ABSTRACT
Purpose@#Intravenous gonadotropin-releasing hormone (IV GnRH) testing is the gold standard for confirming a central precocious puberty (CPP) diagnosis. However, this test is not widely available commercially. Therefore, our study aim was to establish cutoff values for basal gonadotropin level and gonadotrophin responses to a 100-μg subcutaneous IV GnRH test that can distinguish between CPP and premature thelarche (PT) to discover a simple method to detect CPP. @*Methods@#Girls between the ages of 6 and 8 years who attended the pediatric endocrinology outpatient clinic at our tertiary hospital between 2019 and 2022 were included in this study. They were evaluated for breast development, and a subcutaneous 100-μg GnRH test was administered by measuring the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in blood samples at baseline and then 30, 60, 90, and 120 minutes after injection. CPP is characterized by increased height velocity, advanced bone age, and progression of breast development. The cutoff value for diagnosis of CPP was determined using a receiver operating characteristic (ROC) analysis. @*Results@#In 86 Thai girls (56 with CPP and 30 with PT), the ROC analysis showed 71.4% and 100% sensitivity and specificity, respectively, for basal LH (cutoff ≥ 0.2 IU/L) plus the basal LH/FSH ratio (cutoff ≥ 0.1). The optimal cutoff values for peak LH (cutoff ≥ 7 IU/L) demonstrated a sensitivity of 94.6% and a specificity of 100%, whereas the LH value at 30 and 60 minutes after injection (cutoff ≥ 6 IU/L) demonstrated sensitivities of 92.9% and 94.6% and a specificity of 100%, respectively @*Conclusion@#Combining the basal LH (cutoff: 0.2 IU/L) and the basal LH/FSH ratio (cutoff: 0.1) can easily and cost-effectively diagnose CPP in a girl in breast Tanner stage II.
ABSTRACT
Background: Dengue is a common infectious disease in Southeast Asia. The hormonal changes of dengue have rarely been studied.Objective: To demonstrate the endocrine changes in children with dengue viral infection, and to compare these changes with the severity of dengue virus infection.Materials and method: Twenty-three children (11 males and 12 females) presented with clinical features and serological confirmation of dengue fever (DF) were measured for thyroid function test (freeT4, T3 and TSH), serum cortisol and serum insulin-like growth factor-I (IGF-I) and IGF-binding protein 3 (IGFBP-3) during febrile and convalescent periods. Sixteen children (8 males and 8 females) presented with clinical features and serological confirmation of dengue hemorrhagic fever (DHF) were measured for these parameters but during shock and convalescent periods.Results: In shock period of DHF, serum T3 was lower than that in febrile period of DF (90.5±34.0 and 103.1±39.0 ng/dL) but not significantly different. Serum freeT4 had positive correlation with serum T3 during febrile period (r=0.74, p \< 0.001) in DF and during shock period (r=0.48, p=0.02) in DHF. During convalescent period, serum T3 had a positive correlation with serum TSH in DF but not in DHF. The increment of IGF-I was higher in DF than that in DHF in convalescent period. The changes represented a slower recovery of thyroid and GH-IGF axes in DHF. In addition, serum cortisol level trended to be insufficient. (\< 18 μg/dL) during febrile period in DF and shock period in DHF.Conclusion: Thyroid axis was influenced by the illness similar to changes in euthyroid sick syndrome. Insufficiency of adrenal reserve and changes of GH-IGF axis need to be further studied.