stimulation test for precocious puberty.

METHODSTwo hundred and ninety-two girls with signs of advanced breast development received the gonadorelin stimulation test. According to the result of gonadorelin stimulation test, the girls were divided into 3 groups: 151 with central precocious puberty (CPP),119 with premature thelarche (PT) and 22 with peripheral precocious puberty (PPP).

RESULTSLH or FSH levels at 15 min, 30 min, 60 min in PPP group were not significantly different (P>0.05). Those were significantly different in PT group (P<0.01). The highest levels of LH were at 30 min and the highest levels of FSH were at 60 min. LH or FSH levels at 15 min, 30 min, 60 min in CPP group were significantly different (P<0.01) with the highest levels at 30 min. The ratio of basal LH and FSH >0.2 had a diagnostic sensitivity of 48.3 % and specificity of 69.7%. Taking the LH/FSH ratio >0.9 at 15 min, 30 min, 60 min as cut-off value, the diagnostic sensitivity was 80.1%, 68.9% and 38.4%, and the specificity was 90.8%, 96.6% and 69.7%, respectively.

CONCLUSIONThe LH/FSH ratio>0.9 at 15 min after gonadorelin stimulation test can be used as a cut-off value to differentiate CPP from PT and blood sample at 60 min were not necessary.

Child ; Female ; Follicle Stimulating Hormone ; blood ; Gonadotropin-Releasing Hormone ; Gonadotropins ; blood ; Humans ; Luteinizing Hormone ; blood ; Predictive Value of Tests ; Puberty, Precocious ; diagnosis ; Sensitivity and Specificity

Biomarkers ; blood ; Child ; Chorionic Gonadotropin ; blood ; Follicle Stimulating Hormone ; blood ; Growth Disorders ; etiology ; Humans ; Klinefelter Syndrome ; complications ; diagnosis ; genetics ; Magnetic Resonance Imaging ; Male ; Mediastinal Neoplasms ; complications ; diagnosis ; surgery ; Puberty, Precocious ; diagnosis ; etiology ; Teratoma ; complications ; diagnosis ; surgery ; Testis ; pathology

Sometimes, the clinical findings and the results of the gonadotropin-releasing hormone (GnRH) stimulation test are inconsistent in girls with early breast development and bone age advancement. We aimed to investigate the factors predicting positive results of the GnRH stimulation test in girls with suspected central precocious puberty (CPP). We reviewed the records of 574 girls who developed breast budding before the age of 8 yr and underwent the GnRH stimulation test under the age of 9 yr. Positive results of the GnRH stimulated peak luteinizing hormone (LH) level were defined as 5 IU/L and over. Girls with the initial positive results (n = 375) showed accelerated growth, advanced bone age and higher serum basal LH, follicle-stimulating hormone, and estradiol levels, compared to those with the initial negative results (n = 199). Girls with the follow-up positive results (n = 64) showed accelerated growth and advanced bone age, compared to those with the follow-up negative results. In the binary logistic regression, the growth velocity ratio was the most significant predictive factor of positive results. We suggest that the rapid growth velocity is the most useful predictive factor for positive results in the GnRH stimulation test in girls with suspected precocious puberty.
Age Determination by Skeleton ; Breast/growth & development ; Child ; Estradiol/blood ; Female ; Follicle Stimulating Hormone/blood ; Follow-Up Studies ; Gonadotropin-Releasing Hormone/*analysis ; Humans ; Logistic Models ; Luteinizing Hormone/blood ; Predictive Value of Tests ; Puberty, Precocious/*diagnosis ; ROC Curve ; Retrospective Studies

OBJECTIVETo study the clinical manifestations of germinoma in children with precocious puberty and to evaluate the diagnostic value of serum levels of β-human chorionic gonadotropin (β-hcG) combined with detections of β-hcG in cerebrospinal fluid (CSF).

METHODTwelve male children with germinomas confirmed by pathology from Jan. 2005 to Dec. 2009, aged from 4.2 to 10.2 years, were enrolled in this study. Patients were classified into two groups according to tumor locations: intracranial group and non-intracranial group. Levels of β-hcG in serum as well as in CSF were detected before the initiation of therapy. Age and gender matched 5 children undergoing lumbar puncture for other diseases were set as control group for the determinations of β-hcG in CSF. Levels of β-hcG and testosterone in serum and CSF were compared between intracranial group and non-intracranial group, and levels of β-hcG in CSF were compared between non-intracranial group and control group.

RESULTThe 12 children showed elevated serum levels of testosterone: 10.43 (1.70-254.00) µg/L, 11 children had testicular volume > 4 ml, while response to LHRH stimulation tests were low; 6 children had gynecomastia. Serum levels of β-hcG were elevated in both intracranial and non-intracranial group and no significant differences were found between groups 63.75 (8.50-309.50) IU/L vs. 59.00 (25.10-71.77) IU/L, P = 0.644. No correlations were found between serum levels of β-hcG and ages, tumor locations, and courses of the patients. Levels of β-hcG in CSF were significantly higher in intracranial group than that in non-intracranial group 488.99 (17.30-1048.53) IU/L vs. 1.20 (1.20-1.50) IU/L, P = 0.009. Children with non-intracranial germinomas had similar levels of β-hcG in CSF as that in control group (P = 0.571).

CONCLUSIONThe main clinical manifestations in boys suffered from germinoma included pseudo-precocious puberty, disproportionate testicular volume and gynecomastia. Detection of serum levels of β-hcG combined with β-hcG levels in CSF may be useful for determination of the locations of germinomas in children with precocious puberty.

Brain Neoplasms ; complications ; diagnosis ; Case-Control Studies ; Child ; Child, Preschool ; Chorionic Gonadotropin, beta Subunit, Human ; blood ; cerebrospinal fluid ; Germinoma ; complications ; diagnosis ; Humans ; Male ; Mediastinal Neoplasms ; complications ; diagnosis ; Puberty, Precocious ; complications

Steroid cell tumor, not otherwise specified (NOS), are rare ovarian tumor, in addition, it is more rare in children. The majority of these tumors produce several steroid hormones, particularly testosterone. Estrogen also secreted by steroid cell tumor, NOS, but it is uncommon. Furthermore, hypertension is an infrequent sign in steroid cell tumor, NOS. An 8.5-yr-old girl with hypertension and frequent vaginal spotting visited at our clinic. On laboratory evaluation, secondary hypertension due to an elevated plasma renin level and isosexual pseudoprecocious puberty was diagnosed. Right solid ovarian mass was detected in radiologic tests. She underwent a right ooporectomy and it revealed renin and progesterone receptor positive steroid cell tumor, NOS. After operation, her blood pressure returned to normal level and vaginal bleeding disappeared. Even though this case is very rare, when hypertension coincides with virilization or feminization, a renin-secreting ovarian steroid cell tumor, NOS, should be considered.
Child ; Female ; Humans ; Hypertension/*etiology ; Ovarian Neoplasms/complications/*diagnosis/pathology ; Puberty, Precocious/enzymology/*etiology ; Receptors, Cell Surface/metabolism ; Receptors, Progesterone/metabolism ; Renin/blood ; Sex Cord-Gonadal Stromal Tumors/complications/*diagnosis/pathology ; Steroids/biosynthesis ; Tomography, X-Ray Computed ; Vacuolar Proton-Translocating ATPases/metabolism