Gonadotropin-Releasing Hormone Stimulation Test For Disorders Of Puberty

Background:Gonadotropin-releasing hormone (GnRH) stimulation test is the most widely used option to identify various disorders of puberty. However, the cut-off values abroad are not accordant with the actual situation of China, and there is no comprehensive statistical analysis or evaluation on the cut-off values of GnRH stimulation test for diagnosis of these disorders in China. The cut-off values and diagnostic values of GnRH stimulation test were assessed for diagnosis of these disorders.Methods:A study of15central precocious puberty (CPP),65idiopathic hypogonadotropic hypogonadism (IHH),31Kallmann syndrome (KS),27constitutional delayed puberty (CDP) patients,6normal prepubertal children and20normal adults was undertaken. Blood samples were obtained at0,30,60and120min after GnRH administration, and the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured. For each parameter, the sensitivities and specificities were estimated and ROC curves were constructed.Results:The ROC curves indicated that a predict ratio<0.93resulted in high sensitivity (93.3%) and specificity (71.3%) in the diagnosis of CPP. And serum peak LH<9.74IU/L resulted in moderate sensitivity (77.5%) and specificity (85.2%) in the differential diagnosis of HH group (IHH and KS) and CDP.Conclusion:Our data suggest that isolated use of GnRH stimulation test is sufficient to discriminate between CPP and prepuberty group (prepubertal children, IHH and KS), but insufficient to confirm diagnosis of CDP and HH. And the most useful predictor to diagnose all these Disorders of Puberty in GnRH stimulation test is serum peak LH.