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Liu Z, Song Q. Diagnostic model based on multiple factors for girls with central precocious puberty. J Pediatr Endocrinol Metab 2024; 37:150-155. [PMID: 38048057 DOI: 10.1515/jpem-2023-0263] [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: 06/02/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES The GnRH stimulation test has been used as the gold standard for the diagnosis of central precocious puberty (CPP), but it has some practical barriers. This study intends to build a diagnostic model of CPP in girls based on the population in northern China. METHODS A total of 163 girls with precocious puberty (PP) were included from December 2018 to December 2019. Multifactor logistic regression analysis was conducted. Based on the results of multivariate logistic regression analysis, a nomogram was established for clinical application. RESULTS A multi logistic regression model showed that LH (OR=1.238, 95 % CI: 1.067-1.436, p=0.005), inhibin B (OR=1.066, 95 % CI: 1.032-1.100, p<0.001), bone age (OR=1.563, 95 % CI: 1.037-2.358, p=0.033), and uterine length (OR=1.180, 95 % CI: 1.034-1.348, p=0.014) were diagnostic factors for CPP. The prediction model AUC was 0.906 (95 % CI: 0.852-0.959, p<0.001). CONCLUSIONS We successfully developed a nomogram model for CPP patients based on clinical data. The diagnostic prediction model included four indicators: basal LH, inhibin B, bone age, and uterine body length.
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Affiliation(s)
- Ziqin Liu
- Department of Endocrinology, Children's Hospital Capital Institute of Pediatrics, Beijing, P.R. China
| | - Qinwei Song
- Department of Clinical Laboratory, Children's Hospital Capital Institute of Pediatrics, Beijing, P.R. China
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Cipolla C, Sodero G, Pane LC, Mariani F, Di Sarno L, Rigante D, Candelli M. Auxological and Metabolic Parameters of Children Undergoing the Gonadotropin-Releasing Hormone Stimulation Test: Correlations with the Final Diagnosis of Central Precocious Puberty in a Single-Center Study. Biomedicines 2023; 11:1678. [PMID: 37371772 DOI: 10.3390/biomedicines11061678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/03/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Background-Central precocious puberty (CPP) is characterized by clinical, biochemical, and radiological features similar to those of normal puberty, but CPP occurs before the age of eight in girls and before the age of nine in boys, subsequently leading to a reduction in the final body height in adulthood due to premature fusion of growth plates. The diagnosis of CPP is confirmed with a gonadotropin-releasing hormone (GnRH) stimulation test, which can lead to different interpretations because the diagnostic peak levels of luteinizing hormone (LH) can vary. Patients and methods-This was a single-center, retrospective observational study investigating the possible correlation between gonadotropin peaks on the GnRH test and auxological, metabolic, and radiological parameters of patients evaluated for CPP. We collected and analyzed data from the medical records of children with suspected CPP over a period from January 2019 to July 2022 who underwent a GnRH test at the Fondazione Policlinico Universitario Agostino Gemelli in Rome, Italy. Results-Our correlation analysis revealed no statistically significant differences in any auxological and radiological parameters. Among laboratory parameters, baseline levels of LH, follicle-stimulating hormone, sex hormone-binding globulin, and 17-beta estradiol were higher in children with a definitive diagnosis of CPP than in those with a negative GnRH test. In particular, the levels of LH at baseline and after the GnRH test were statistically significant in the group of CPP patients, consistent with the interpretation of the test. In the multivariate analysis, using a cut-off value of 4.1 IU/L, LH peaks showed both very high sensitivity (94%) and very high specificity (95%); all other variables showed high specificity (90%) but unsatisfactory sensitivity. Conclusion-Basal hormone dosages and, especially, basal levels of LH should be considered before performing a GnRH test as they might anticipate the final diagnosis of CPP.
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Affiliation(s)
- Clelia Cipolla
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Giorgio Sodero
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Lucia Celeste Pane
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Mariani
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Di Sarno
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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Chen H, Mo C, Zhong LY, Zhong LY. Heterogeneity of IGF-1 Levels in Children with hCG-Induced Precocious Puberty. Int J Endocrinol 2022; 2022:1068896. [PMID: 36425849 PMCID: PMC9681542 DOI: 10.1155/2022/1068896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Sex steroid stimulates growth hormone release during puberty. However, the role of IGF-1 levels in human-chorionic-gonadotropin-induced precocious puberty remains unclear. METHODS A retrospective study reviewing thirty patients with precocious puberty due to human-chorionic-gonadotropin-secreting intracranial germ cell tumors was performed. Changes in IGF-1 levels were collected. RESULT All patients included were boys. At diagnosis, the median IGF-1 standard deviation was 0.87 (0.1, 1.87). When human-chorionic-gonadotropin normalized, the median IGF-1 standard deviation was 1.58 (-0.53, 2.55), which is slightly higher than baseline (p = 0.408). When patients completed their therapeutic plan, the median IGF-1 standard deviation was 0.10 (-1.05, 0.68), which was significantly lower than that of baseline (p = 0.004) and of human-chorionic-gonadotropin being normalized (p = 0.003). At the last visit, the mean IGF-1 standard deviation was -1.11(-1.97, 0.76), which is slightly lower than that of baseline (p = 0.109) and post-therapy levels (p = 0.575), but significantly lower than that of human-chorionic-gonadotropin being normalized. Two patients had IGF-1 levels above 2 standard deviations at diagnosis, eight at the time when human-chorionic-gonadotropin normalized, and two at the end of therapy. Only one patient had an IGF-1 level below 2 standard deviations at diagnosis and at the time when human-chorionic-gonadotropin normalized, and two patients at the end of therapy. At the last follow-up, all patients had normal IGF-1 levels. CONCLUSION IGF-1 levels in patients with human-chorionic-gonadotropin-induced precocious puberty have heterogeneity, but IGF-1 standard deviations are mostly within the normal range. If elevated, it might decline later with a decrease in human-chorionic-gonadotropin level. IGF-1 levels seem not valuable enough to assess human-chorionic-gonadotropin-induced precocity regression.
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Affiliation(s)
- Han Chen
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cai‐Yan Mo
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ling-Yu Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li -Yong Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Kim MS, Koh HJ, Lee GY, Kang DH, Kim SY. Comparing adult height gain and menarcheal age between girls with central precocious puberty treated with gonadotropin-releasing hormone agonist alone and those treated with combined growth hormone therapy. Ann Pediatr Endocrinol Metab 2019; 24:116-123. [PMID: 31261476 PMCID: PMC6603606 DOI: 10.6065/apem.2019.24.2.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study aimed to investigate the outcomes of gonadotropin-releasing hormone agonist (GnRHa) therapy with or without growth hormone (GH) therapy for girls with idiopathic central precocious puberty (CPP). METHODS The medical records of 166 girls diagnosed with CPP from 2002 to 2017 were retrospectively reviewed. All included patients were treated with GnRHa for ≥36 months. Changes in height standard deviation score (SDS) for bone age, chronological age (CA), and predicted adult height (PAH) were assessed for the first three years of treatment. The final height gain SDS was calculated as the difference between the initial PAH SDS and adult height (AH) SDS; these were then compared between the GnRHa group (group A, n=135) and the combined GnRHa/GH group (group B, n=31). RESULTS The initial mean CA was 7.89 years. The mean menarcheal age was 13.12 years (group A, 13.1±0.99; group B, 13.18±0.58 years; P=0.755). PAH SDS at the start of GnRHa treatment and AH SDS were significantly lower in group B than in group A (PAH SDS: -2.20±0.83 vs. -3.19±0.84, P<0.001; AH SDS: 0.18±084 vs. -0.30±0.66, P=0.021). The increase in PAH SDS was higher in group B than in group A for the first three years of GnRHa treatment (1.66±0.66 vs. 2.35±0.93, P<0.001). The height gain SDS was significantly higher in group B than in group A (2.5±0.75 vs. 2.93±1.02, P=0.048). Younger age, higher PAH at the start of treatment, and a greater increase in PAH SDS during the first year of GnRHa treatment positively affected AH. CONCLUSION The combined GH group had more additional height gain than the GnRHa-alone group.
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Affiliation(s)
- Min Sub Kim
- Department of Pediatrics, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Hyo Jung Koh
- Department of Pediatrics, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Gwang Yeon Lee
- Department of Pediatrics, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Dong Hee Kang
- Department of Pediatrics, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
| | - Se Young Kim
- Department of Pediatrics, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea,Address for correspondence: Se Young Kim, MD, PhD Department of Pediatrics, Bundang Jesaeng General Hospital Daejin Medical Center, Seongnam 13590, Korea Tel: +82-31-779-0525 Fax: +82-31-779-0894 E-mail:
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Nam HK, Rhie YJ, Son CS, Park SH, Lee KH. Factors to predict positive results of gonadotropin releasing hormone stimulation test in girls with suspected precocious puberty. J Korean Med Sci 2012; 27:194-9. [PMID: 22323868 PMCID: PMC3271294 DOI: 10.3346/jkms.2012.27.2.194] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 11/28/2011] [Indexed: 11/20/2022] Open
Abstract
Sometimes, the clinical findings and the results of the gonadotropin-releasing hormone (GnRH) stimulation test are inconsistent in girls with early breast development and bone age advancement. We aimed to investigate the factors predicting positive results of the GnRH stimulation test in girls with suspected central precocious puberty (CPP). We reviewed the records of 574 girls who developed breast budding before the age of 8 yr and underwent the GnRH stimulation test under the age of 9 yr. Positive results of the GnRH stimulated peak luteinizing hormone (LH) level were defined as 5 IU/L and over. Girls with the initial positive results (n = 375) showed accelerated growth, advanced bone age and higher serum basal LH, follicle-stimulating hormone, and estradiol levels, compared to those with the initial negative results (n = 199). Girls with the follow-up positive results (n = 64) showed accelerated growth and advanced bone age, compared to those with the follow-up negative results. In the binary logistic regression, the growth velocity ratio was the most significant predictive factor of positive results. We suggest that the rapid growth velocity is the most useful predictive factor for positive results in the GnRH stimulation test in girls with suspected precocious puberty.
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Affiliation(s)
- Hyo-Kyoung Nam
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Young Jun Rhie
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Chang Sung Son
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Sang Hee Park
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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Choi JY, Kang HJ, Cho WK, Cho KS, Park SH, Hahn SH, Jung MH, Suh BK, Lee BC. Analysis of gonadotropin-releasing hormone (GnRH) test results in girls with precocious puberty. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.12.1377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jung Yun Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Ju Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Soon Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Hyun Park
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Hoon Hahn
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Ho Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Kyu Suh
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Churl Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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