{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:51:43Z","timestamp":1790833903627,"version":"4.1.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100008386","name":"Marmara University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100008386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Endocrinol Invest"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Gonadotropin-releasing-hormone (GnRH) stimulation test is used for assessment of gonadotropic activation in patients with central precocious puberty (CPP). However, it is invasive and GnRH preparation is not available in all countries. Depot-leuprolide acetate (dLA), used for the treatment of CPP, stimulates gonadotropins briefly before suppressing them. This study aimed to evaluate the utility of luteinizing hormone (LH) level measured 40-minutes after dLA injection for assessing gonadotropic activation compared to GnRH stimulation test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective study, girls with idiopathic CPP were randomized to receive dLA 3.75\u00a0mg\/4 weeks IM, 11.25\u00a0mg\/12 weeks SC or 11.25\u00a0mg\/12 weeks IM. A standard GnRH test was performed before (baseline) and after 6 months of treatment. Forty minutes after the first dLA injection, LH and follicle-stimulating hormone (FSH) levels were measured, and the same measurements were repeated after 6 months of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study recruited 132 girls. Peak LH on the GnRH test did not differ from the 40-minute-post-dLA LH levels [11.0(6.8\u201317.1) vs. 9.4(5.8\u201316.6);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06]. There were no significant differences between the treatment groups. Using the GnRH test peak of LH\u2009\u2265\u20095 IU\/L as the gold-standard, ROC analysis identified the optimal cut-off of post-dLA injection LH\u2009\u2265\u20095.4 IU\/L on initial measurement (sensitivity\u2009=\u200986%, specificity\u2009=\u200990% and AUC\u2009=\u20090.91). At 6 months, peak LH levels in treatment groups were similarly suppressed (2.1\u2009\u00b1\u20091.6, 2.5\u2009\u00b1\u20091.8, 2.2\u2009\u00b1\u20090.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.2011). Furthermore, post- dLA LH cut-off of &lt;\u20093.07 IU\/L yielded an AUC\u2009=\u20090.83, sensitivity\u2009=\u200980.8% and specificity\u2009=\u200975.5%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 40-minute post-dLA LH provided clinically useful information concerning gonadotropic activity for both diagnosis and treatment monitoring and may provide a practical and clinically informative alternative in selected settings, particularly when standard GnRH testing is not readily available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40618-026-02925-0","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:01:33Z","timestamp":1779793293000},"page":"2375-2383","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Utility of a 40-minute LH level after depot leuprolide for diagnosis and treatment monitoring in girls with CPP"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8687-6326","authenticated-orcid":false,"given":"Didem","family":"Helvacioglu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilsu","family":"Turkmen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5172-5402","authenticated-orcid":false,"given":"Serap","family":"Turan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2658-6866","authenticated-orcid":false,"given":"Tulay","family":"Guran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9946-235X","authenticated-orcid":false,"given":"Belma","family":"Haliloglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7588-9807","authenticated-orcid":false,"given":"Busra Gurpinar","family":"Tosun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Kahveci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6584-9043","authenticated-orcid":false,"given":"Abdullah","family":"Bereket","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"issue":"5","key":"2925_CR1","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1210\/jc.2010-2745","volume":"96","author":"SS Mogensen","year":"2011","unstructured":"Mogensen SS, Aksglaede L, Mouritsen A et al (2011) Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab 96(5):1393\u20131401. https:\/\/doi.org\/10.1210\/jc.2010-2745","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2925_CR2","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1210\/jcem.74.5.1569169","volume":"74","author":"JS Cook","year":"1992","unstructured":"Cook JS, Doty KL, Conn PM, Hansen JR (1992) Assessment of depot leuprolide acetate dose-adequacy for central precocious puberty. J Clin Endocrinol Metab 74(5):1206\u20131209. https:\/\/doi.org\/10.1210\/jcem.74.5.1569169","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2925_CR3","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1542\/peds.97.4.517","volume":"97","author":"KL Eckert","year":"1996","unstructured":"Eckert KL, Wilson DM, Bachrach LK et al (1996) A single-sample, subcutaneous gonadotropin-releasing hormone test for central precocious puberty. Pediatrics 97(4):517\u2013519","journal-title":"Pediatrics"},{"issue":"5","key":"2925_CR4","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/j.jpag.2014.09.006","volume":"28","author":"FRR Junqueira","year":"2015","unstructured":"Junqueira FRR, Lara LAS, Martins WP et al (2015) Gonadotropin and estradiol levels after leuprolide stimulation tests in Brazilian girls with precocious puberty. J Pediatr Adolesc Gynecol 28(5):313\u2013316. https:\/\/doi.org\/10.1016\/j.jpag.2014.09.006","journal-title":"J Pediatr Adolesc Gynecol"},{"issue":"3","key":"2925_CR5","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1111\/j.1365-2265.2010.03796.x","volume":"73","author":"A Sathasivam","year":"2010","unstructured":"Sathasivam A, Garibaldi L, Shapiro S, Godbold J, Rapaport R (2010) Leuprolide stimulation testing for the evaluation of early female sexual maturation. Clin Endocrinol (Oxf) 73(3):375\u2013381. https:\/\/doi.org\/10.1111\/j.1365-2265.2010.03796.x","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"2","key":"2925_CR6","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.2.e30","volume":"109","author":"S Bhatia","year":"2002","unstructured":"Bhatia S, Neely EK, Wilson DM (2002) Serum luteinizing hormone rises within minutes after depot leuprolide injection: implications for monitoring therapy. Pediatrics 109(2):E30. https:\/\/doi.org\/10.1542\/peds.109.2.e30","journal-title":"Pediatrics"},{"issue":"9","key":"2925_CR7","doi-asserted-by":"publisher","first-page":"4338","DOI":"10.1210\/jc.2003-031537","volume":"89","author":"VN Brito","year":"2004","unstructured":"Brito VN, Latronico AC, Arnhold IJ, Mendonca BB (2004) A single luteinizing hormone determination 2 hours after depot leuprolide is useful for therapy monitoring of gonadotropin-dependent precocious puberty in girls. J Clin Endocrinol Metab 89(9):4338\u20134342. https:\/\/doi.org\/10.1210\/jc.2003-031537","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2925_CR8","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1210\/js.2019-00036","volume":"3","author":"EA Eugster","year":"2019","unstructured":"Eugster EA (2019) Treatment of central precocious puberty. J Endocr Soc 3(5):965\u2013972. https:\/\/doi.org\/10.1210\/js.2019-00036","journal-title":"J Endocr Soc"},{"issue":"1","key":"2925_CR9","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1210\/edrv-7-1-24.","volume":"7","author":"PA Boepple","year":"1986","unstructured":"Boepple PA, Mansfield MJ, Wierman ME et al (1986) Use of a potent, long-acting agonist of gonadotropin-releasing hormone in the treatment of precocious puberty. Endocr Rev 7(1):24\u201333. https:\/\/doi.org\/10.1210\/edrv-7-1-24.","journal-title":"Endocr Rev"},{"issue":"Suppl 1","key":"2925_CR10","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1515\/jpem.2000.13.s1.723","volume":"13","author":"N Lahlou","year":"2000","unstructured":"Lahlou N, Carel JC, Chaussain JL, Roger M (2000) Pharmacokinetics and pharmacodynamics of GnRH agonists: clinical implications in pediatrics. J Pediatr Endocrinol Metab 13(Suppl 1):723\u2013737. https:\/\/doi.org\/10.1515\/jpem.2000.13.s1.723","journal-title":"J Pediatr Endocrinol Metab"},{"issue":"4","key":"2925_CR11","doi-asserted-by":"publisher","first-page":"e752","DOI":"10.1542\/peds.2008-1783","volume":"123","author":"JC Carel","year":"2009","unstructured":"Carel JC, Eugster EA, Rogol A et al (2009) Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 123(4):e752\u2013e762. https:\/\/doi.org\/10.1542\/peds.2008-1783","journal-title":"Pediatrics"},{"issue":"6","key":"2925_CR12","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1530\/eje.1.02151","volume":"154","author":"L de Vries","year":"2006","unstructured":"de Vries L, Horev G, Schwartz M, Phillip M (2006) Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol 154(6):891\u2013898. https:\/\/doi.org\/10.1530\/eje.1.02151","journal-title":"Eur J Endocrinol"},{"issue":"3","key":"2925_CR13","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1007\/BF01954267","volume":"154","author":"HP Haber","year":"1995","unstructured":"Haber HP, Wollmann HA, Ranke MB (1995) Pelvic ultrasonography: early differentiation between isolated premature thelarche and central precocious puberty. Eur J Pediatr 154(3):182\u2013186. https:\/\/doi.org\/10.1007\/BF01954267","journal-title":"Eur J Pediatr"},{"issue":"1","key":"2925_CR14","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/S0022","volume":"127","author":"EK Neely","year":"1995","unstructured":"Neely EK, Hintz RL, Wilson DM et al (1995) Normal ranges for immunochemiluminometric gonadotropin assays. J Pediatr 127(1):40\u201346. https:\/\/doi.org\/10.1016\/S00223476(95)70254-7","journal-title":"J Pediatr"},{"issue":"235","key":"2925_CR15","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1136\/adc.44.235.291","volume":"44","author":"WA Marshall","year":"1969","unstructured":"Marshall WA, Tanner JM (1969) Variations in pattern of pubertal changes in girls. Arch Dis Child 44(235):291\u2013303. https:\/\/doi.org\/10.1136\/adc.44.235.291","journal-title":"Arch Dis Child"},{"issue":"4","key":"2925_CR16","doi-asserted-by":"publisher","first-page":"280","DOI":"10.4274\/jcrpe.2183","volume":"7","author":"O Neyzi","year":"2015","unstructured":"Neyzi O, Bundak R, G\u00f6k\u00e7ay G et al (2015) Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 7(4):280\u2013293. https:\/\/doi.org\/10.4274\/jcrpe.2183","journal-title":"J Clin Res Pediatr Endocrinol"},{"issue":"12","key":"2925_CR17","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1080\/08035250600652013","volume":"95","author":"O Neyzi","year":"2006","unstructured":"Neyzi O, Furman A, Bundak R et al (2006) Growth references for Turkish children aged 6 to 18 years. Acta Paediatr 95(12):1635\u20131641. https:\/\/doi.org\/10.1080\/08035250600652013","journal-title":"Acta Paediatr"},{"issue":"2","key":"2925_CR18","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/08035250500334738","volume":"95","author":"R Bundak","year":"2006","unstructured":"Bundak R, Furman A, G\u00f6n\u00f6z H, Darendeliler F, Bas F, Neyzi O (2006) Body mass index references for Turkish children. Acta Paediatr 95(2):194\u2013198. https:\/\/doi.org\/10.1080\/08035250500334738","journal-title":"Acta Paediatr"},{"key":"2925_CR19","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-195909000-00030","volume-title":"Radiographic Atlas of Skeletal Development of the Hand and Wrist","author":"WW Greulich","year":"1959","unstructured":"Greulich WW, Pyle SI (1959) Radiographic Atlas of Skeletal Development of the Hand and Wrist. Stanford University Press"},{"issue":"1","key":"2925_CR20","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1530\/eje.1.02056","volume":"154","author":"JC Carel","year":"2006","unstructured":"Carel JC, Blumberg J, Seymour C, Adamsbaum C, Lahlou N, Triptorelin 3-month CPP Study Group (2006) Three-month sustained-release Triptorelin (11.25 mg) in the treatment of central precocious puberty. Eur J Endocrinol 154(1):119\u201324. https:\/\/doi.org\/10.1530\/eje.1.02056","journal-title":"Eur J Endocrinol"},{"key":"2925_CR21","doi-asserted-by":"publisher","DOI":"10.1100\/2012\/583751","volume":"2012","author":"E Chiocca","year":"2012","unstructured":"Chiocca E, Dati E, Baroncelli GI et al (2012) Central precocious puberty: Treatment with Triptorelin 11.25 mg. ScientificWorldJournal 2012:583751. https:\/\/doi.org\/10.1100\/2012\/583751","journal-title":"ScientificWorldJournal"},{"issue":"4","key":"2925_CR22","doi-asserted-by":"publisher","first-page":"173","DOI":"10.6065\/apem.2013.18.4.173","volume":"18","author":"YJ Kim","year":"2013","unstructured":"Kim YJ, Lee HS, Lee YJ et al (2013) Multicenter clinical trial of Leuprolide Acetate depot (Luphere depot 3.75 mg) for efficacy and safety in girls with central precocious puberty. Ann Pediatr Endocrinol Metab 18(4):173\u20138. https:\/\/doi.org\/10.6065\/apem.2013.18.4.173","journal-title":"Ann Pediatr Endocrinol Metab"},{"issue":"4","key":"2925_CR23","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/s40272-015-0130-8","volume":"17","author":"M Chen","year":"2015","unstructured":"Chen M, Eugster EA (2015) Central precocious puberty: Update on diagnosis and treatment. Paediatr Drugs 17(4):273\u2013281. https:\/\/doi.org\/10.1007\/s40272-015-0130-8","journal-title":"Paediatr Drugs"},{"issue":"10","key":"2925_CR24","doi-asserted-by":"publisher","first-page":"e3660","DOI":"10.1210\/clinem\/dgaa479","volume":"105","author":"KO Klein","year":"2020","unstructured":"Klein KO, Freire A, Gryngarten MG et al (2020) Phase 3 trial of a small-volume subcutaneous 6-month duration Leuprolide Acetate treatment for Central Precocious Puberty. J Clin Endocrinol Metab 105(10):e3660-71. https:\/\/doi.org\/10.1210\/clinem\/dgaa479","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"2925_CR25","doi-asserted-by":"publisher","first-page":"4537","DOI":"10.1007\/s12325-024-02991-x","volume":"41","author":"X Yu","year":"2024","unstructured":"Yu X, Cheng X, Wei H et al (2024) A phase 3, open-label, single-arm trial of the efficacy and safety of Triptorelin 6-month formulation in Chinese children with central precocious puberty. Adv Ther 41(12):4537\u20134556. https:\/\/doi.org\/10.1007\/s12325-024-02991-x","journal-title":"Adv Ther"},{"issue":"1","key":"2925_CR26","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1111\/j.13652265.2011.04185.x","volume":"76","author":"H Demirbilek","year":"2012","unstructured":"Demirbilek H, Alikasifoglu A, Gonc NE, Ozon A, Kandemir N (2012) Assessment of gonadotrophin suppression in girls treated with GnRH analogue for central precocious puberty; validity of single luteinizing hormone measurement after Leuprolide Acetate injection. Clin Endocrinol (Oxf) 76(1):126\u2013130. https:\/\/doi.org\/10.1111\/j.13652265.2011.04185.x","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"2","key":"2925_CR27","doi-asserted-by":"publisher","first-page":"204","DOI":"10.4274\/jcrpe.galenos.2020.2020.0210","volume":"13","author":"S Schubert","year":"2021","unstructured":"Schubert S, Hvelplund AH, Handberg A, Hagstroem S, Leunbach TL (2021) Elevated pre-injection basal luteinizing hormone concentrations are common in girls treated for central precocious puberty. J Clin Res Pediatr Endocrinol 13(2):204\u2013211. https:\/\/doi.org\/10.4274\/jcrpe.galenos.2020.2020.0210","journal-title":"J Clin Res Pediatr Endocrinol"},{"issue":"3","key":"2925_CR28","doi-asserted-by":"publisher","first-page":"227","DOI":"10.4274\/jcrpe.galenos.2018.2018.0213","volume":"11","author":"P Wiromrat","year":"2019","unstructured":"Wiromrat P, Panamonta O (2019) Elevated random luteinizing hormone is an unreliable indicator for pubertal suppression in girls treated with monthly Leuprolide for idiopathic central precocious puberty. J Clin Res Pediatr Endocrinol 11(3):227\u2013233. https:\/\/doi.org\/10.4274\/jcrpe.galenos.2018.2018.0213","journal-title":"J Clin Res Pediatr Endocrinol"},{"issue":"1","key":"2925_CR29","doi-asserted-by":"publisher","DOI":"10.1186\/1687-9856-2013-20","volume":"2013","author":"EK Neely","year":"2013","unstructured":"Neely EK, Silverman LA, Geffner ME, Danoff TM, Gould E, Thornton PS (2013) Random unstimulated pediatric luteinizing hormone levels are not reliable in the assessment of pubertal suppression during histrelin implant therapy. Int J Pediatr Endocrinol 2013(1):20. https:\/\/doi.org\/10.1186\/1687-9856-2013-20","journal-title":"Int J Pediatr Endocrinol"},{"issue":"8","key":"2925_CR30","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1007\/s12098-024-05137-7","volume":"92","author":"Q Wang","year":"2025","unstructured":"Wang Q, Wu D, Zeng Q, Ban C, Wang L, Lv X (2025) Diagnostic value of single LH and LH\/FSH ratio at 60-minute after GnRHa stimulation test for central precocious puberty. Indian J Pediatr 92(8):853\u2013859. https:\/\/doi.org\/10.1007\/s12098-024-05137-7","journal-title":"Indian J Pediatr"},{"issue":"1","key":"2925_CR31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.4274\/jcrpe.v3i1.03","volume":"3","author":"N Kandemir","year":"2011","unstructured":"Kandemir N, Demirbilek H, \u00d6z\u00f6n ZA, G\u00f6n\u00e7 N, Alika\u015fifo\u011flu A (2011) GnRH stimulation test in precocious puberty: single sample is adequate for diagnosis and dose adjustment. J Clin Res Pediatr Endocrinol 3(1):12\u201317. https:\/\/doi.org\/10.4274\/jcrpe.v3i1.03","journal-title":"J Clin Res Pediatr Endocrinol"}],"container-title":["Journal of Endocrinological Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-026-02925-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40618-026-02925-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-026-02925-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:08:52Z","timestamp":1787292532000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40618-026-02925-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["2925"],"URL":"https:\/\/doi.org\/10.1007\/s40618-026-02925-0","relation":{},"ISSN":["1720-8386"],"issn-type":[{"value":"1720-8386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"10 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Ethics Committee of Marmara University (Approval No: 09.2022.486) and was conducted in accordance with the principles of the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the parents or legal guardians of all participants included in the study.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Tulay Guran is a member of the Editorial Board of\n                      Journal of Endocrinological Investigation\n                      . She was not involved in the selection of reviewers, editorial evaluation, or decision-making process for this manuscript. The other authors have no relevant financial or non-financial interests to disclose.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}