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A Short-Duration Gonadotropin-Releasing Hormone Stimulation Test for the Diagnosis of Central Precocious Puberty - PubMed Skip to main page content
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. 2023 Dec 22;60(1):24.
doi: 10.3390/medicina60010024.

A Short-Duration Gonadotropin-Releasing Hormone Stimulation Test for the Diagnosis of Central Precocious Puberty

Maria Chiara Pellegrin  1 , Chiara Marzin  2 , Lorenzo Monasta  1 , Gianluca Tamaro  1 , Viviana Vidonis  1 , Giada Vittori  1 , Elena Faleschini  1 , Egidio Barbi  1   2 , Gianluca Tornese  1   2
Affiliations

A Short-Duration Gonadotropin-Releasing Hormone Stimulation Test for the Diagnosis of Central Precocious Puberty

Maria Chiara Pellegrin et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard method for diagnosing central precocious puberty (CPP), although it requires multiple blood samplings over 120 min. This study aimed to evaluate if a shorter test may have an equivalent diagnostic accuracy. Materials and Methods: We retrospectively reviewed the GnRH tests of 188 consecutive pediatric patients (169 females) referred for signs of early pubertal development. The diagnostic accuracy of the hormonal levels was evaluated at different time points (15, 0, 60, 90, and 120 min after the GnRH stimulus). Results: A diagnosis of CPP was made in 130 cases (69%), with 111 (85%) being female. Sensitivity and specificity ratings higher than 99% for the diagnosis of CPP were achieved for LH levels ≥4.7 mU/mL at 30 and 60 min after the stimulus (area under the ROC curve (AUC) = 1), with no further increase in the diagnostic accuracy in the remaining time points. No sex differences in diagnostic accuracy were found. The LH/FSH ratio at 30 min showed a sensitivity of 94.9%, with an AUC of 0.997 and a value ≥0.76. Conclusions: A short-duration GnRH test of 60 min provided optimal results for the diagnosis of CPP. Extending the test for an extra hour is therefore unnecessary and inadvisable.

Keywords: GnRH stimulation test; LHRH stimulation test; precocious puberty.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves for central precocious puberty diagnosis with LH levels at 15, 30, 45, and 60 min.
Figure 2
Figure 2
Receiver operating characteristic curves for central precocious puberty diagnosis with LH/FSH ratio at 30 min.
Figure 3
Figure 3
LH (a) and FSH (b) levels and LH/SH ratio (c) after the stimulus. Blue lines = females with central precocious puberty; red lines = females without central precocious puberty.
Figure 4
Figure 4
Comparison of (a) LH and (b) FSH levels and (c) LH/FSH ratio in males and females after GnRH stimulus. * p < 0.05 Mann–Whitney U test. Green lines = females; yellow lines = males.
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