Ayfer Alikaşifoğlu, Doğuş Vurallı, E. Nazlı Gönç, Z. Alev Özön

Santral puberte prekoks tanısında bazal lütenizan hormon düzeyinin yeterliliği

Amaç: Bu çalışmada 3–8 yaş arasında meme gelişimi başlayan santralpuberte prekoks ve prematür telarş tanılı kız olguların klinik, antropometrik ve laboratuvar bulguları incelenerek santral puberte prekoksve prematür telarş ayırımında kullanılabilecek ölçümlerin belirlenmesiamaçlanmıştır.Gereç ve Yöntemler: Çalışmaya meme gelişimi nedeniyle gonadotropin-salgılatıcı hormon uyarı testi yapılmış 344 kız olgu (196 idiyopatiksantral puberte prekoks, 148 prematür telarş) alındı. Olguların tanı yaşı,kemik yaşı, antropometrik ölçümleri, bazal/uyarılmış hormon düzeylerikaydedildi. Santral puberte prekoks ve prematür telarş ayırımında kullanılabilecek ölçümleri belirlemek için tek değişkenli regresyon analiziyapıldı. Anlamlı gelen ölçümler işlem karakteristik eğrisiyle saptananeşik değerlere göre gruplandırıldı ve çok değişkenli analiz ile değerlendirildi.Bulgular: Santral puberte prekokslu olguların tanıda kemik yaşı,boy-standart sapma skoru, vücut kitle indeksi-standart sapma skoru,büyüme hızı-standart sapma skoru prematür telarşlılardan daha yüksek, puberte evreleri daha ileri, uterus-over hacimleri daha büyük, bazal/doruk lütenizan hormon, follikül uyarıcı hormon, lütenizan hormon/follikül uyarıcı hormon oranları daha yüksek iken östradiol düzeyleriarasında fark yoktu. İki grubu ayırt etmede en iyi eşik değerler bazallütenizan hormon, follikül uyarıcı hormon, lütenizan hormon/folliküluyarıcı hormon, büyüme hızı-standart sapma skoru için sırasıyla 0,65IU/L (%78 duyarlılık, %100 özgüllük), 1,9 IU/L (%100 duyarlılık, %72 özgüllük), 0,25 (%67 duyarlılık, %100 özgüllük), 1,1 (%69 duyarlılık, %71 özgüllük) olarak saptandı.Çıkarımlar: Erken meme gelişimi ile gelen kızlarda bazal lütenizanhormon ≥0,65 IU/L, lütenizan hormon/follikül uyarıcı hormon ≥0,25olması hipotalamo-hipofiz-gonad ekseninin harekete geçmesini göstermede kullanılabilecek duyarlı yöntemlerdir. Bu yöntemler arasındaen iyi duyarlılık ve özgüllük veren değişken bazal lütenizan hormonölçümüdür. Bazal lütenizan hormon ≥0,65 IU/L olması santral puberte prekoks tanısında tarama testi olarak kullanılabilecek duyarlı birtesttir.

Adequacy of basal luteinizing hormone levels in the diagnosis of central precocious puberty

Aim: To determine the clinical, anthropometric, and laboratory parameters that could be used for differentiating central precocious puberty from premature thelarche in girls who had breast development between the ages of 3 and 8 years. Material and Methods: The study included 344 girls (196 girls with idiopathic central precocious puberty, 148 girls with premature thelarche) who underwent gonadotropin- releasing hormone stimulation tests for breast development. Age at diagnosis, bone age, anthropometric measurements, basal/stimulated hormone levels were recorded. Univariate regression analysis was performed to determine the parameters that could be used for differentiating precocious puberty from premature thelarche. Significant parameters in univariate analyses were grouped according to the thresholds determined using receiver operating characteristic curves and reevaluated through multivariate analysis. Results: The bone age, height-standard deviation score, body mass index-standard deviation score, and growth velocity-standard deviation score at diagnosis were found to be higher; pubertal stages were found to be more advanced; uterus and ovary volumes were found to be larger; and the basal/peak luteinizing hormone, follicle-stimulating hormone, luteinizing hormone/follicle-stimulating hormone levels were found to be higher in the subjects with precocious puberty. There was no difference between estradiol levels between the two groups. The best thresh olds to differentiate the two groups were found as 0.65 IU/L (78% sensitivity, 100% specificity), 1.9 IU/L (100% sensitivity, 72% specificity), 0.25 (67% sensitivity, 100% specificity) and 1.1 (69% sensitivity, 71% specificity), respectively, for basal luteinizing hormone, follicle-stimulating hormone, luteinizing hormone/follicle-stimulating hormone ratio, and the growth velocity-standard deviation score. Conclusion: In girls presenting with early breast development, a basal luteinizing hormone level of ≥0.65 IU/L and a luteinizing hormone/follicle-stimulating hormone ratio of ≥0.25 are sensitive ways to demonstrate activation of the hypothalamo-pituitary-gonadal axis. Among these, the variable that gives the best sensitivity and specificity is the measurement of basal luteinizing hormone levels (≥0.65 IU/L), which can be used as a screening test in the diagnosis of central precocious puberty.

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