The Use of Morning Urinary Gonadotropins and Sexual Hormones in the Management of Early Puberty in Chinese Girls.
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.We evaluated whether urinary hormones could be potential biomarkers for pre- or post- puberty, aiming to simplify the current diagnosis and prognosis procedure.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.We measured luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, prolactin, progesterone, testosterone, and human chorionic gonadotropin in the first morning voided urine samples.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.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.
Authors: Shumin Zhan, Ke Huang, Wei Wu, Danni Zhang, Ana Liu, Robert M Dorazio, Jianrong Shi, Rahim Ullah, Li Zhang, Jinling Wang, Guanping Dong, Yan Ni, Junfen Fu