{
  "abstract": "Objective\n\nThe diagnosis of central precocious puberty (CPP) in girls relies on the invasive gonadotropin-releasing hormone (GnRH) stimulation test. Urinary luteinizing hormone (LH) is a noninvasive candidate biomarker, but evidence from Chinese populations and its integration into multivariable prediction frameworks remain limited. We evaluated the diagnostic accuracy of first-morning urinary LH for CPP, established sex- and pubertal stage-specific reference intervals, and developed a two-step prediction model based on a bone age decomposition.Methods\n\nIn this single-center retrospective diagnostic accuracy study, we enrolled 808 children: 295 girls with early breast development (146 CPP, 149 non-CPP), 271 healthy girls, and 242 healthy boys (reference intervals only). First-morning urine was assayed for LH, follicle-stimulating hormone (FSH), and creatinine. Diagnostic performance was evaluated primarily in the 295 symptomatic girls, with an extended analysis in 566 girls including healthy controls; multivariable logistic regression decomposed bone age into chronological age (CA) and the BA-CA difference as separate predictors.Results\n\nUrinary LH showed moderate accuracy for CPP in the primary symptomatic cohort (AUC 0.692, 95% CI 0.630-0.752), peaking in girls aged 7-8 years (AUC 0.708, 95% CI 0.621-0.785); the extended cohort gave similar results (AUC 0.712; secondary, spectrum-extended estimate). The LH-to-creatinine ratio offered no improvement. Basal serum LH was the superior single marker (AUC 0.868 vs 0.692, P < 0.001). The noninvasive Model 1 (CA + BA-CA + urinary LH + breast Tanner stage + uterine length) achieved a C-statistic of 0.853 (sensitivity 73.3%, specificity 83.2%), with CA, BA-CA, and urinary LH as independent predictors. Adding basal serum LH and FSH (Model 2) improved the C-statistic to 0.909; urinary LH retained independent significance (aOR 1.280, P = 0.024), whereas basal FSH was inversely associated with CPP. Bootstrap-corrected C-statistics were 0.838 (Model 1) and 0.893 (Model 2). Pubertal-onset cutoffs were >1.02 mIU/mL in girls and >0.95 mIU/mL in boys.Conclusions\n\nDecomposing bone age into CA and BA-CA enables tiered CPP risk stratification: the noninvasive model supports initial screening without blood sampling, and the complete model refines risk once serum gonadotropins become available. Urinary LH is a clinically useful component of tiered diagnostic algorithms for CPP.",
  "abstract_shown": true,
  "affiliations": [
    "Shenzhen Maternity and Child Healthcare Hospital, Women's and Children's Medical Center, Southern Medical University, Shenzhen, Guangdong, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Miao Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Xiyan Lu"
    },
    {
      "affs": [
        0
      ],
      "name": "Peipei Liu"
    },
    {
      "affs": [
        0
      ],
      "name": "Guoqing Dong"
    },
    {
      "affs": [
        0
      ],
      "name": "Mingzhu Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Wujin Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jianxu Li"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ftqq55exc1ysp.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1948363",
  "fulltext_url": "https://europepmc.org/articles/PMC13686030",
  "id": "ftqq55exc1ysp",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://europepmc.org/article/MED/42910289",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2743|Hypothalamic control of reproductive hormones"
    ]
  ],
  "openalex": "W7220836567",
  "pdf_url": "https://europepmc.org/articles/PMC13686030?pdf=render",
  "pmcid": "PMC13686030",
  "pmid": "42910289",
  "published": "2026-10-07",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/ftqq55exc1ysp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "MED:42910289",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42910289"
    },
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.3389/fendo.2026.1948363",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1948363/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2743|Hypothalamic control of reproductive hormones",
      "subfield": "reproductive-child"
    }
  ],
  "title": "First-morning urinary luteinizing hormone and bone age decomposition for diagnosis of central precocious puberty in girls: a two-step prediction model study.",
  "title_text": "First-morning urinary luteinizing hormone and bone age decomposition for diagnosis of central precocious puberty in girls: a two-step prediction model study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/ftqq55exc1ysp",
  "venue": "Frontiers in endocrinology",
  "versions": []
}