{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:55:58Z","timestamp":1791395758052,"version":"4.3.3"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012151","name":"Sanming Project of Medicine in Shenzen Municipality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012151","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The 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\u2013specific reference intervals, and developed a two-step prediction model based on a bone age decomposition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 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\u2013CA difference as separate predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Urinary LH showed moderate accuracy for CPP in the primary symptomatic cohort (AUC 0.692, 95% CI 0.630\u20130.752), peaking in girls aged 7\u20138 years (AUC 0.708, 95% CI 0.621\u20130.785); 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 &amp;lt; 0.001). The noninvasive Model 1 (CA + BA\u2013CA + urinary LH + breast Tanner stage + uterine length) achieved a C-statistic of 0.853 (sensitivity 73.3%, specificity 83.2%), with CA, BA\u2013CA, 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\u00a0=\u00a00.024), 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 &amp;gt;1.02 mIU\/mL in girls and &amp;gt;0.95 mIU\/mL in boys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Decomposing bone age into CA and BA\u2013CA 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1948363","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T17:20:11Z","timestamp":1791393611000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["First-morning urinary luteinizing hormone and bone age decomposition for diagnosis of central precocious puberty in girls: a two-step prediction model study"],"prefix":"10.3389","volume":"17","author":[{"given":"Miao","family":"Huang","sequence":"first","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyan","family":"Lu","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peipei","family":"Liu","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqing","family":"Dong","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhu","family":"Li","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wujin","family":"Wang","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxu","family":"Li","sequence":"additional","affiliation":[{"name":"Shenzhen Maternity and Child Healthcare Hospital, Women\u2019s and Children\u2019s Medical Center, Southern Medical University","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(95)70254-7","article-title":"Normal ranges for immunochemiluminometric gonadotropin 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