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Huang RH, Yang L, Yang Y, Xu QB, Xie LL, Cao LF. Development and application of a nomogram model for predicting the risk of central precocious puberty in obese girls. Front Pediatr 2024; 12:1421775. [PMID: 39281189 PMCID: PMC11393738 DOI: 10.3389/fped.2024.1421775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024] Open
Abstract
Objective The purpose of this study is to develop and assess a nomogram risk prediction model for central precocious puberty (CPP) in obese girls. Methods We selected 154 cases of obese girls and 765 cases of non-obese girls with precocious puberty (PP) who underwent the gonadotropin-releasing hormone stimulation test at the Jiangxi Provincial Children's Hospital. Univariate analysis and multivariate analysis were conducted to identify predictors of progression to CPP in girls with PP. A predictive model was developed and its predictive ability was preliminarily evaluated. The nomogram was used to represent the risk prediction model for CPP in girls with obesity. The model was validated internally using the Bootstrap method, and its efficacy was assessed using calibration curves and clinical decision analysis curves. Results In obese girls with PP, basal luteinizing hormone (LH) and follicular stimulating hormone (FSH) levels, as well as uterine volume, were identified as independent risk factors for progression to CPP. In non-obese girls, the basal LH level, bone age, and uterine volume were identified as independent risk factors for progression to CPP. With an AUC of 0.896, the risk prediction model for obese girls, was found to be superior to that for non-obese girls, which had an AUC of 0.810. The model displayed strong predictive accuracy. Additionally, a nomogram was used to illustrate the CPP risk prediction model for obese girls. This model performs well in internal validation and is well calibrated, providing a substantial net benefit for clinical use. Conclusion A medical nomogram model of CPP risk in obese girls comprised of basal LH value, basal FSH value, and uterine volume, which can be used to identify those at high risk for progression of CPP in obese girls and develop individualized prevention programs.
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Affiliation(s)
- Ren-Hao Huang
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Yang
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Yu Yang
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Qing-Bo Xu
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Li-Ling Xie
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Lan-Fang Cao
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
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Sakornyutthadej N, Mahachoklertwattana P, Wankanit S, Poomthavorn P. Peak serum luteinising hormone cut-off during gonadotropin-releasing hormone analogue test for diagnosing central precocious puberty was lower in girls with obesity as compared with girls with normal weight. Clin Endocrinol (Oxf) 2024; 100:368-378. [PMID: 38300440 DOI: 10.1111/cen.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Serum luteinising hormone (LH) concentration has been reported to be lower in girls with overweight and obesity (OW/OB) as compared with girls with normal weight (NW). This study aimed to evaluate peak serum LH concentration during gonadotropin-releasing hormone analogue (GnRHa) test in girls with OW/OB and NW who had central precocious puberty (CPP) and to determine peak serum LH cut-off for diagnosing CPP in girls with OW/OB. DESIGN, PATIENTS AND MEASUREMENTS Medical records of 971 girls with premature breast development who underwent subcutaneous GnRHa (100 µg of triptorelin acetate) test were reviewed. All girls were classified as either CPP or premature thelarche. All of them were further classified into two groups according to their body mass index as NW and OW/OB groups for each Tanner stage. RESULTS There were 634 and 337 girls in NW and OW/OB groups, respectively. CPP was diagnosed in 600 girls (249 had Tanner stage II and 351 had Tanner stage III). There were no differences in peak serum LH concentrations between CPP girls with NW and OW/OB. Peak serum LH cut-off of 5 IU/L (the current widely used cut-off) had a sensitivity and a specificity of 75% and 90%, respectively in NW group. Peak serum LH cut-off for CPP diagnosis was lower at 4 IU/L in the OW/OB group with greater sensitivity and specificity of 86% and 93%, respectively. The results were reproducible for each Tanner stage of breasts. CONCLUSION Lower peak serum LH cut-off to 4 IU/L for diagnosing CPP in girls with OW/OB should be considered to avoid underdiagnosis of the condition.
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Affiliation(s)
- Natee Sakornyutthadej
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pat Mahachoklertwattana
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Somboon Wankanit
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preamrudee Poomthavorn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Zhang M, Sun J, Wang Y, Wu Y, Li X, Li R, Fang Y, Bai H, Luo P, Yuan Y. The value of luteinizing hormone basal values and sex hormone-binding globulin for early diagnosis of rapidly progressive central precocious puberty. Front Endocrinol (Lausanne) 2024; 14:1273170. [PMID: 38317710 PMCID: PMC10840421 DOI: 10.3389/fendo.2023.1273170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
Objective This study aimed to investigate the diagnostic value of luteinizing hormone (LH) basal values and sex hormone-binding globulin (SHBG) for rapidly progressive central precocious puberty (RP-CPP). Methods A total of 121 girls presenting with secondary sexual characteristics were selected from the Department of Pediatric Endocrinology, Lianyungang Clinical Medical College of Nanjing Medical University, from May 2021 to June 2023. The children were followed up for 6 months and were divided into three groups: RP-CPP group (n=40), slowly progressive central precocious puberty (SP-CPP) group (n=40), and premature thelarche (PT) group (n=41). The differences in LH basal values and SHBG among girls in the three groups were compared. ROC curves were drawn to analyze the value of LH basal values and SHBG in identifying RP-CPP. Results Significant differences were observed in age, height, predicted adult height (PAH), weight, body mass index (BMI), bone age (BA), BA-chronological age (CA), LH basal, LH peak, FSH basal, LH peak/FSH peak, estradiol (E2), testosterone, and SHBG levels between the RP-CPP group and the SP-CPP and PT groups (P < 0.05). The LH basal value in the RP-CPP group was higher than that in the SP-CPP group and the PT group, while SHBG levels were lower than in the latter two groups, and these differences were statistically significant (P < 0.05). When the LH basal value was ≥0.58 IU/L and SHBG was ≤58.79 nmol/L, the sensitivity for diagnosing RP-CPP was 77.5% and 67.5%, and the specificity was 66.7% and 74.1%. Conclusion Detection of basal LH and SHBG levels allows for early diagnosis of the progression of central precocious puberty.
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Affiliation(s)
- Meiyu Zhang
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
| | - Jun Sun
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Ying Wang
- Pediatric Endocrinology Department, Postgraduate Training Base of Lianyungang First People's Hospital of Jinzhou Medical University, Liaoning, China
| | - Yanhui Wu
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
| | - Xiaona Li
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Rong Li
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Yafei Fang
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Hua Bai
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Peiliang Luo
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
| | - Yingdi Yuan
- Pediatric Endocrinology Department, The First People's Hospital of Lianyuangang, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, China
- Pediatric Endocrinology Department, Xuzhou Medical University Affiliated Hospital of Lianyungang, Lianyungang, China
- Pediatric Endocrinology Department, Postgraduate Training Base of Lianyungang First People's Hospital of Jinzhou Medical University, Liaoning, China
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Chotipakornkul N, Onsoi W, Numsriskulrat N, Aroonparkmongkol S, Supornsilchai V, Srilanchakon K. The utilization of basal luteinizing hormone in combination with the basal luteinizing hormone and follicle-stimulating hormone ratio as a diagnostic tool for central precocious puberty in girls. Ann Pediatr Endocrinol Metab 2023; 28:138-143. [PMID: 37401058 DOI: 10.6065/apem.2346072.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE Intravenous gonadotropin-releasing hormone (IV GnRH) testing is the gold standard for confirming a central precocious puberty (CPP) diagnosis. However, this test is not widely available commercially. Therefore, our study aim was to establish cutoff values for basal gonadotropin level and gonadotrophin responses to a 100-μg subcutaneous IV GnRH test that can distinguish between CPP and premature thelarche (PT) to discover a simple method to detect CPP. METHODS Girls between the ages of 6 and 8 years who attended the pediatric endocrinology outpatient clinic at our tertiary hospital between 2019 and 2022 were included in this study. They were evaluated for breast development, and a subcutaneous 100-μg GnRH test was administered by measuring the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in blood samples at baseline and then 30, 60, 90, and 120 minutes after injection. CPP is characterized by increased height velocity, advanced bone age, and progression of breast development. The cutoff value for diagnosis of CPP was determined using a receiver operating characteristic (ROC) analysis. RESULTS In 86 Thai girls (56 with CPP and 30 with PT), the ROC analysis showed 71.4% and 100% sensitivity and specificity, respectively, for basal LH (cutoff ≥ 0.2 IU/L) plus the basal LH/FSH ratio (cutoff ≥ 0.1). The optimal cutoff values for peak LH (cutoff ≥ 7 IU/L) demonstrated a sensitivity of 94.6% and a specificity of 100%, whereas the LH value at 30 and 60 minutes after injection (cutoff ≥ 6 IU/L) demonstrated sensitivities of 92.9% and 94.6% and a specificity of 100%, respectively. CONCLUSION Combining the basal LH (cutoff: 0.2 IU/L) and the basal LH/FSH ratio (cutoff: 0.1) can easily and cost-effectively diagnose CPP in a girl in breast Tanner stage II.
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Affiliation(s)
- Nuntika Chotipakornkul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Witchuwan Onsoi
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattakarn Numsriskulrat
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suphab Aroonparkmongkol
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vichit Supornsilchai
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khomsak Srilanchakon
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of medicine, Chulalongkorn University, Bangkok, Thailand
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Wang W, Cao NN, Xiao Y, Wang Y, Wang YF, Sun J. [Value of basal luteinizing hormone level combined with uterine volume measurement in the early diagnosis of central precocious puberty in girls with different Tanner stages]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:159-165. [PMID: 36854692 PMCID: PMC9979391 DOI: 10.7499/j.issn.1008-8830.2208204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/01/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To study the value of basal luteinizing hormone (LH) level combined with uterine volume measurement in the early diagnosis of central precocious puberty (CPP) in girls with different Tanner stages. METHODS A retrospective analysis was performed on the girls who presented with breast development before the age of 8 years and attended the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2022. According to the results of gonadotropin-releasing hormone (GnRH) agonist test, the girls with peak LH ≥5.0 IU/L and peak LH/follicle stimulating hormone ≥0.6 were enrolled as the positive group, and the other girls were enrolled as the negative group. The two groups were compared in terms of the basal LH level and uterine volume. The receiver operating characteristic (ROC) curve was used to analyze their value in the early diagnosis of CPP. RESULTS For the girls with Tanner B2 and B3 stages, the positive group had significantly higher basal LH level and uterine volume than the negative group (P<0.05). The basal LH level had an optimal cut-off value of 0.325 IU/L and 0.505 IU/L respectively in the diagnosis of Tanner stage B2/B3 CPP, while uterine volume had an optimal cut-off value of 1.639 mL and 2.158 mL respectively. Basal LH level combined with uterine volume measurement had a significantly larger area under the ROC curve than uterine volume measurement alone (P<0.001), but with no significant difference compared with that of basal LH level measurement alone (P>0.05). CONCLUSIONS Basal LH level combined with uterine volume measurement is valuable in the early diagnosis of CPP in girls with different Tanner stages, which provides a basis and guiding significance for clinical diagnosis of CPP.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Niu-Niu Cao
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Ya Xiao
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Yan Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Yi-Fan Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Jun Sun
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
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de Souza KBF, Veiga MSP, Martins GRF, da Silva AP, Fujita LGA, Tomé JM, Palhares HMDC, Borges MDF. Assessment of Gonadotropin Concentrations Stimulated by Gonadotropin-Releasing Hormone Analog by Electrochemiluminescence in Girls with Precocious Puberty and Premature Thelarche. Horm Res Paediatr 2022; 94:433-440. [PMID: 34933304 DOI: 10.1159/000521593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the cutoff values of gonadotropin response to gonadotropin-releasing hormone analogs (GnRHas) corresponding to the activation of the hypothalamic-pituitary-gonadal axis that could differentiate central precocious puberty (CPP) from premature thelarche (PT) and using the electrochemiluminescence assay method. METHODS A total of 49 girls underwent the stimulation test with an intramuscular injection of 3.75 mg leuprolide acetate. Based on the clinical and laboratory characteristics, they were divided into two groups: CPP (n = 22) and PT (n = 27). Baseline estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were collected before GnRHa administration and LH and FSH at 60 and 120 min, respectively, after GnRHa administration. RESULTS The girls with CPP presented an increased height Z-score, advanced bone age, and higher baseline LH, FSH, estradiol, and LH/FSH ratio in relation to PT (p < 0.001). Stimulated LH differed significantly between the two groups, and the LH cutoff values were ≥4.29 IU/L (p < 0.001) and ≥3.95 IU/L at 60 and 120 min, respectively (p < 0.001). The LH peak was found at 60 min after stimulation. CONCLUSIONS The GnRHa test is effective in distinguishing CPP from PT, and a single sampling, at 60 min, with LH concentrations above 4.29 may be the parameter of choice with the advantage of greater convenience and practicality.
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Affiliation(s)
- Kamila Botelho Fernandes de Souza
- Medical Endocrinologist, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Melyna Shayanne Pessôa Veiga
- Medical Endocrinologist, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Gabriela Ráina Ferreira Martins
- Pediatric Endocrinologist Physician, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Adriana Paula da Silva
- Nutritionist Collaborator, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Lívia Grimaldi Abud Fujita
- Endocrinologist, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Janaíne Machado Tomé
- Biomedical Collaborator, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Heloísa Marcelina da Cunha Palhares
- Physician Collaborator in Pediatric Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Maria de Fátima Borges
- Associated Professor of Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
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Abstract
Central precocious puberty (CPP) is due to the premature activation of the hypothalamic–pituitary–gonadal axis, which is responsible for the appearance of secondary sexual characteristics. It occurs before the age of 8 and 9 in girls and boys, respectively. CPP shows higher incidence in females than in males. Causes of CPP are similar in both sexes, but the idiopathic form is more frequent in girls, while organic forms are more frequent in males. Recent studies demonstrated a role of some genetic variants in the pathogenesis of CPP. The diagnostic evaluation based on accurate physical examination, assessment of the pituitary–gonadal axis, pelvic sonography in girls, and determination of bone age. Magnetic resonance of the central nervous system should be done in all boys and selected girls. Since the 1980s, pharmacologic treatment involves the use of gonadotropin-releasing hormone (GnRH) analogs. These drugs are characterized by few side effects and long-term safety. Many data are available on the outcome of GnRH analog treated female patients, while poor data are reported in boys. Adult height is improved in both sexes.
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