BSPED2024 Poster Presentations Gonadal, DSD and Reproduction 2 (7 abstracts)
Clinical decision making based on LHRH test: an audit of practice in a tertiary center
Eshita Bhowmik , Renuka Dias , Ruth Krone , Melanie Kershaw , Vrinda Saraff , Zainaba Mohamed , Tim Barrett , Suma Uday , Jan Idkowiak , Nikolina Kyprianou & Ruchi Nadar
Birmingham Women’s & Children’s Hospital, Birmingham, United Kingdom
Introduction: The LHRH (luteinizing hormone releasing hormone) is routinely performed for both precocious (PP) and delayed puberty (DP) in children.
Aim: To assess utility of LHRH test results in guiding clinical decisions.
Materials & Methods: In this pilot study, we retrospectively studied LHRH tests done in 2019. A peak luteinizing hormone (LH) (pLH) ≥ 5 IU/l and an LH:FSH (follicle stimulating hormone) ratio > 1 indicated a pubertal response, pLH < 5 IU/l indicated a pre-pubertal response. Pubertal status at discharge was noted for the DP cohort
Results: 71(35M:36F) tests were done in 2019. 39 (10M:29F, mean age 7.41 years) were done to assess PP and, 32 [23M:6F:3 disorder of sex development (DSD), mean age 13.81 years] for DP.
Precocious puberty: 31% (11/35) tests showed a pubertal response. GnRH analogue treatment was given to all boys with pLH> 5 IU/l (n = 5) and females with pLH ≥10 IU/l (n = 5), regardless of LH: FSH ratio, and in selected females with pLH 5-9 IU/l and LH: FSH >1 (n = 1).
Delayed puberty: Of the 32 tests, 78% (25) showed a pubertal response and 22% (7), a prepubertal response. 15 (13M, 2F) of those with pLH>5 had constitutional delay in growth and puberty (CDGP), and hypogonadism was ruled out in two DSD cases. 6 were lost to follow up. Testosterone therapy was given to 3 of 4 males with pLH < 5 IU/l, both with pLH 5-8 IU/l, and 66% (6/9) with pLH > 8 IU/l. Where long term data was available, of those with pLH > 5 IU/l, 92% (12/13) males and 75% (3 of 4) females progressed spontaneously in puberty. One male and one female developed hypogonadotropic hypogonadism at follow up. Of those with pLH<5IU/l all 5 (3 males) with long term data, remained on sex steroid replacement at transition.
Conclusion: Whereas the practice to use GnRH analogue treatment in Precocious puberty with pLH>5 was uniform, sex steroid therapy for Delayed puberty was variable across pLH subgroups. pLH>5 IU/l had a positive predictive value of 88% for spontaneous pubertal progress and pLH<5IU/l was highly sensitive to predict continued sex steroid replacement at transition.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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