Comparison of Detection of Normal Puberty in Boys by a Hormonal Sleep Test and a Gonadotropin- Releasing Hormone Agonist Test

Context: The magnitude of sleep-related gonadotropin rise required to activate pubertal feminization is not established. Objective: The objective of the study was to determine the normal relationship of pubertal hormone responses to sleep and to GnRH agonist (GnRHag) challenge across the female pubertal transition. Design/Setting: This was a prospective study in a General Clinical Research Center. Participants: Sixty-two healthy 6- to 13-year-old volunteer girls participated in the study. Interventions: Interventions included overnight blood sampling followed by GnRHag (leuprolide acetate) injection. Primary Outcome Variables: The primary outcome variables included LH, FSH, and estradiol. Results: LH levels rose steadily during sleep and after GnRHag throughout the prepubertal years. The LH response to sleep and GnRHag correlated well across groups (eg, r = 0.807, peak vs 4 h post-GnRHag value); however, this correlation was less robust than in boys (r = 0.964, P < .01). Sleep peak LH of 1.3 U/L or greate...