1
|
Jiang M, Gao Y, Qu T, Ji Y, Niu Y, Zhang J, Huang L. Dose inhibin B or anti-Müllerian hormone relate to precocious puberty in girls? result of a systematic review and meta-analysis. J Ovarian Res 2023; 16:227. [PMID: 37996919 PMCID: PMC10668349 DOI: 10.1186/s13048-023-01302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUNDS Existing studies have investigated the relationship between the levels of serum inhibin B (INHB), anti-müllerian hormone (AMH) and precocious puberty in girls, but the results are inconsistent. OBJECTIVE The aim of this meta-analysis was to assess whether the INHB and AMH levels changed in girls with precocious puberty relative to healthy controls. METHODS PubMed, Embase, Cochrane Library and Web of Science were searched through June 2022. We included observational clinical studies reporting the serum levels INHB and AMH in girls with precocious puberty. Conference articles and observational study abstracts were included if they contained enough information regarding study design and outcome data. Case series and reports were excluded. An overall standard mean difference (SMD) between precocious puberty and healthy controls was estimated using a DerSimonian-Laird random-effects model. RESULTS A total of 11 studies featuring 552 girls with precocious puberty and 405 healthy girls were selected for analysis. The meta-analysis showed that the INHB level of precocious puberty [including central precocious puberty (CPP) and premature the larche (PT)] were significantly increased. While there was no significant association between precocious puberty [including CPP, PT, premature pubarche (PP) and premature adrenarche (PA)] and the level of serum AMH. CONCLUSION Scientific evidence suggested that the INHB level, but not the AMH level, altered in girls with precocious puberty compared with healthy controls. Through our results we think that INHB level might be a marker for the auxiliary diagnosis of precocious puberty (especially CPP and PT). Therefore, it is important to evaluate and thoroughly investigate the clinical indicators (e.g., INHB) in order to ensure early diagnosis and medical intervention, and the risk of physical, psychological and social disorders in immature girls with precocious puberty is minimized.
Collapse
Affiliation(s)
- Mei Jiang
- Beijing Research Institute of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Acupuncture, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Tiange Qu
- Department of Dermatology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuechen Ji
- School of traditional Chinese Medicine, Beijing University of Chinese Medicine, No.11 Beisanhuandong Road, Chaoyang, Beijing, 100029, P. R. China
| | - Yiwen Niu
- School of traditional Chinese Medicine, Beijing University of Chinese Medicine, No.11 Beisanhuandong Road, Chaoyang, Beijing, 100029, P. R. China
| | - Jiaxin Zhang
- Department of Gastroenterology, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Ling Huang
- School of traditional Chinese Medicine, Beijing University of Chinese Medicine, No.11 Beisanhuandong Road, Chaoyang, Beijing, 100029, P. R. China.
| |
Collapse
|
2
|
Ziqin L, Qinwei S, Xiaobo C, Xiaohui L. The utility of serum inhibin B, anti-Müllerian hormone and insulin growth factor-1 in predicting a positive response to GnRH analogs for diagnosing central precocious puberty in girls. J Pediatr Endocrinol Metab 2021; 34:1257-1262. [PMID: 34291618 DOI: 10.1515/jpem-2021-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The use of inhibin B (INHB), anti-Müllerian hormone (AMH) and insulin-like growth factor-1 (IGF-1) in differentiating central precocious puberty (CPP) from non-CPP was evaluated. METHODS In total, 115 Chinese girls were recruited (CPP: 44, non-CPP: 71). The diagnostic performance of INHB, AMH and IGF-1 in differentiating CPP from non-CPP was analyzed using receiver operating characteristic (ROC) curves. RESULTS INHB levels were higher in the CPP group than in the non-CPP group (55.56 ± 22.42 vs. 32.97 ± 15.59 pg/mL; p<0.001). AMH levels were similar in the CPP and non-CPP groups (6.63 ± 3.74 vs. 5.70 ± 3.15 pg/mL; p=0.158), and IGF-1 levels were much higher in the CPP group than in the non-CPP group (290.75 ± 79.78 vs. 200.10 ± 54.01 pg/mL; p<0.001). The area under the ROC curve (AUC) was greatest for INHB (0.819, standard error (SE) 0.041), followed by IGF-1 (0.809, SE 0.047) and AMH (0.567, SE 0.057). Among the ROC curves including combinations of these parameters, the AUC for INHB + IGF-1 was 0.849 and that for INHB + AMH was 0.768. CONCLUSIONS Serum INHB and IGF-1 measurements could predict positive responses to gonadotropin-releasing hormone (GnRH) analog stimulation in girls with precocious puberty.
Collapse
Affiliation(s)
- Liu Ziqin
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, P. R. China
- Peking Union Medical College Graduate School, Beijing, P. R. China
| | - Song Qinwei
- Department of Clinical Laboratory, Capital Institute of Pediatrics, Beijing, P. R. China
| | - Chen Xiaobo
- Department of Endocrinology, Capital Institute of Pediatrics, Beijing, P. R. China
| | - Li Xiaohui
- Peking Union Medical College Graduate School, Beijing, P. R. China
- Department of Cardiology, Capital Institute of Pediatrics, Beijing, P. R. China
| |
Collapse
|
3
|
Maione L, Bouvattier C, Kaiser UB. Central precocious puberty: Recent advances in understanding the aetiology and in the clinical approach. Clin Endocrinol (Oxf) 2021; 95:542-555. [PMID: 33797780 PMCID: PMC8586890 DOI: 10.1111/cen.14475] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022]
Abstract
Central precocious puberty (CPP) results from early activation of the hypothalamic-pituitary-gonadal (HPG) axis. The current state of knowledge of the complex neural network acting at the level of the hypothalamus and the GnRH neuron to control puberty onset has expanded, particularly in the context of molecular interactions. Along with these advances, the knowledge of pubertal physiology and pathophysiology has also increased. This review focuses on regulatory abnormalities occurring at the hypothalamic level of the HPG axis to cause CPP. The clinical approach to diagnosis of puberty and pubertal disorders is also reviewed, with a particular focus on aetiologies of CPP. The recent identification of mutations in MKRN3 and DLK1 in familial as well sporadic forms of CPP has changed the state of the art of the approach to patients with CPP. Genetic advances have also had important repercussions beyond consideration of puberty alone. Syndromic disorders and central nervous system lesions associated with CPP are also discussed. If untreated, these conditions may lead to adverse physical, psychosocial and medical outcomes.
Collapse
Affiliation(s)
- Luigi Maione
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Université Paris-Saclay, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Claire Bouvattier
- Inserm, Physiologie et Physiopathologie Endocriniennes, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service d’Endocrinologie et des Maladies de la Reproduction, Centre de Référence des Maladies Rares de l’Hypophyse, Université Paris-Saclay, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Ursula B. Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Calcaterra V, De Filippo G, Albertini R, Rendina D, Messini B, Monti CM, Bozzola E, Villani A, Bozzola M. Effectiveness of basal LH in monitoring central precocious puberty treatment in girls. J Pediatr Endocrinol Metab 2021; 34:45-50. [PMID: 33189082 DOI: 10.1515/jpem-2020-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Treatment of central precocious puberty (CPP) is based on administration of GnRH agonists in order to suppress hypothalamic-pituitary-gonadal axis and thus induce the stabilization or regression of pubertal development. Our aim was to determine whether the single basal serum LH and/or FSH concentration could be an effective tool to assess the efficacy of treatment to suppress activation of hypothalamic-pituitary axis. PATIENTS AND METHODS Serum LH and FSH were measured before and after the GnRH injection, as well as E2 basal levels in 60 girls with documented idiopathic CPP at diagnosis and 18 and 30 months after the beginning of therapy. RESULTS At diagnosis, peaks of >5 IU/L of LH and of FSH were observed in 100 and 91.6% of girls, respectively, with basal LH values of <1 IU/L in 70% and basal FSH levels of <1 IU/L in 10%. E2 were <20 pg/mL in 36.6%. After 18 months, a suppressed peak (i.e. <3 IU/L) was recorded in 85% of girls (p<0.01) for LH and in 98.3% for FSH (p<0.01). Basal LH <1 IU/L was detected in 85% (p<0.01) and basal FSH ≤1 IU/L in 40% (p<0.01). Serum E2 ≤20 pg/mL was recorded in 61.6% (p<0.01). After 30 months, all patients showed LH suppressed peak (p<0.01) and 98.3% suppressed FSH peak (p<0.01). 100% showed basal LH concentrations <1 IU/L (p<0.01) and 38.3% FSH basal values <1 UI/mL (p<0.01). E2 ≤20 pg/mL was observed in 32.72% (p=NS). CONCLUSIONS Basal LH values are a reliable indicator of the efficacy of GnRHa therapy after 30 months of GnRHa therapy.
Collapse
Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, Pediatrics and Adolescent Unit, University of Pavia, Pavia, Italy.,Department of Pediatrics, Children's Hospital "V. Buzzi", Milan, Italy
| | - Gianpaolo De Filippo
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Robert-Debré, Paris, France.,French Clinical Research Group in Adolescent Medicine and Health, Paris, France
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Foundation IRCCS San Matteo, Pavia, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Beatrice Messini
- Department of Pediatrics, Hospital "San Giovanni Battista", Foligno, Italy
| | | | - Elena Bozzola
- Department of Pediatrics, Unit of Pediatrics and Infectious Diseases, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Pediatrics, Unit of Pediatrics and Infectious Diseases, Bambino Gesù Children Hospital IRCCS, Rome, Italy
| | - Mauro Bozzola
- University of Pavia, Pavia, Italy.,Onlus Il bambino e il suo pediatra, Novara, Italy
| |
Collapse
|
5
|
Jeong HR, Lee HJ, Shim YS, Kang MJ, Yang S, Hwang IT. Inhibin B as a screening tool for early detection and treatment monitoring of central precocious puberty. Gynecol Endocrinol 2020; 36:768-771. [PMID: 32162574 DOI: 10.1080/09513590.2020.1718642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Anti-Müllerian hormone (AMH) and inhibin B are considered possible biomarkers of central precocious puberty (CPP). The aim of this study was to evaluate serum levels of AMH and inhibin B, to investigate their regulatory patterns, and to study their clinical significance in girls with CPP. In total, 48 girls with CPP and 35 age-matched prepubertal control girls were enrolled in the study. AMH and inhibin B levels were determined in the CPP and control groups. In the patient group, AMH and inhibin B levels were evaluated during 1 year of gonadotropin releasing hormone analog (GnRHa) treatment. The mean inhibin B level in the CPP group was significantly higher than that in the control. AMH levels were not different between the two groups. After GnRHa treatment. AMH and inhibin B levels decreased significantly. Based on the ROC analysis, the cutoff value for inhibin B to determine CPP was 19.59 pg/mL, with 83.3% sensitivity and 82.9% specificity, and the area under the curve was 0. 852. Inhibin B was useful for determining CPP and the therapeutic effects of GnRHa treatment in girls with CPP. AMH interacted, in part, with the hypothalamo-pituitary gonadal axis, but its clinical implications in CPP should be further investigated.
Collapse
Affiliation(s)
- Hwal Rim Jeong
- Department of Pediatrics, School of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Hye Jin Lee
- Department of Pediatrics, Hallym University, College of Medicine, Chuncheon, Korea
| | - Yeong Suk Shim
- Department of Pediatrics, Hallym University, College of Medicine, Chuncheon, Korea
| | - Min Jae Kang
- Department of Pediatrics, Hallym University, College of Medicine, Chuncheon, Korea
| | - Seung Yang
- Department of Pediatrics, Hallym University, College of Medicine, Chuncheon, Korea
| | - Il Tae Hwang
- Department of Pediatrics, Hallym University, College of Medicine, Chuncheon, Korea
| |
Collapse
|
6
|
Serum inhibin B concentration as a predictor of age at first menstruation in girls with idiopathic central precocious puberty. PLoS One 2018; 13:e0205810. [PMID: 30550563 PMCID: PMC6294425 DOI: 10.1371/journal.pone.0205810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the serum inhibin B, anti-Müllerian hormone (AMH) and leptin concentrations in girls with idiopathic central precocious puberty (CPP) to their concomitant characteristics and evaluate the capacity of each of these hormones to predict the age at first menstruation in those who were untreated and who completed their puberty. Methods This single-center study included 94 girls selected from a cohort of 493 girls seen between 1981 and 2012 and diagnosed with idiopathic CPP for whom a remaining serum sample collected at the initial evaluation was available. Of these 25 were untreated and completed their puberty. Results- correlations at initial evaluation In the whole cohort the inhibin B concentration displayed significant positive correlations with the age at the onset of puberty and at initial evaluation; bone age; breast Tanner stage; serum basal estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and AMH concentrations, LH peak and LH/FSH peak ratio. The AMH concentration displayed a significant positive correlation with serum estradiol and a negative correlation with basal FSH concentration. The leptin concentration displayed significant positive correlations with the age at initial evaluation, bone age, and body mass index and a negative correlation with the FSH peak. Results- prediction of age at first menstruation In 25 untreated girls, the inhibin B concentration was negatively correlated with the age at first menstruation (r = -0.61, p = 0.001) and the time between the onset of puberty and first menstruation (r = -0.59, p = 0.002). Inhibin B concentrations <30 pg/mL were associated with a time between the onset of puberty and first menstruation ≥3 years in 14/15 patients with a sensitivity of 0.67 and a specificity of 0.75. The age at first menstruation was estimated using a formula: min (11.15–0.510 LH/FSH peak ratio, 11.57–0.025 inhibin B)available at: http://www.kamick.org/lemaire/med/girls-cpp18.html. Conclusion We established formulas based on the serum inhibin B concentrations and LH/FSH peak ratio at the initial evaluation, alone or in combination, to predict the age at first menstruation in girls with CPP. These formulas can assist with determining the indications for treatment in CPP.
Collapse
|
7
|
Chen T, Wu H, Xie R, Wang F, Chen X, Sun H, Chen L. Serum Anti-Müllerian Hormone and Inhibin B as Potential Markers for Progressive Central Precocious Puberty in Girls. J Pediatr Adolesc Gynecol 2017; 30:362-366. [PMID: 28161677 DOI: 10.1016/j.jpag.2017.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/02/2017] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To investigate the potential of serum anti-Müllerian hormone (AMH) and inhibin B (INHB) levels as markers for pubertal progression rate in girls with central precocious puberty (CPP). DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A total of 148 girls were enrolled, including 65 girls with premature thelarche and 83 girls with CPP, grouped on the basis of the results of gonadotropin-releasing hormone stimulation tests. Girls with CPP underwent a 6-month follow-up, and were further divided into 2 subgroups: the progressive CPP (P-CPP) group (n = 55) and the slowly P-CPP (SP-CPP) group (n = 28). Serum AMH and INHB levels were assessed in all enrolled girls. Using receiver operating characteristic curves, we analyzed the diagnostic performance of AMH and INHB to differentiate the 2 forms of CPP. RESULTS Our data showed that AMH and INHB offer the potential to act as markers that distinguish SP-CPP from P-CPP. Compared with the SP-CPP group, girls with P-CPP showed lower AMH levels and higher INHB levels. On the basis of the receiver operating characteristics analysis, the area under the curve was 0.92 for the combination of AMH and INHB, with 80% sensitivity and 89.3% specificity. CONCLUSION Our results suggest that serum AMH and INHB levels provide a promising method in differentiating SP-CPP from P-CPP.
Collapse
Affiliation(s)
- Ting Chen
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haiying Wu
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Rongrong Xie
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fengyun Wang
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiuli Chen
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui Sun
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Linqi Chen
- Department of Endocrinology, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.
| |
Collapse
|