A Short-Duration Gonadotropin-Releasing Hormone Stimulation Test for the Diagnosis of Central Precocious Puberty

Abstract

Background and Objectives: The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard method for diagnosing central precocious puberty (CPP), although it requires multiple blood samplings over 120 min. This study aimed to evaluate if a shorter test may have an equivalent diagnostic accuracy. Materials and Methods: We retrospectively reviewed the GnRH tests of 188 consecutive pediatric patients (169 females) referred for signs of early pubertal development. The diagnostic accuracy of the hormonal levels was evaluated at different time points (15, 0, 60, 90, and 120 min after the GnRH stimulus). Results: A diagnosis of CPP was made in 130 cases (69%), with 111 (85%) being female. Sensitivity and specificity ratings higher than 99% for the diagnosis of CPP were achieved for LH levels ≥4.7 mU/mL at 30 and 60 min after the stimulus (area under the ROC curve (AUC) = 1), with no further increase in the diagnostic accuracy in the remaining time points. No sex differences in diagnostic accuracy were found. The LH/FSH ratio at 30 min showed a sensitivity of 94.9%, with an AUC of 0.997 and a value ≥0.76. Conclusions: A short-duration GnRH test of 60 min provided optimal results for the diagnosis of CPP. Extending the test for an extra hour is therefore unnecessary and inadvisable.

Does Basal Morning Luteinizing Hormone (bLH) Predict Central Precocious Puberty (CPP) in Girls?

“…At our center, we conduct the GnRH test using a fixed administration of 50 mcg of gonadorelin acetate. Although we cannot rule out the possibility of insufficient stimulation, we have observed that in girls with an LH peak greater than 5 IU/L, the mean dosage of gonadorelin per body weight was lower than in others [ 31 ].…”

“…Our research supports the findings of Pellegrin et al, who discovered that a 30 min GnRH test has a high sensitivity rate of 99.03% and specificity in diagnosing CPP in females. Additionally, two samples collected after 30 and 60 min, respectively, provide 100% sensitivity and specificity in diagnosing CPP in both males and females [ 2 , 31 ].…”

Lipid Profile and Triglyceride-Glucose Index (TyG) Alterations in a Single-Center Cohort of Children Diagnosed with Central Precocious Puberty

“…The search for parameters useful in differentiating patients with CPP from those with normal variants of pubertal development is important as clues for diagnosis of early activation of the hypothalamic-pituitary-gonadal axis are not yet standardized to date [ 1 , 35 ], and any potential differences could be helpful to exactly identify cases needing medical assessments with a GnRH test. Our statistical analysis showed no significant differences in the lipid profile between children having CPP and not: in fact, despite HDL cholesterol was lower in the CPP group, this association was not confirmed at the multivariate analysis after adjustment for confounding factors.…”