Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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성조숙증 여아에서 생식샘자극호르몬분비호르몬 검사 결과의 분석

Analysis of gonadotropin-releasing hormone (GnRH) test results in girls with precocious puberty

  • 최정윤 (가톨릭대학교 의과대학 소아과학교실) ;
  • 강현주 (가톨릭대학교 의과대학 소아과학교실) ;
  • 조원경 (가톨릭대학교 의과대학 소아과학교실) ;
  • 조경순 (가톨릭대학교 의과대학 소아과학교실) ;
  • 박소현 (가톨릭대학교 의과대학 소아과학교실) ;
  • 한승훈 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정민호 (가톨릭대학교 의과대학 소아과학교실) ;
  • 서병규 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이병철 (가톨릭대학교 의과대학 소아과학교실)
  • Choi, Jung Yun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kang, Hyun-Ju (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Cho, Won Kyoung (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Cho, Kyoung Soon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Park, So Hyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Hahn, Seung Hoon (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Jung, Min Ho (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Seo, Byung Kyu (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Byung Churl (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 투고 : 2009.08.17
  • 심사 : 2009.10.02
  • 발행 : 2009.12.15
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초록

목 적:저자들은 성조숙증으로 내원한 여아들에서 GnRH 검사의 결과를 분석하여 이 검사의 결과를 더 단순하고 명확하게 이용하기 위한 자료를 얻고, 중심성 성조숙증과 다른 원인을 감별하는 데 유용한 인자들에 대해 알아보고자 하였다. 방 법:성조숙증의 진단과 감별을 위하여 GnRH 검사를 시행 받은 여아 54명(역연령 $7.8{\pm}1.0$세, 골 연령 $10.0{\pm}1.1$세)의 임상 자료와 GnRH 검사 결과를 분석하였다. GnRH 검사는 100 mg 정맥주사 후 0, 30, 60, 90분에 채혈하였으며, LH 최고치 ${\geq}5.0IU/L$일 때 중심성 성조숙증으로 판정하였다. 결 과:중심성 성조숙증 여아 40명에서 GnRH 자극 후 30분, 60분, 90분에 LH가 최고치에 도달한 여아는 각각 36명(90.0%), 3명(7.5%), 1명(2.5%)이었다. 그리고 30분, 60분, 90분까지 LH ${\geq}5.0IU/L$에 도달한 여아의 비율은 각각 92.5%, 100%, 100%이었다. 중심성 성조숙증 여아들의 최고치 LH/FSH 비는 $0.89{\pm}0.49$이었으며, 이 비가 1.0보다 큰 환아는 16명(40.0%)이었다. 최고치 LH/FSH 비가 1보다 큰 여아들은 최고치 LH/FSH 비가 1 이하인 여아들보다 역연령($8.3{\pm}0.6$세 vs. $7.7{\pm}1.0$세, P=0.033), 골 연령($10.9{\pm}0.8$세 vs. $9.7{\pm}1.1$세, P=0.001), 골 연령과 역연령의 차이($2.6{\pm}0.7$년 vs. $2.0{\pm}0.7$년, P=0.009)가 더 높았다. 유방 발달이 Tanner 단계 III 이상이었던 여아의 비율은 최고치 LH/FSH 비가 1보다 큰 군에서 더 높았다(93.7% vs. 41.7%, P=0.001). 결 론:여아의 중심성 성조숙증을 감별할 때에는 GnRH 정맥주사 후 30분과 60분의 LH 측정치가 가장 유용한 판정 자료로 이용될 수 있을 것으로 사료된다.

Purpose:The gonadotropin-releasing hormone (GnRH) test results of girls with precocious puberty were analyzed to determine whether this test can efficiently and clearly differentiate between central precocious puberty (CPP) and other disorders. Methods:Clinical and laboratory data of 54 girls with precocious pubertal signs were reviewed. Intravenous GnRH test was performed with blood samples obtained at 0, 30, 60, and 90 minutes. A peak luteinizing hormone (LH) level of ${\geq}5.0IU/L$ was indicative of CPP. Results:Of the 40 girls with CPP, 36 (90.0%), 3 (7.5%), and 1 (2.5%) showed peak LH levels at 30, 60, and 90 minutes, respectively. A percentage of girls whose peak LH ${\geq}5.0IU/L$ up to 30, 60, and 90 minutes was 92.5%, 100%, and 100%, respectively. The peak LH/follicle stimulating hormone (FSH) ratio of girls with CPP was 0.89${\pm}$0.49 and was <1 in 16 of the 40 girls (40.0%). Girls with peak LH/FSH ratio of >1.0 showed higher chronological age (CA) ($8.3{\pm}0.6$ vs. $7.7{\pm}1.0$ years, P=0.033), bone age (BA) ($10.9{\pm}0.8$ vs. $9.7{\pm}1.1$ years, P=0.001), and BA-CA difference ($2.6{\pm}0.7$ vs. $2.0{\pm}0.7$ years, P=0.009) than those of girls with peak LH/FSH ratio of ${\leq}1.0$. Higher percentage of girls with peak LH/FSH ratio of >1.0 showed advanced breast development (${\geq}TannerIII$) (93.7% vs. 41.7%, P=0.001). Conclusion:LH levels after 30 and 60 minutes of intravenous GnRH administration are the most useful for diagnosing CPP in girls.

키워드

참고문헌

  1. Garibaldi L. Disorders of pubertal development. In: Berman RE, Kilegman RM, Jenson HB, editors, Nelson textbook of pediatrics. 18th ed. Philadelphia: WB Saunders Co, 2007: 2309-11
  2. Lee PA. Central precocious puberty. An overview of diagnosis, treatment, and outcome. Endocrinol Metab Clin North Am 1999;28:901-18 https://doi.org/10.1016/S0889-8529(05)70108-0
  3. Dickerman Z, Prager-Lewis R, Laron Z. Response of plasma LH and FSH to synthetic LH-RH in children at various pubertal stages. Am J Dis Child 1976;130:634-8
  4. Eckert KL, Wilson DM, Bachrach LK, Anhalt H, Habiby RL, Olney RC, et al. A single-sample, subcutaneous gonadotropin- releasing hormone test for central precocious puberty. Pediatrics 1996;97:517-9
  5. Cavallo A, Richards GE, Busey S, Michaels SE. A simplified gonadotrophin-releasing hormone test for precocious puberty. Clin Endocrinol (Oxf) 1995;42:641-6 https://doi.org/10.1111/j.1365-2265.1995.tb02692.x
  6. Carel JC, L\acute{e}ger J. Precocious puberty. New Engl J Med 2008; 358:2366-77 https://doi.org/10.1056/NEJMcp0800459
  7. de Vries L, Horev G, Schwartz M, Phillip M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol 2006;154:891-8 https://doi.org/10.1530/eje.1.02151
  8. Su PH, Wang SL, Chen JY, Chen SJ, Ke JC. A study of anthropomorphic and biochemical characteristics in girls with central precocious puberty and thelarche variant. J Pediatr Endocrinol Metab 2008;21:213-20
  9. Garibaldi LR, Aceto T Jr, Weber C, The pattern of gonadotropin and estradiol secretion in exaggerated thelarche. Acat Endocrinol (Copenh) 1993;128:345-50 https://doi.org/10.1530/acta.0.1280345
  10. Garibaldi LR, Aceto T Jr, Weber C, Pang S. The relationship between luteinizing hormone and estradiol secretion in female precocious puberty: evaluation by sensitive gonadotropin assays and the leuprolide stimulation test. J Clin Endocrinol Metab 1993;76:851-6 https://doi.org/10.1210/jc.76.4.851
  11. Resende EA, Lara BH, Reis JD, Ferreira BP, Pereira GA, Borges MF. Assessment of basal and gonadotropin-releasing hormone-stimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children. J Clin Endocrinol Metab 2007;92:1424-9 https://doi.org/10.1210/jc.2006-1569
  12. Pescovitz OH, Hench KD, Barnes KM, Loriaux DL, Cutler GB Jr. Premature thelarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab 1988;67:474-9 https://doi.org/10.1210/jcem-67-3-474
  13. Brito VN, Latronico AC, Cukier P, Teles MG, Silveira LF, Arnhold IJ, et al. Factors determining normal adult height in girls with gonadotropin-dependent precocious puberty treated with depot gonadotropin-releasing hormone analogs. J Clin Endocrine Metab 2008;93:2662-9 https://doi.org/10.1210/jc.2007-2183
  14. Osuna JA, Arata-Bellabarba G, Tortolero MI. GnRH and hCG tests in healthy adolescents and adults. Arch Androl 2001;47: 9-14 https://doi.org/10.1080/01485010152103955
  15. Roger M, Lahlou N, Chaussain JL. Gonadotropin-releasing hormone testing in pediatrics. In: Ranke MB, editor. Diagnostics of Endocrine Function in Children and Adolescents. Heidelberg: Johann Ambrosius Barth 1996:346-9
  16. Cavallo A, Zhou XH. LHRH test in the assessment of puberty in normal children. Horm Res 1994;41:10-5 https://doi.org/10.1159/000183870
  17. Spratt DI, Crowley WF Jr, Butler JP, Hoffman AR, Conn PM, Badger TM. Pituitary luteinizing hormone responses to intravenous and subcutaneous administration of gonadotropin- releasing hormone in men. J Clin Endocrinol Metab 1985;61: 890-5 https://doi.org/10.1210/jcem-61-5-890
  18. Brito VN, Batista MC, Borges MF, Latronico AC, Kohek MB, Thirone AC, et al. Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab 1999;84:3539-44 https://doi.org/10.1210/jc.84.10.3539
  19. Neely EK, Hintz RL, Wilson DM, Lee PA, Gautier T, Argente J, et al. Normal ranges for immunochemiluminometric gonadotropin assays. J Pediatr 1995;127:40-6 https://doi.org/10.1016/S0022-3476(95)70254-7
  20. Choi JH, Shin YL, Yoo HW. The predictive factors for central nervous system lesion in central precocious puberty and the utility of single timed LH after GnRH administration. J Korean Soc Pediatr Endocrinol 2002;7:206-14
  21. Lee HS, Yu JE, Yi KH, Hwang JS. Clinical and biochemical factors associated with GnRH stimulation test in the idiopathic central precocious puberty and early puberty girls. J Korean Soc Pediatr Endocrinol 2008;13:41-9

피인용 문헌

  1. KISS1 gene analysis in Korean girls with central precocious puberty: a polymorphism, p.P110T, suggested to exert a protective effect vol.57, pp.8, 2009, https://doi.org/10.1507/endocrj.k10e-073
  2. Genetic Variations ofGNRH1,GNRHRandGPR54Genes in Korean Girls with Central Precocious Puberty vol.16, pp.1, 2009, https://doi.org/10.6065/jkspe.2011.16.1.38