Treatment of central precocious puberty (CPP) is based on administration of GnRH agonists in order to suppress hypothalamic-pituitary-gonadal axis and thus induce the stabilization or regression of pubertal development. Our aim was to determine whether the single basal serum LH and/or FSH concentration could be an effective tool to assess the efficacy of treatment to suppress activation of hypothalamic-pituitary axis.
Patients and methods
Serum LH and FSH were measured before and after the GnRH injection, as well as E2 basal levels in 60 girls with documented idiopathic CPP at diagnosis and 18 and 30 months after the beginning of therapy.
At diagnosis, peaks of >5 IU/L of LH and of FSH were observed in 100 and 91.6% of girls, respectively, with basal LH values of <1 IU/L in 70% and basal FSH levels of <1 IU/L in 10%. E2 were <20 pg/mL in 36.6%. After 18 months, a suppressed peak (i.e. <3 IU/L) was recorded in 85% of girls (p<0.01) for LH and in 98.3% for FSH (p<0.01). Basal LH <1 IU/L was detected in 85% (p<0.01) and basal FSH ≤1 IU/L in 40% (p<0.01). Serum E2 ≤20 pg/mL was recorded in 61.6% (p<0.01). After 30 months, all patients showed LH suppressed peak (p<0.01) and 98.3% suppressed FSH peak (p<0.01). 100% showed basal LH concentrations <1 IU/L (p<0.01) and 38.3% FSH basal values <1 UI/mL (p<0.01). E2 ≤20 pg/mL was observed in 32.72% (p=NS).
Basal LH values are a reliable indicator of the efficacy of GnRHa therapy after 30 months of GnRHa therapy.
The authors are grateful to Dr. Sheila McVeigh, native-language lector at the University of Pavia, for the English revision of the manuscript.
Research funding: None declared.
Author contribution: VC and GDF conceptualized and designed the study, drafted the initial manuscript and approved the final manuscript as submitted. RA performed biochemical analysis, carried out analysis and interpretation of data and approved the final manuscript as submitted. DR and BM carried out analysis and interpretation of data, revised the literature and approved the final manuscript as submitted. CMM gave technical assistance, revised the literature and approved the final manuscript as submitted. EB, AV and MB designed the study, revised the manuscript, gave conceptual advice and approved the final manuscript as submitted.
Competing interest: Authors state no conflict of interest.
Ethical approval: The study was approved by the “Comitato Etico Area di Pavia”, the Ethics Committee of the Foundation IRCCS San Matteo Hospital, on May 17th, 2016 (reference number 20160005680) and was carried out according to the principles of the Declaration of Helsinki. Written assent was obtained from the children and written informed consent was obtained from their parents, in accordance with the study protocol.
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