Diagnostic performance of a simplified GnRH stimulation test in central precocious puberty: a multicentre study

Measuring LH at 60 minutes during the GnRH stimulation test may simplify the diagnostic process for central precocious puberty without compromising accuracy.

Summary and findings

This study evaluated the diagnostic performance of a simplified GnRH stimulation test in children suspected of central precocious puberty (CPP). A total of 209 children underwent standard testing, with serum LH and FSH measured at multiple time points after intravenous gonadorelin. The study found that LH measurement at 60 minutes provided comparable diagnostic performance to longer protocols.

Abstract

<title>Abstract</title> <p>Background Diagnosis of central precocious puberty (CPP) relies on biochemical confirmation of premature activation of the hypothalamic–pituitary–gonadal axis, with the GnRH stimulation test considered the reference standard. However, the test is time-consuming and burdensome, and current sampling schedules were established via older assay technologies. Objectives To evaluate whether optimizing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) sampling during GnRH stimulation can simplify the procedure without compromising diagnostic accuracy. Methods In this multicentre cross-sectional study, children aged ≥ 3 years evaluated for suspected CPP (2015–2024) underwent standard GnRH stimulation testing. Serum LH and FSH were measured via electrochemiluminescence immunoassay at baseline and at 30, 60, 90, and 120 minutes after intravenous gonadorelin. CPP was defined as a peak LH ≥ 5 IU/L. Diagnostic performance at each time point and agreement with the full protocol were assessed. Results Among the 209 children (mean age, 7.23 ± 1.30 years; 4.8% boys), 146 (69.9%) were diagnosed with CPP. LH peaked at 30 minutes; however, reliance on this time point alone would have resulted in two cases being missed. Measurements at 60, 90, and 120 minutes showed identical diagnostic performance. Conclusions LH measurement at 60 minutes showed diagnostic performance comparable to that of longer protocols. These findings may help simplify clinical workflows and reduce patient burden in routine practice.</p>

Elsewhere in the Gonadorelin (GnRH) corpus