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 le...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Italian Journal of Pediatrics |
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| Online Access: | https://doi.org/10.1186/s13052-023-01506-8 |
| _version_ | 1797557666163195904 |
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| author | Ilaria Brambilla Carmen Guarracino Carmelo Pistone Catherine Klersy Amelia Licari Gian Luigi Marseglia Enrico Tondina |
| author_facet | Ilaria Brambilla Carmen Guarracino Carmelo Pistone Catherine Klersy Amelia Licari Gian Luigi Marseglia Enrico Tondina |
| author_sort | Ilaria Brambilla |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T17:19:51Z |
| format | Article |
| id | doaj.art-fdb9a3f7448e42c0b9333423f016f23c |
| institution | Directory Open Access Journal |
| issn | 1824-7288 |
| language | English |
| last_indexed | 2024-03-10T17:19:51Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-fdb9a3f7448e42c0b9333423f016f23c2023-11-20T10:23:45ZengBMCItalian Journal of Pediatrics1824-72882023-08-0149111010.1186/s13052-023-01506-8Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious pubertyIlaria Brambilla0Carmen Guarracino1Carmelo Pistone2Catherine Klersy3Amelia Licari4Gian Luigi Marseglia5Enrico Tondina6Pediatric Clinic, Fondazione IRCCS Policlinico San MatteoPediatric Clinic, Fondazione IRCCS Policlinico San MatteoPediatric Clinic, Fondazione IRCCS Policlinico San MatteoDepartment of Epidemiology and Biostatistics, Fondazione IRCCS Policlinico San MatteoPediatric Clinic, Fondazione IRCCS Policlinico San MatteoPediatric Clinic, Fondazione IRCCS Policlinico San MatteoDepartment of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pediatric Unit, University of PaviaAbstract 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.https://doi.org/10.1186/s13052-023-01506-8Central precocious pubertyGnRH testLuteinizing hormone urinary levels (uLH)DiagnosisMonitoring |
| spellingShingle | Ilaria Brambilla Carmen Guarracino Carmelo Pistone Catherine Klersy Amelia Licari Gian Luigi Marseglia Enrico Tondina Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty Italian Journal of Pediatrics Central precocious puberty GnRH test Luteinizing hormone urinary levels (uLH) Diagnosis Monitoring |
| title | Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty |
| title_full | Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty |
| title_fullStr | Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty |
| title_full_unstemmed | Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty |
| title_short | Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty |
| title_sort | role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty |
| topic | Central precocious puberty GnRH test Luteinizing hormone urinary levels (uLH) Diagnosis Monitoring |
| url | https://doi.org/10.1186/s13052-023-01506-8 |
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