Diurnal variation of gonadotropin levels in girls with early stages of puberty

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Abstract

Purpose

Pubertal gonadotropin secretion shows circadian pattern and the luteinizing hormone (LH) levels tend to rise in later stages of puberty in girls. We studied the usefulness of basal LH in the evaluation of central precocious puberty with emphasis on the influence of sampling time.

Methods

Medical records of 334 girls that underwent gonadotropin-releasing hormone stimulation test (GnRHST) were reviewed. Auxological and laboratory data were compared between those with early morning (EM, before 10 AM) and late morning/afternoon (LM/A, after 10 AM) basal samples.

Results

Among those in sexual maturity rating (SMR) 2, EM samples showed higher basal LH ( P=0.004) compare to LM/A samples, whereas those in SMR 3 showed no difference in LH levels between EM and LM/A samples. Among girls with pubertal response, EM group showed higher basal LH ( P=0.031) and follicular stimulating hormone ( P=0.008) than LM/A group. The EM basal LH was more closely related with the peak stimulated LH than the LM/A basal LH did (r _s=0.871 vs. r _s=0.524). The optimal basal LH cutoffs to predict a pubertal response to GnRHST were 0.11 IU/L with a sensitivity of 66.7% and a specificity of 78.7% in EM group, and 0.07 IU/L with a sensitivity of 60.0% and a specificity of 78.9% in LM/A group, respectively.

Conclusions

In girls with early stages of puberty, EM basal LH is a more sensitive screening tool than the LM/A basal LH. Diurnal variation should be considered in evaluating children with precocious puberty.

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Most cited references 23

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Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples.

Stephen J. Perkins, Aiyi Liu, Howard Bondell … (2004)

Costs can hamper the evaluation of the effectiveness of new biomarkers. Analysis of smaller numbers of pooled specimens has been shown to be a useful cost-cutting technique. The Youden index (J), a function of sensitivity (q) and specificity (p), is a commonly used measure of overall diagnostic effectiveness. More importantly, J is the maximum vertical distance or difference between the ROC curve and the diagonal or chance line; it occurs at the cut-point that optimizes the biomarker's differentiating ability when equal weight is given to sensitivity and specificity. Using the additive property of the gamma and normal distributions, we present a method to estimate the Youden index and the optimal cut-point, and extend its applications to pooled samples. We study the effect of pooling when only a fixed number of individuals are available for testing, and pooling is carried out to save on the number of assays. We measure loss of information by the change in root mean squared error of the estimates of the optimal cut-point and the Youden index, and we study the extent of this loss via a simulation study. In conclusion, pooling can result in a substantial cost reduction while preserving the effectiveness of estimators, especially when the pool size is not very large.

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Weight status in young girls and the onset of puberty.

Joyce Lee, Danielle Appugliese, Niko Kaciroti … (2007)

We sought to examine the association between weight status in early childhood and onset of puberty. The study included 354 girls from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Girls were followed longitudinally with height and weight measurements at 36 and 54 months and grades 1, 4, 5, and 6 and with assessment of pubertal stage by physical examination and maternal report in grades 4 through 6. The main outcome was the presence of early puberty, indexed as follows: (a) breast development at or more than Tanner stage 2 by physical examination at grade 4; (b) breast development at or more than Tanner stage 3 by physical examination at grade 5; (c) maternal report of breast development at or more than Tanner stage 3 at grade 5; and (d) maternal report of menarche having already occurred (yes versus no) at grade 6. Multiple logistic regression models predicting early versus late puberty were constructed by using the covariate BMI z score at 36 months, rate of change of BMI and accelerated BMI between 36 months and grade 1, race, maternal education, and maternal age of menarche. BMI z score at 36 months, rate of change of BMI between 36 months and grade 1, an earlier age of maternal menarche, and nonwhite race were each consistently and positively associated with an earlier onset of puberty across the various measures of puberty. Higher BMI z score in girls as young as 36 months of age and higher rate of change of BMI between 36 months old and grade 1, a period well before the onset of puberty, are associated with earlier puberty, which suggests that increasing rates of obesity in the United States may result in an earlier average age of onset of puberty for US girls.

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Percent body fat at age 5 predicts earlier pubertal development among girls at age 9.

Kirsten Krahnstoever Davison, Elizabeth J. Susman, Leann Lipps Birch (2003)

This study examines the causal direction of the relationship between weight status and pubertal timing in girls using a longitudinal sample of 183 white girls followed from ages 5 to 9. Girls' weight status (body mass index percentile, percent body fat, waist circumference) was assessed when they were 5, 7, and 9 years old, and their pubertal development was assessed when they were 9 years old (breast development, Estradiol, Pubertal Development Scale). Information from all measures of pubertal development at 9 years was combined to identify girls exhibiting earlier (N = 44) and later (N = 136) pubertal development relative to the sample. Girls' weight status at each age (5, 7, and 9 years old) and change in weight status across the ages of 5 to 9 years were used to predict their pubertal timing at 9 years of age. Girls with higher percent body fat at 5 years, and girls with higher percent body fat, higher BMI percentile, or larger waist circumference at 7 years, were more likely to be classified with earlier pubertal development at 9 years. In addition, girls showing larger increases in percent body fat from 5 to 9 years of age, and larger increases in waist circumference from 7 to 9 years of age, were more likely to exhibit earlier pubertal development at 9 years. Results were still present after controlling for accelerated growth. Girls with higher weight status in early childhood were more likely to exhibit earlier pubertal development relative to peers at 9 years, indicating that weight status preceded pubertal timing in girls.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Pediatr Endocrinol Metab

Journal ID (iso-abbrev): Ann Pediatr Endocrinol Metab

Journal ID (publisher-id): APEM

Title: Annals of Pediatric Endocrinology & Metabolism

Publisher: Korean Society of Pediatric Endocrinology

ISSN (Print): 2287-1012

ISSN (Electronic): 2287-1292

Publication date (Print): September 2017

Publication date (Electronic): 28 September 2017

Volume: 22

Issue: 3

Pages: 183-188

Affiliations

[1 ]Department of Pediatrics, CHA Gumi Medical Center, CHA University, Gumi, Korea

[2 ]Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea

[3 ]Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea

Author notes

Address for correspondence: Eun-Gyong Yoo, MD, PhD https://orcid.org/0000-0002-6452-655X Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: +82-31-780-1999 Fax: +82-31-780-5239 E-mail: pedyoo@ 123456cha.ac.kr

Author information

Eun-Gyong Yoo http://orcid.org/0000-0002-6452-655X

Article

Publisher ID: apem-2017-22-3-183

DOI: 10.6065/apem.2017.22.3.183

PMC ID: 5642085

PubMed ID: 29025205

SO-VID: 717ea708-fe51-44c2-a4cb-c61667596be5

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 30 September 2016

Date revision received : 4 January 2017

Date accepted : 21 February 2017

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Diurnal variation of gonadotropin levels in girls with early stages of puberty

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Most cited references 23

Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples.

Weight status in young girls and the onset of puberty.

Percent body fat at age 5 predicts earlier pubertal development among girls at age 9.

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