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The response to gonadotropin releasing hormone (GnRH) stimulation test does not predict the progression to true precocious puberty in girls with onset of premature thelarche in the first three years of life.
J Clin Endocrinol Metab. 2014 Feb; 99(2):433-9.JC

Abstract

CONTEXT

Premature thelarche in early childhood may evolve into true precocious puberty. The individuation of cases progressing to precocious puberty is challenging.

OBJECTIVE

We analyzed the parameters predictive for progression in girls younger than 3 years.

DESIGN AND SETTING

We conducted a retrospective longitudinal study.

PATIENTS AND METHODS

A total of 450 girls referred for premature thelarche were initially evaluated, 353 were clinically monitored at 3-month intervals, and 97 underwent endocrine and imaging assessment. Central precocious puberty (CPP) was diagnosed in girls showing LH peak response to GnRH testing >5 mU/mL with tuber cinereum hamartoma at magnetic resonance imaging, or with normal magnetic resonance imaging but progression of puberty during follow-up.

MAIN OUTCOME MEASURE

We measured the progression to precocious puberty.

RESULTS

Idiopathic premature thelarche (IPT) was diagnosed in 85 of the 97 girls who underwent extensive evaluation, CPP in nine girls, and peripheral precocious puberty in three girls. The uterus was >34 mm in six (7%) IPT girls and six (66.6%) CPP girls. Basal LH was >0.2 mU/mL in one (1.17%) IPT girl and eight (88.8%) CPP girls. LH peak was >5 mU/mL in 31 (36.4%) IPT girls and nine (100%) CPP girls. LH peak/FSH peak ratio was >1 in six (66.6%) CPP girls.

CONCLUSIONS

None of the available tests alone allows identification of girls who will progress to precocious puberty. Elevated LH responses to GnRH are common but are not related to progression toward puberty. The combined measurement of basal LH and longitudinal diameter of the uterus represents a reliable screening approach to identify subjects who should undergo GnRH testing.

Authors+Show Affiliations

Endocrinology and Diabetes Unit (C.B., M.C.), "Bambino Gesù" Children's Hospital, 00165 Rome, Italy; Dipartimento Pediatrico Universitario Ospedaliero (G.L.S., G.B., G.M., S.C.), "Bambino Gesù" Children's Hospital-Tor Vergata University, 00165 Rome, Italy; Department of Chemistry (G.G.), "Bambino Gesù" Children's Hospital, 00165 Rome, Italy; and Department of Women's and Children's Health (S.C.), Karolinska Institute, SE 17177 Stockholm, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24297793

Citation

Bizzarri, Carla, et al. "The Response to Gonadotropin Releasing Hormone (GnRH) Stimulation Test Does Not Predict the Progression to True Precocious Puberty in Girls With Onset of Premature Thelarche in the First Three Years of Life." The Journal of Clinical Endocrinology and Metabolism, vol. 99, no. 2, 2014, pp. 433-9.
Bizzarri C, Spadoni GL, Bottaro G, et al. The response to gonadotropin releasing hormone (GnRH) stimulation test does not predict the progression to true precocious puberty in girls with onset of premature thelarche in the first three years of life. J Clin Endocrinol Metab. 2014;99(2):433-9.
Bizzarri, C., Spadoni, G. L., Bottaro, G., Montanari, G., Giannone, G., Cappa, M., & Cianfarani, S. (2014). The response to gonadotropin releasing hormone (GnRH) stimulation test does not predict the progression to true precocious puberty in girls with onset of premature thelarche in the first three years of life. The Journal of Clinical Endocrinology and Metabolism, 99(2), 433-9. https://doi.org/10.1210/jc.2013-3292
Bizzarri C, et al. The Response to Gonadotropin Releasing Hormone (GnRH) Stimulation Test Does Not Predict the Progression to True Precocious Puberty in Girls With Onset of Premature Thelarche in the First Three Years of Life. J Clin Endocrinol Metab. 2014;99(2):433-9. PubMed PMID: 24297793.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The response to gonadotropin releasing hormone (GnRH) stimulation test does not predict the progression to true precocious puberty in girls with onset of premature thelarche in the first three years of life. AU - Bizzarri,Carla, AU - Spadoni,Gian Luigi, AU - Bottaro,Giorgia, AU - Montanari,Giulia, AU - Giannone,Germana, AU - Cappa,Marco, AU - Cianfarani,Stefano, Y1 - 2013/12/02/ PY - 2013/12/4/entrez PY - 2013/12/4/pubmed PY - 2014/4/9/medline SP - 433 EP - 9 JF - The Journal of clinical endocrinology and metabolism JO - J. Clin. Endocrinol. Metab. VL - 99 IS - 2 N2 - CONTEXT: Premature thelarche in early childhood may evolve into true precocious puberty. The individuation of cases progressing to precocious puberty is challenging. OBJECTIVE: We analyzed the parameters predictive for progression in girls younger than 3 years. DESIGN AND SETTING: We conducted a retrospective longitudinal study. PATIENTS AND METHODS: A total of 450 girls referred for premature thelarche were initially evaluated, 353 were clinically monitored at 3-month intervals, and 97 underwent endocrine and imaging assessment. Central precocious puberty (CPP) was diagnosed in girls showing LH peak response to GnRH testing >5 mU/mL with tuber cinereum hamartoma at magnetic resonance imaging, or with normal magnetic resonance imaging but progression of puberty during follow-up. MAIN OUTCOME MEASURE: We measured the progression to precocious puberty. RESULTS: Idiopathic premature thelarche (IPT) was diagnosed in 85 of the 97 girls who underwent extensive evaluation, CPP in nine girls, and peripheral precocious puberty in three girls. The uterus was >34 mm in six (7%) IPT girls and six (66.6%) CPP girls. Basal LH was >0.2 mU/mL in one (1.17%) IPT girl and eight (88.8%) CPP girls. LH peak was >5 mU/mL in 31 (36.4%) IPT girls and nine (100%) CPP girls. LH peak/FSH peak ratio was >1 in six (66.6%) CPP girls. CONCLUSIONS: None of the available tests alone allows identification of girls who will progress to precocious puberty. Elevated LH responses to GnRH are common but are not related to progression toward puberty. The combined measurement of basal LH and longitudinal diameter of the uterus represents a reliable screening approach to identify subjects who should undergo GnRH testing. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/24297793/The_response_to_gonadotropin_releasing_hormone__GnRH__stimulation_test_does_not_predict_the_progression_to_true_precocious_puberty_in_girls_with_onset_of_premature_thelarche_in_the_first_three_years_of_life_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2013-3292 DB - PRIME DP - Unbound Medicine ER -