Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty

Abstract

Background Diagnosing central precocious puberty (CPP) requires an integrated approach based on clinical, biochemical and instrumental data. The diagnostic gold standard is represented by GnRH (gonadotropin-releasing hormone) stimulation test. Some undoubted limitations of this procedure led the international scientific community to look for cheaper and less invasive alternative diagnostic methods, such as luteinizing hormone urinary levels (uLH) measurement. This study aims to define the reliability of urinary LH levels as a biomarker of pubertal development, both concerning the initial diagnostic management and the monitoring of patients with central precocious puberty undergoing therapy with GnRH analogues. Furthermore, the study plans to detect the potential association between LH peak serum (pLH) and urinary LH in patients undergoing diagnostic tests with GnRH and to identify a possible cut-off of uLH that may be suggestive of ensued successful hormonal stimulation. Methods The study includes 130 female patients with suspected precocious puberty or in follow-up during suppressive therapy. After the collection of the informed consent, the patients underwent clinical evaluation, auxological assessment, and hormone assays (basal levels of LH, FSH, and oestradiol; GnRH stimulating test in patients with suspected precocious puberty; urinary LH assay on the first-morning urine sample, collected after waking up). Results Two uLH cut-off values have been identified: the first of 0.25 UI/L [C.I. 95% 0.23–0.27], able to distinguish between pubertal and pre-pubertal patients, the second of 0.45 UI/L [C.I. 95% 0,20 − 0,70] suggestive of occurred hormonal stimulation in patients with diagnosis of CPP at GnRH test. All 30 patients with CPP in follow-up during suppressive therapy presented uLH values ≤ 0.45 IU/L (pU < 0.05), and uLH collected in prepubertal group control. Conclusions uLH assays on the first morning urine specimen could be considered a low-cost and minimally invasive tool for precocious puberty diagnosing and monitoring, making possible to be easily performed even by a general pediatrician. Thus, this could help referring only selected patients to pediatric endocrinologists. After an appropriate validation, this approach could reasonably reduce hospital attendance and costs of performing more invasive procedures, with a more significant emotional impact on the pediatric patient.

Alterations of the hormones follitropin and lutropin in the blood of young mice dosed with lindane

“…and greater G.D., which reflects greater gonadal maturity unrelated to gonadotropins. The results of this study appear to be inconsistent with what is indicated by Pawlina and Ross (2015), who point out that the maturation of the sexual organs, both internal and external, during puberty is mediated by estrogens (steroids) promoted by gonadotropins, which foster the maturation of follicles (Brambilla et al 2023;Gea et al 2023). According to Villanueva and de Roux (2016) and Dickerson et al (2011) the main indicator of puberty is given by the increase in gonadotropin secretion, just before the onset of SSCs, which coincides with the onset of puberty and gonadal maturity (Micangeli et al 2023).…”

“…As early puberty signals, gonadotropin-releasing hormones (GnRH) promote the release of lutropin (LH) and follitropin (FSH), which incite the production of sex steroid hormones and stimulate sexual maturation (Abdelaziz 2023;Fanis et al 2023). The pulsatile increase in LH and FSH indicates the characteristic biological signs of pubertal maturation (Léger and Carel 2016;Brambilla et al 2023), as the advent of secondary sexual characteristics (SSC) (Chotipakornkul et al 2023).…”

“…In mammals, LH and FSH are the main hormones transported in the blood (Brambilla et al 2023); however, they act differently between males and females. In females, FSH binds to specific receptors on granulosa cells and induces the development and maturation of ovarian follicles (Björvang et al 2022).…”