The Use of Morning Urinary Gonadotropins and Sex Hormones in the Management of Early Puberty in Chinese Girls

Abstract

Context Although gonadotropin-releasing hormone stimulation test (GnRHST) is the gold standard in diagnosing central precocious puberty (CPP), it is invasive, expensive, and time-consuming, requiring multiple blood samples to measure gonadotropin levels. Objective We evaluated whether urinary hormones could be potential biomarkers for pre- or post- puberty, aiming to simplify the current diagnosis and prognosis procedure. Design, Setting, and Participants We performed a cross-sectional study of a total of 355 girls with CPP in National Clinical Research Center for Child Health in China, including 258 girls with positive and 97 girls with negative results from GnRHST. Twenty patients received GnRH analogue (GnRHa) treatment and completed a six-month follow up. Main Outcome Measures We measured luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, progesterone, testosterone, and human chorionic gonadotropin in the first morning voided urine samples. Results Their urinary LH levels and the ratios of LH: FSH increased significantly with the advancement in Tanner Stages. uLH levels were positively associated with basal and peak LH levels in the serum after GnRH stimulation. A cut-off value of 1.74 IU/L for uLH reached a sensitivity of 69.4% and a specificity of 75.3% in predicting a positive GnRHST result. For the combined threshold (uLH≥1.74+uLH: uFSH ratio >0.4), the specificity reached 86.6%. After 3 months of GnRHa therapy, the uLH and uFSH levels decreased accordingly. Conclusions uLH could be a reliable biomarker for the initial CPP diagnosis and screening; uLH also could be an effective marker for evaluating the efficacy of clinical treatment.

A Quadruplex Ultrasensitive Immunoassay for Simultaneous Assessment of Human Reproductive Hormone Proteins in Multiple Biofluid Samples

“…Biomarker tests in fingertip blood and spot urine samples can be used to diagnose reproductive diseases and to monitor reproductive health. , These tests are noninvasive and cost-effective compared to traditional blood tests. We tested fingertip blood and urine samples separately using the proposed quadruplex immunoassay.…”

“…The simultaneous measurement of FSH, LH, PRL, and AMH can provide a comprehensive hormonal profile that is useful in assessing the stage of pubertal development, identifying underlying disorders, and differentiating between central and peripheral causes. , Therefore, the simultaneous assessment of the four reproductive hormone protein levels is of great importance for the detection of reproductive health. Furthermore, the change of urinary FSH, LH, and PRL levels also indicates the problems of reproductive health and demonstrates the efficacy of fertility treatments. , Nevertheless, recent studies have failed to detect the presence of AMH in urine. , Therefore, it is essential to conduct a thorough exploration into urinary AMH levels with the assistance of a more sensitive detection technique for studying the relationship between AMH levels and the development of related diseases.…”

“…Furthermore, the change of urinary FSH, LH, and PRL levels also indicates the problems of reproductive health and demonstrates the efficacy of fertility treatments. 48,49 Nevertheless, recent studies have failed to detect the presence of AMH in urine. 50,51 Therefore, it is essential to conduct a thorough exploration into urinary AMH levels with the assistance of a more sensitive detection technique for studying the relationship between AMH levels and the development of related diseases.…”

Urinary gonadotropin assay on 24-h collections as a tool to detect early central puberty onset in girls: determination of predictive thresholds

“…Comparison with morning or random micturition would be of high interest. Previous studies have agreed that there is no benefit in calculating the urinary gonadotropins/urinary creatinine ratio; this does not refine correlation of values with breast Tanner stages ( Zhan et al , 2021 ), and even impairs it ( Demir et al , 2021 ). Moreover, Singh et al (2015) showed in a large cohort of teenagers that an adjustment of steroid or urinary LH assays on hydration status (osmolality, specific gravity, urine creatinine) did not confer an improved relevance of the results.…”

“…The measurement of FSH and LH in urine samples was previously reported to be a useful biological tool to detect the pubertal increase of gonadotropin secretion ( Buckler and Clayton, 1970 ; Rifkind et al , 1970 ; Chipman et al , 1981 ). Several studies have reported interesting results regarding the usefulness of first-morning voided (FMV) or random non-timed urines to detect puberty onset with good sensitivity in girls ( McNeilly et al , 2012 ; Zung et al , 2014 ; Demir et al , 2016 , 2021 ; Lucaccioni et al , 2016 ; Kolby et al , 2017 ; Shim et al , 2019 ; Yüce et al , 2020 ; Lee et al , 2021 ; Zhan et al , 2021 ). The collection of 24-h urine samples provides the complete nychthemeral activity of the HPG axis and the data correlates well with that from morning urine samples ( Maesaka et al , 1990 ).…”