Session: OR37-Pediatric Endocrinology: HPG Axis Disorders
Room 102 (Moscone Center)
Objective We aimed to assess the diagnostic value of ULH compared with GnRH-stimulated gonadotropins in differentiating SP- from RP-PP.
Design, setting and participants 62 girls with PP underwent both GnRH stimulation and ULH assay. Fifteen girls with peak LH>10 IU/L (i.e. advanced puberty) started treatment immediately whereas other 47 girls were evaluated after 6 months for pubertal advancement, height acceleration and bone-age maturation. Based on these criteria, the participants were assigned to 5 subgroups: pubertal regression, no progression or progression by one, two or three criteria. The first three subgroups were defined as SP-PP (n=29) while the other subgroups (including advanced puberty) were defined as RP-PP (n=33). Additional 23 prepubertal girls were evaluated for ULH.
Methods Both serum gonadotropins and ULH were measured by the same immunochemiluminescence assay. A preliminary study was peformed to validate this assay for ULH. Spiking recoveries of ULH ranged from 93% to 115%, functional sensitivity was 0.76 IU/L and intra- and inter-assay variability ranged from 5.2 to 19.5 IU/L and from 4.7 to 9.7 IU/L respectivrly, for a wide range of ULH values.
Results First voided ULH but not serum gonadotropins could distinguish girls with two and three criteria from less progressive subgroups. By comparison to SP-PP, those with RP-PP had higher basal (0.81±1.43 vs. 0.12±0.05 IU/L; p=0.003) and peak LH (10.90±10.09 vs. 2.78±1.78 IU/L; p<0.001), basal FSH (2.60±2.07 vs. 1.17±0.89), peak LH/FSH ratio (0.98±0.76 vs. 0.22±0.12; p<0.001) and ULH (2.68±1.83 vs. 1.05±0.26 IU/L; p<0.001). Based on ROC analysis, a ULH cutoff of 1.15 IU/L had a better sensitivity (91%) and negative predictive value (88%) than other parameters, with a specificity and positive predictive value of 72% and 79%, respectively. The area under the ROC curve was the largest in ULH curve (0.901).
Conclusion ULH assay is a non-invasive, reliable method that can assist in the distinction between SP- and RP-PP.
Nothing to Disclose: AZ, EB, MU, TG, MR, MC, ZZ
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