Background: A test involving 100 μg of intravenous gonadotropin-releasing hormone (GnRH) is a gold standard for confirming the diagnosis of central precocious puberty (CPP). However, intravenous GnRH for testing is commercially limited. Objective: To develop subcutaneous GnRH agonist (GnRH-A) testing and define a peak luteinizing hormone (LH) cutoff value in diagnosing CPP. Methods: A retrospective study of 101 girls with sexual precocity was undertaken. All girls underwent 100 μg subcutaneous GnRH-A (triptorelin) testing. Blood samples before and 30, 60, 90 and 120 min after GnRH-A injection were analyzed for LH and follicle-stimulating hormone levels. Criteria for diagnosing CPP include accelerated height, advanced bone age and pubertal-sized uterus and ovaries. Results: Fifty-five girls were documented as having CPP. The remaining 46 girls were diagnosed with premature thelarche (PT). Peak LH concentration in the CPP group was significantly greater than that of the PT group with a median (range) of 10.0 IU/l (2.93–65.39) and 3.04 IU/l (0.19–8.82), respectively. Peak LH was achieved within 60 min following GnRH-A injection. Peak LH of 6 IU/l provided the most appropriate cutoff level in diagnosing CPP with a sensitivity of 89.1% and a specificity of 91.3%. Conclusion: Subcutaneous GnRH-A can be used as an alternative to confirm the diagnosis of CPP.

Lee PA: Laboratory monitoring of children with precocious puberty. Arch Pediatr Adolesc Med 1994;148:369–376.
Eckert KL, Wilson DM, Bachrach LK, Anhalt H, Habiby RL, Olney RC, Hintz RL, Neely EK: A single-sample, subcutaneous gonadotropin-releasing hormone test for central precocious puberty. Pediatrics 1996;97:517–519.
Lawson ML, Cohen N: 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. J Clin Endocrinol Metab 1999;84:4536–4540.
Tanner JM, Whitehouse RH: Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976;51:170–179.
Greulich WW, Pyle SI: Radiographic Atlas of Skeletal Development of the Hand and Wrist, ed 2. Stanford, Stanford University Press, 1959.
Garel L, Dubois J, Grignon A, Filiatrault D, Van Vliet G: US of the pediatric female pelvis: a clinical perspective. Radiographics 2001;21:1393–1407.
Bhatia S, Neely EK, Wilson DM: Serum luteinizing hormone rises within minutes after depot leuprolide injection: implications for monitoring therapy. Pediatrics 2002;109:E30.
Parker KL, Baens-Bailon RG, Lee PA: Depot leuprolide acetate dosage for sexual precocity. J Clin Endocrinol Metab 1991;73:50–52.
Neely EK, Hintz RL, Wilson DM, Lee PA, Gautier T, Argente J, Stene M: Normal ranges for immunochemiluminometric gonadotropin assays. J Pediatr 1995;127:40–46.
Handelsman DJ, Jansen RP, Boylan LM, Spaliviero JA, Turtle JR: Pharmacokinetics of gonadotropin-releasing hormone: comparison of subcutaneous and intravenous routes. J Clin Endocrinol Metab 1984;59:739–746.
Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL: Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr 1995;127:47–52.
Resende EA, Lara BH, Reis JD, Ferreira BP, Pereira GA, Borges MF: Assessment of basal and gonadotropin-releasing hormone-stimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children. J Clin Endocrinol Metab 2007;92:1424–1429.
Brito VN, Latronico AC, Arnhold IJ, Mendonca BB: A single luteinizing hormone determination 2 hours after depot leuprolide is useful for therapy monitoring of gonadotropin-dependent precocious puberty in girls. J Clin Endocrinol Metab 2004;89:4338–4342.
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