Basal serum luteinising hormone cut‐off, and its utility and cost‐effectiveness for aiding the diagnosis of the onset of puberty in girls with early stages of breast development

Abstract

Objective To determine basal and gonadotrophin‐releasing hormone analogue (GnRHa)‐stimulated peak luteinising hormone (LH) cut‐offs to diagnose onset of early or normal puberty in girls with each Tanner stage of breast (II and III). Design, Patients and Measurements A retrospective study of 601 girls with breast onset before 8 years of age who underwent GnRHa test was conducted. Patients were categorized as CPP and premature thelarche. Each group was divided into two subgroups; Tanner II and III. Cost‐effectiveness analysis was performed. Results In comparison with basal LH cut‐off of 0.3 IU/L, basal LH cut‐off of 0.2 IU/L had comparable specificity (Tanner II: 98.0% vs 94.8%, Tanner III: 98.8% vs 93.8%), but greater sensitivity (Tanner II: 28.3% vs 41.7%, Tanner III: 45.2% vs 59.3%). Specificity of basal LH cut‐off of 0.2 IU/L was not inferior to that of the traditionally used peak LH of 5 IU/L. Using basal LH cut‐off of 0.2 IU/L followed by GnRHa test in girls with negative basal LH was more cost‐saving when compared with using the cut‐off of 0.3 IU/L. Moreover, using basal LH cut‐off of 0.2 IU/L followed by GnRHa test provided a cost reduction when compared with performing GnRHa test in all patients. Conclusions Basal serum LH cut‐off of 0.2 IU/L could be a simple and cost‐saving tool for initial diagnosis of onset of early or normal puberty in girls with Tanner II and III before proceeding to GnRH testing.

Assessment of Gonadotropin Concentrations Stimulated by Gonadotropin-Releasing Hormone Analog by Electrochemiluminescence in Girls with Precocious Puberty and Premature Thelarche

“…However, based on the minimum baseline values of the group with CPP, an overlap of these data was observed, indicating the uncertainty of these values in girls, as a way to differentiate CPP from PT as previously demonstrated in the literature [11,12]. We agree, however, that baseline values above 0.6-1.0 could dispense the test [11,[27][28][29][30].…”

“…The analysis of the ROC curve showed cutoffs of 0.10 IU/L for baseline LH, 0.16 for baseline LH/FSH ratio, and 13.3 pg/mL for estradiol with sensitivity and specificity profiles shown in Table 3. Some authors have reported similar values and suggested that the baseline LH values are sufficient to demonstrate the activation of the HPG axis [29,30]. However, based on the minimum baseline values of the group with CPP, an overlap of these data was observed, indicating the uncertainty of these values in girls, as a way to differentiate CPP from PT as previously demonstrated in the literature [11,12].…”

Central Precocious Puberty in Boys and Girls: Similarities and Differences

“…Distinct cut-off values for boys and girls are rarely reported (Table 4). Neely et al [43] found the same cut-off values in both the sexes, while Brito et al [41] indicated a higher cut-off in boys in comparison with girls. Resende et al [45] reported a higher cut-off in girls than in boys by using an IFMA method as in Brito et al [41], while they found the contrary with an ICMA assay [45] (Table 4).…”

Central Precocious Puberty in Girls: Diagnosis, Management and Outcome

“…[19][20][21][22][23][24][25][26][27][28] A recent study in 2020 by Wankanit et al suggested a cut-off basal LH level of 0.2 IU/L for CPP diagnosis with a sensitivity and specificity of 90.0-95.0%. 29 Brain pathology has been identified in 5.0-15.0% of CPP girls and 50.0-100% of CPP boys. The most common brain pathology is a hypothalamic hamartoma.…”