J Clin Endocrinol Metab. 2021 Oct 21;106(11):e4520-e4530. doi: 10.1210/clinem/dgab448. Erratum in: J Clin Endocrinol Metab. 2021 Nov 15;: PMID: 34160619https://academic.oup.com/jcem/article/106/11/e4520/6308284
Brief Summary: This cross-sectional study of 355 girls with Central Precocious Puberty (CPP) evaluates the diagnostic role of urinary gonadotropins.
The gold standard diagnostic for CPP is the GnRH stimulation test (GnRH-ST), which is invasive and costly [1]. Previous studies described the detectability of urinary gonadotropins and hypothesized that First Morning Voided (FMV) urinary gonadotropins may play a role in assessing CPP [2], [3]. This study validated urinary gonadotropins in the diagnosis and monitoring of CPP.
The cross-sectional study included 355 girls with CPP aged between 3.9 and 9.8 years. GnRH-ST was used to categorize girls as having a positive (LH peak > 5 IU/L, 258 girls) or negative (LH peak < 5 IU/L, 97 girls) LH response. One FMV urine specimen was collected the same day. Using Pearson’s correlation, uLH and uLH-to-uFSH ratio were strongly correlated with basal and stimulated serum gonadotropins. Using ROC analysis, authors defined a uLH cutoff value of 0.55 IU/L for the CPP screening, with a 95% sensitivity and a value of 1.74 IU/L for CPP diagnosis, with a 69.4% sensitivity and a 75.3% specificity to predict a positive GnRH-ST. When combining uLH with uLH-to-uFSH ratio > 0.4 IU/L, the specificity increased to 86.6%. 20 patients receiving GnRH-analogue treatment were evaluated at 3 and 6 months of follow up and both serum gonadotropins and uLH indicated adequate suppression of the gonadal axis.
In conclusion, these findings show that FMV uLH may be an interesting alternative for CPP screening, but further studies will be necessary in independent cohorts to validate the method particularly in pre-pubertal and pubertal controls.
References: 1. Carel JC, Léger J. (2008) “Clinical practice. Precocious puberty.,” N Engl J Med; 358(22):2366–77. 2. Apter D, Bützow TL, Laughlin GA, Yen SSC. (1993) “Gonadotropin-releasing hormone pulse generator activity during pubertal transition in girls: Pulsatile and diurnal patterns of circulating gonadotropins,” J Clin Endocrinol Metab; 76(4):940–9. 3. Rifkind AB, Kulin HE, Ross GT. (1967) “Follicle-stimulating hormone (FSH) and luteninizing hormone (LH) in the urine of prepubertal children.,” J Clin Invest; 46(12):1925–31.
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ESPE Yearbook of Paediatric Endocrinology
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