Time Points for Gonadotropin-Releasing Hormone Stimulation Test Results in Korean Children

Abstract

The gold standard for the laboratory diagnosis of central precocious puberty is based on the measurement of luteinizing hormone (LH) after gonadotropin-releasing hormone (GnRH) stimulation. We sought to investigate the laboratory data for GnRH stimulation testing using samples collected from Korean children at different time points. Sampling times were at the basal time point (0) and 15, 30, 45, 60, 90, and 120 min after GnRH stimulation. Pubertal response was defined as occurring when the peak LH concentration was 5 IU/L or more and rose to at least 2 times the basal LH concentration after GnRH stimulation. During the study period, 19,990 test results from 1958 Korean children (1841 females aged 1.3-8.9 years and 117 males aged 7.3-9.9 years) were obtained. Among the 1958 children, 1232 (62.9%) showed pubertal responses. The receiver operating characteristic curve that demonstrated the greatest area under the curve (AUC) among all examined time points was 45 min after GnRH stimulation in males (AUC 0.982, 95% CI 0.938-0.998) and 60 min in females (AUC 0.975, 95% CI 0.967-0.981). The combination of 45 min and 60 min showed the greatest AUC (0.996, 95% confidence interval 0.991-0.998), with a sensitivity level of 99.1% and a specificity of 100% for all children. The results of this study provide a possibility for a reduction in sampling time points (45 min and 60 min) to identify the presence of a pubertal response after GnRH stimulation in Korean children.