Diagnostic value of urinary luteinizing hormone levels in the monitoring of precocious puberty treatment

ABSTRACT Objective To determine whether first-voided urinary LH (FV-ULH) – level measurement can adequately assess pubertal suppression as much as standard tests can. Subjects and methods The study group included patients with central precocious puberty and rapidly progressing early puberty who received up to 3 – 4 doses of GnRHa therapy monthly and did not have adequate hormonal suppression after GnRH stimulation (90-minute LH level > 4 IU/L). Design: All of the participants underwent an LHRH test just after admission to the study. According to the stimulated peak LH levels, the patients were divided into 2 groups and followed until the end of the first year of treatment. The concordance between FV-ULH and stimulated LH levels was assessed. Results The FV-ULH levels in patients with inadequate hormonal suppression were significantly high compared to patients with adequate hormonal suppression. FV-ULH levels were very strongly correlated with stimulated LH levels (r = 0.91). Its correlation with basal LH levels was significant (r = 0.65). However, this positive correlation was modestly weakened after the first year of treatment. The cutoff value for FV-ULH of 1.01 mIU/mL had the highest sensitivity (92.3%) and specificity (100%). Conclusion FV-ULH levels, using more reliable and sensitive assay methods, can be used to monitor the adequacy of GnRHa therapy.摘要 研究目的：本研究旨在探讨首次排尿尿液黄体生成素（FV-ULH，first-voided urinary LH）水平检测，能否如标准检测方法一般，充分评估促性腺激素释放激素类似物（GnRHa）治疗后的青春期抑制效果。 研究对象与方法：本研究纳入的研究对象为每月接受最多3~4次促性腺激素释放激素类似物（GnRHa）治疗，且在促性腺激素释放激素（GnRH）兴奋试验后未达到充分激素抑制状态（试验后90分钟时黄体生成素（LH）水平>4 IU/L）的中枢性性早熟及快速进展性早青春期患者。 研究设计：所有受试者入组后即刻接受黄体生成素释放激素（LHRH）兴奋试验。根据兴奋试验后的峰值LH水平将患者分为两组，并随访至治疗满1年。本研究评估了FV-ULH与兴奋后LH水平之间的一致性。 结果：激素抑制不充分患者的FV-ULH水平显著高于激素抑制充分的患者。FV-ULH水平与兴奋后LH水平呈极强相关性（r=0.91），与基础LH水平亦存在显著相关性（r=0.65）。但在治疗满1年后，这种正相关程度有所减弱。当FV-ULH临界值设定为1.01 mIU/mL时，其诊断灵敏度最高（92.3%），特异度达100%。 结论：采用更可靠、灵敏的检测方法测定的FV-ULH水平，可用于监测GnRHa治疗的充分性。