Basal serum luteinising hormone cut‐off, and its utility and cost‐effectiveness for aiding the diagnosis of the onset of puberty in girls with early stages of breast development

2019 ◽  
Vol 92 (1) ◽  
pp. 46-54
Author(s):  
Somboon Wankanit ◽  
Pat Mahachoklertwattana ◽  
Oraluck Pattanaprateep ◽  
Preamrudee Poomthavorn
Keyword(s):  
Cost Effectiveness ◽  
Luteinising Hormone ◽  
Breast Development ◽  
Early Stages ◽  
Basal Serum ◽  
Serum Luteinising Hormone

Exacerbated mini-puberty of infancy in an ex-extreme preterm girl

2020 ◽  
Vol 13 (9) ◽  
pp. e235492
Author(s):  
Mafalda Casinhas Santos ◽  
Sara Limão ◽  
Patrícia Ferreira
Keyword(s):  
Ovarian Cyst ◽  
Luteinising Hormone ◽  
Vaginal Bleeding ◽  
Expectant Management ◽  
Central Precocious Puberty ◽  
Spontaneous Resolution ◽  
Breast Development ◽  
Long Term Follow Up

Vaginal bleeding can occur shortly after delivery in 3%–5% of newborns as a consequence of placental hormone withdrawal . Although usually benign, its differential diagnosis includes central precocious puberty, tumours and other pathological conditions. A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.

scholarly journals The utility of basal serum LH in prediction of central precocious puberty in girls

2012 ◽  
Vol 166 (2) ◽  
pp. 295-299 ◽  
Author(s):  
Yehonatan Pasternak ◽  
Michael Friger ◽  
Neta Loewenthal ◽  
Alon Haim ◽  
Eli Hershkovitz
Keyword(s):  
Precocious Puberty ◽  
Predictive Value ◽  
Central Precocious Puberty ◽  
Stimulation Test ◽  
Breast Development ◽  
Basal Serum ◽  
Serum Lh ◽  
Before And After ◽  
Design And Methods ◽  
Prepubertal Girls

ObjectiveThe mainstay of distinction between prepubertal girls and girls who are suspected of having central precocious puberty (CPP) is based on gonadotropin measurements after a GnRH stimulation test to evaluate hypothalamic–pituitary–gonadal axis maturity. The objective of this study was to determine whether a single basal gonadotropin measurement carries a useful predictive value in verifying or refuting the diagnosis of CPP.Design and methodsBasal serum LH and FSH were measured by a chemiluminescent immunometric assay in a cohort of girls who had been evaluated for CPP before and after GnRH stimulation test. Peak LH levels higher than 5 IU/l were considered a pubertal response.ResultsEighty girls with suspected breast development before 8 years of age were enrolled to the study, out of whom 42 had CPP.Low basal serum LH (≤0.1 IU/l) was sufficient to rule out the diagnosis of CPP in 94.7% of the 38 prepubertal girls; the sensitivity of basal LH levels for this purpose was only 64%. The basal FSH and the basal LH to FSH ratio achieved less efficient predictive value with 76 and 71% sensitivity and 73 and 86% specificity respectively.ConclusionA single basal LH measurement may be adequate to confirm but not to refute the presence of CPP in most of the girls who are evaluated for early pubertal signs.

PHARMACOECONOMICS OF ORAL PARICALCITOL THERAPY IN PATIENTS WITH A CHRONIC KIDNEY DISEASE AND SECONDARY HYPERPARATHYROIDISM

2019 ◽  
Vol 23 (1) ◽  
pp. 67-72
Author(s):  
A. V. Rudakova
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Impact Analysis ◽  
Budget Impact ◽  
Budget Impact Analysis ◽  
Early Stages ◽  
Ckd Stage ◽  
The Cost

Selective vitamin D receptors agonist paricalcitol can increase probability of proteinuria reduction at patients with the chronic kidney disease (CKD) and secondary hyperparathyroid-ism. THE AIM of this study was to determine the cost effectiveness of oral paricalcitol in patients with a CKD and secondary hyperparathyroidism and to carry out the budget impact analysis to understand the potential financial effect of introducing this drug in a health plan. MATERIALS AND METHODS. Assessment was carried out from a health care payer per-spective with use of the 5-year temporary horizon. Markov modeling on the basis of results of double blind trials at whom the efficacy of a paricalcitol at patients with hyperparathyroidism was estimated is carried out. The analysis is carried out taking into account tariffs of compulsory health insurances across St. Petersburg for 2018. Cost of paricalcitol corresponded to the price of registration including VAT for 2018 and 10% of a trade extra charge (5061.27 rub for 28 caps. on 1 mcg). During cost-effectiveness assessment clinical and economic outcomes were discounted at 3,5% a year. The budget impact analysis was carried out without discount-ing. RESULTS. Purpose of an oral paricalcitol to patients with CKD stage 3-4 and secondary hyperparathyroidism allows to increase time before transition to dialysis and life expectancy on average for 0,049-0,134 and for 0,033-0,144 year, respectively (when calculating without dis-counting). The cost effectiveness of an oral paricalcitol is higher at early stages of a nephropathy – 1,377 million rubles / year without dialysis gained, 1,408 million rubles / life year gained and 1,647 million rubles / QALY. At the same time paricalcitol therapy of patients with early stages of a nephropathy demands increase of cumulative expenses in 5 years by 2,24 times. CONCLUSIONS. Oral paricalcitol therapy in patients with a CKD and secondary hyperparathyroidism, according to results of modeling, allows to postpone transition of patients to dial-ysis and, taking into account the made assumptions, can be considered in patients with early stages of a nephropathy as economically acceptable intervention.

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