진성 성조숙증과 조기 사춘기 여아에서생식샘자극호르몬방출호르몬 자극 검사에영향을 미치는 임상적, 생화학적 인자 = Clinical and Biochemical Factors Associated with GnRH Stimulation test in the Idiopathic Central Precocious Puberty and Early Puberty Girls

다국어 초록 (Multilingual Abstract)

Purpose : Gonadotropin releasing hormone (GnRH) stimulation test is the gold standard method for the diagnosis of central precocious puberty. To predict the result of this test, we studied clinical and biochemical factors associated with the test.
Methods : We evaluated 168 girls under 9 years old with the signs of breast budding and more than one year bone age advancement who underwent this test. We defined the result as two criteria. In the first criteria, positive result of the test means peak LH≥5 IU/L and peak/basal LH≥2. In the second criteria, positive result means peak LH≥5 IU/L, peak/basal LH≥2 and peak LH/FSH≥1.
Results : In the both first and second criteria, 83 and 31 girls had positive results and other 85 and 137 girls had negative results respectively. In both criteria, the patients with positive results turned out to have more advancement in bone age, smaller predicted adult height, smaller paternal height and higher insulin like growth factor-1 (IGF-1) than those of the patients with negative results. Peak LH was positively correlated with bone age advancement (r=0.35, P<0.001) and IGF-1 (r=0.42, P<0.001) and negatively correlated with predicted adult height (r=-0.22, P=0.01). In multiple logistic regression, bone age was significant predictive factor [first criteria, OR 1.43 (95% CI 1.09, 1.87), P=0.01; second criteria, OR 2.46 (95% CI 1.48, 4.08), P=0.01] of the positive results.
Conclusion : The result of GnRH stimulation test depends on the degree of breast development and advancement in bone age. Also, IGF-1 is the only positively correlated biochemical factor with the test.

참고문헌 (Reference)

1 Lee J.M., "Weight status in young girls and the onset of puberty" 119 : 624-630, 2007

2 de Vries L., "Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche" 154 : 891-898, 2006

3 Neely E.K., "Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty" 127 : 47-52, 1995

4 Sales D.S., "Serum insulin-like growth factor (IGF)-I and IGF-binding protein-3 in girls with premature thelarche" 16 : 827-833, 2003

5 Herman-Giddens M.E., "Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network" 99 : 505-512, 1997

6 Tanaka T., "Results of long-term follow- up after treatment of central precocious puberty with leuprorelin acetate: evaluation of effectiveness of treatment and recovery of gonadal function. The TAP-144-SR Japanese Study Group on Central Precocious Puberty" 90 : 1371-1376, 2005

7 Guercio G., "Relationship between the growth hormone/insulin-like growth factor-I axis, insulin sensitivity, and adrenal androgens in normal prepubertal and pubertal girls" 88 : 1389-1393, 2003

8 Kaplowitz P.B., "Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society" 104 : 936-941, 1999

9 Pasquino A.M., "Progression of premature thelarche to central precocious puberty" 126 : 11-14, 1995

10 Prescovitz O.H., "Premature thelarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone" 67 : 474-479, 1988

11 Choi J.H., "Predictive factors for organic central precocious puberty and utility of simplified gonadotropin-releasing hormone tests" 49 : 806-810, 2007

12 Neely E.K., "Normal ranges for immunochemiluminometric gonadotropin assays" 127 : 40-46, 1995

13 Berman R.E., "Nelson textbook of pediatrics" Philadelphia: WB Saunders Co 2308-2311, 2007

14 Sun S.S., "National estimates of the timing of sexual maturation and racial differences among US children" 110 : 911-919, 2002

15 Kaplowitz P.B., "Link between body fat and the timing of puberty" 208-217, 2008

16 Belgorosky A., "Irreversible increase of serum IGF-1 and IGFBP-3 levels in GnRH-dependent precocious puberty of different etiologies: implications for the onset of puberty" 49 : 226-232, 1998

17 Boyar R.M., "Human puberty. Simultaneous augmented secretion of luteinizing hormone and testosterone during sleep" 54 : 609-618, 1974

18 Kirkland J.L., "Height predictions in girls with idiopathic precocious puberty by the Bayley-Pinneau method" 68 : 251-252, 1981

19 Apter D., "Gonadotropin-releasing hormone pulse generator activity during pubertal transition in girls: pulsatile and diurnal patterns of circulating gonadotropins" 76 : 940-949, 1993

20 Wu T., "Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey" 110 : 752-757, 2002

21 Kaplowitz P.B., "Earlier onset of puberty in girls: relation to increased body mass index and race" 108 : 347-353, 2001

22 Brito V.N., "Diagnostic value of fluorometric assays in the evaluation of precocious puberty" 84 : 3539-3544, 1999

23 Iughetti L., "Diagnosis of central precocious puberty: endocrine assessment" 709-715, 2000

24 Bar A., "DiMartino- Nardi J. Bayley-Pinneau method of height prediction in girls with central precocious puberty: correlation with adult height" 126 : 955-958, 1995

25 Oerter K.E., "Cutler GB Jr. Gonadotropin secretory dynamics during puberty in normal girls and boys" 71 : 1251-1258, 1990

26 Salerno M., "Central precocious puberty: a single blood sample after gonadotropin-releasing hormone agonist administration in monitoring treatment" 50 : 205-211, 1998

27 Lee P.A., "Central precocious puberty. An overview of diagnosis, treatment, and outcome" 28 : 901-918, 1999

28 de Ridder C.M., "Body fat mass, body fat distribution, and pubertal development: a longitudinal study of physical and hormonal sexual maturation of girls" 75 : 442-446, 1992

29 Resenda E.A., "Assessment of basal and gonadotropin-releasing hormone-stimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children" 92 : 1424-1429, 2007

30 Brauner R., "Adult height in girls with idiopathic true precocious puberty" 79 : 415-420, 1994

31 Lawson M.L., "A single sample subcutaneous luteinizing hormone (LH)-releasing hormone (LHRH) stimulation test for monitoring LH suppression in children with central precocious puberty receiving LHRH agonists" 84 : 4536-4540, 1999