The Predictive Factors for Central Nervous System Lesion in Central Precocious Puberty and the Utility of Single Timed LH after GnRH Administration / 대한소아내분비학회지

PURPOSE: This study was undertaken to determine whether the clinical presentation of patients with central precocius puberty(CPP) varies according to the etiology, whether this permits the differentiation between idiopathic and organic forms and to examine whether LH determination in a single timed blood sample after GnRH administration is sufficient to diagnose CPP. METHODS: This study included 33 girls with signs of breast development, of whom 23 were diagnosed as definite central precocious puberty. Sixteen patients had idiopathic CPP; the remaining 7 patients had organic CPP. Ten patients were classified as non-CPP. Potential clinical and laboratory predictors of CNS abnormalities were assessed and GnRH stimulation test was done. RESULTS: The age of onset in patients with organic CPP was 4.11+/-2.08 years, whereas the age in patients with idiopathic CPP was 7.25+/-1.34 years. This parameter is the only one showing statistical significance. We compared sensitivities and specificities at 0, 15, 30, 60, 90 and 120 min which yielded sensitivities of 8.7%, 87.0%, 91.3%, 87.0%, 73.9%, 60.9%. CONCLUSION: It is impossible to exclude a central nervous system lesion in patient with central precocious puberty without performing central nervous system imaging. However, this study indicates earlier the onset of disease, higher the possibility of presence of CNS lesion. According to the mean GnRH stimulated LH levels and sensitivity at each times, a single blood sample obtained for LH determined after GnRH administration at 30 min can be used to diagnose the central precocious puberty.

Clinical significance of GnRH stimulation test in male infertility / 대한비뇨기과학회지

GnRH stimulation test has been used to distinguish patients with hypogonadotropic hypogonadism of pituitary origin from those with hypothalamic disease. GnRH stimulation test also has been used to identify early stage of Sertoli cell insufficiency and to know the subtle abnormalities or spermatogenesis. Some investigators reported that exaggerated FSH response after GnRH stimulation means the same diagnostic meaning as basely elevated FSH level and this in turn reflects Sertoli cell insutriciency or may help to identify patients with isolated primary germ cell failure in azoospermic patients. So they suggested the possibility that GnRH stimulation test can replace testis biopsy in male infertility. To define the normal range of the gonadotropin response after GnRH stimulation and to know the indications for GnRH stimulation test if it is useful as an evaluation method for spermatogenesis, and especially to test the possibility whether GnRH stimulation test may replace testis biopsy, we performed GnRH stimulation test in 118 infertile men and 20 fertile adult male volunteers and compared the results with testicular histology. Normal basal serum levels for LH, FSH, testosterone were 1.4-18.3( mean 9.9) mIU/ml, 2.8-18.4 (mean 10.0) mIU/ml, 2.0-9.1 (mean 5.0)ng/ml respectively, and 95% confidence intervals for the peak responses to an intravenous bolus injection of 100ug GnRH were 360-1950{mean 1098)% of the basal serum LH level, and 111-318(mean 225)% of the basal FSH level in 20 rertile adult male volunteers. The results of the FSH response in GnRH stimulation test were not helpful in distinguishing patients with bad testicular histology from those with good ones in 118 infertile men. So we came to the conclusion that GnRH stimulation test can not replace testis biopsy as an evaluation method for spermatogenesis in the majority of infertile patients.

The presumption of serotoli cell insufficiency with GnRH test / 대한비뇨기과학회지

This study was designed to evaluate the usefulness of the GnRH stimulation test in 83 infertile azoospermia and oligoasthenospermia patients. GnRH stimulation test may be helpful not only to differentiate hypogonadotropic hypogonadism of pituitary or hypothalamic origin, but also to identify early Sertoli cell insufficiency in patients with normal basaI FSH level.

The presumption of serotoli cell insufficiency with GnRH test / 대한비뇨기과학회지

This study was designed to evaluate the usefulness of the GnRH stimulation test in 83 infertile azoospermia and oligoasthenospermia patients. GnRH stimulation test may be helpful not only to differentiate hypogonadotropic hypogonadism of pituitary or hypothalamic origin, but also to identify early Sertoli cell insufficiency in patients with normal basaI FSH level.