Subcutaneous gonadotropin-releasing hormone agonist (triptorelin) test for diagnosing precocious puberty.
BACKGROUND
A test involving 100 microg of intravenous gonadotropin-releasing hormone (GnRH) is a gold standard for confirming the diagnosis of central precocious puberty (CPP). However, intravenous GnRH for testing is commercially limited.


OBJECTIVE
To develop subcutaneous GnRH agonist (GnRH-A) testing and define a peak luteinizing hormone (LH) cutoff value in diagnosing CPP.


METHODS
A retrospective study of 101 girls with sexual precocity was undertaken. All girls underwent 100 microg subcutaneous GnRH-A (triptorelin) testing. Blood samples before and 30, 60, 90 and 120 min after GnRH-A injection were analyzed for LH and follicle-stimulating hormone levels. Criteria for diagnosing CPP include accelerated height, advanced bone age and pubertal-sized uterus and ovaries.


RESULTS
Fifty-five girls were documented as having CPP. The remaining 46 girls were diagnosed with premature thelarche (PT). Peak LH concentration in the CPP group was significantly greater than that of the PT group with a median (range) of 10.0 IU/l (2.93-65.39) and 3.04 IU/l (0.19-8.82), respectively. Peak LH was achieved within 60 min following GnRH-A injection. Peak LH of 6 IU/l provided the most appropriate cutoff level in diagnosing CPP with a sensitivity of 89.1% and a specificity of 91.3%.


CONCLUSIONS
Subcutaneous GnRH-A can be used as an alternative to confirm the diagnosis of CPP.
Poomthavorn
Preamrudee
P
Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Khlairit
Patcharin
P
Mahachoklertwattana
Pat
P
D002648:Child; D002675:Child, Preschool; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006801:Humans; D007279:Injections, Subcutaneous; D007986:Luteinizing Hormone / Q000097:blood; D008186:Luteolytic Agents / Q000008:administration & dosage*; D011629:Puberty, Precocious / Q000097:blood* / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017329:Triptorelin Pamoate / Q000008:administration & dosage*
D008186:Luteolytic Agents; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone