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HelpTest Code LHPED Luteinizing Hormone (LH), Pediatrics, Serum
Reporting Name
LH, Pediatrics, SUseful For
Diagnosis of precocious puberty and delayed puberty in children
Method Name
Chemiluminescent Immunoassay (CIA)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering Guidance
This test is only available for pediatric patients. If testing request is for a patient 18 years of age or older, order LH / Luteinizing Hormone (LH), Serum.
Specimen Required
Supplies: Sarstedt 5 mL Aliquot Tube (T914)
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 0.25 mL
Collection Instructions:
1. Red-top tubes should be centrifuged, and the serum transferred to a plastic vial within 2 hours of collection.
2. Serum gel tubes should be centrifuged within 2 hours of collection.
Specimen Minimum Volume
0.13 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 90 days |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Reference Values
Females
<1 year: <0.02-18.3 IU/L
1-8 years: <0.02-0.3 IU/L
9-10 years: <0.02-4.8 IU/L
11-13 years: <0.02-11.7 IU/L
14-17 years: <0.02-16.7 IU/L
Tanner Stages*
Stage I (1-8 years): <0.02-0.3 IU/L
Stage II: <0.02-4.1 IU/L
Stage IIl: 0.6-7.2 IU/L
Stage IV-V: 0.9-13.3 IU/L
*Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for girls at a median age of 10.5 (± 2) years. There is evidence that it may occur up to 1 year earlier in obese girls and in African-American girls. Progression through Tanner stages is variable. Tanner stage V (adult) should be reached by age 18.
Males
<1 year: <0.02-5.0 IU/L
1-8 years: <0.02-0.5 IU/L
9-10 years: <0.02-3.6 IU/L
11-13 years: 0.1-5.7 IU/L
14-17 years: 0.8-8.7 IU/L
Tanner Stages*
Stage I (1-8 years): <0.02-0.5 IU/L
Stage II: 0.03-3.7 IU/L
Stage IIl: 0.09-4.2 IU/L
Stage IV-V: 1.3-9.8 IU/L
*Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of 11.5 (± 2) years. For boys there is no proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage V (adult) should be reached by age 18.
Day(s) Performed
Monday, Wednesday, Friday
CPT Code Information
83002
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| LHPED | LH, Pediatrics, S | 83103-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 62999 | LH, Pediatrics, S | 83103-2 |
Secondary ID
62999Highlights
In children, luteinizing hormone, along with follicle-stimulating hormone, is used to diagnose delayed and precocious (early) puberty.
This assay is sensitive to 0.02 IU/L and is more appropriate for use in children.
This assay offers a 10-fold increase in analytical sensitivity over existing automated immunoassays.
Clinical Information
Luteinizing hormone (LH) is a glycoprotein hormone consisting of 2 noncovalently bound subunits (alpha and beta). LH is produced by the anterior pituitary gland under regulation of the hypothalamic gonadotropin releasing hormone (GnRH) and feedback from gonadal steroid hormones. In children, LH, along with follicle-stimulating hormone (FSH), is used to diagnose precocious (early) and delayed puberty.
Precocious puberty refers to the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal (before 8 years of age in girls and 9 years of age in boys). Evaluation of precocious puberty includes measurement of LH and FSH to determine whether gonadotropins are increased in relation to chronologic age (gonadotropin-dependent) or whether sex steroid secretion is occurring independent of LH and FSH (gonadotropin-independent). In gonadotropin-dependent precocious puberty, basal LH levels are often elevated into the pubertal range and show a pubertal (heightened) response to GnRH stimulation. In gonadotropin-independent precocious puberty, the LH level is low at baseline and fails to respond to GnRH stimulation.
Delayed puberty is defined clinically by the absence or incomplete development of secondary sexual characteristics by age 14 years in boys and by age 12 years in girls. Delayed puberty usually results from inadequate gonadal steroid secretion that, in turn, is most often caused by a defective gonadotropin secretion from the anterior pituitary, due to defective production of GnRH from the hypothalamus. Random measurements of LH and FSH, together with estradiol (girls) or testosterone (boys), are useful to distinguish between primary and secondary causes of delayed puberty.
Interpretation
In young children, high levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), along with the development of secondary sexual characteristics at an unusually young age, are an indication of gonadotropin-dependent precocious puberty (also called central precocious puberty). Prepubertal levels of LH and FSH in children exhibiting some signs of pubertal changes may be an indication of gonadotropin-independent precocious puberty (also refer as precocious pseudopuberty). In precocious pseudopuberty the signs and symptoms are the result of elevated levels of estrogen in girls or testosterone in boys.
In delayed puberty, LH and FSH levels can be normal or below what is expected for a youth within this age range. The test for LH response to gonadotropin releasing hormone in addition to other testing may help to diagnose the reason for the delayed puberty.
Cautions
No clinically significant cross-reactivity has been demonstrated with follicle-stimulating hormone, human chorionic gonadotropin, free alpha subunit of pituitary glycoprotein hormones, or free beta subunit of luteinizing hormone. Cross-reactivity with thyrotropin (TSH) (<5%) might be observed at TSH concentrations of 500 mIU/L.
Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedures, may have circulating anti-animal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.
Clinical Reference
1. Jameson JL, ed. Reproductive Endocrinology. In: Harrison's Endocrinology. 2nd ed. McGraw-Hill. 2010;144-241
2. Wei C, Davis N, Honour J, Crowne E: The investigation of children and adolescents with abnormalities of pubertal timing. Ann Clin Biochem. 2017 Jan;54(1):20-32
Method Description
The AnshLite LH CLIA is a quantitative three-step sandwich type immunoassay. In the first step calibrators, controls, and unknown samples are added to luteinizing hormone (LH) antibody-coated microtiter wells and incubated. After washing, the wells are incubated with biotinylated LH antibody solution. After the second incubation and washing, the wells are incubated with streptavidin horseradish peroxidase conjugate solution. Finally, the antibody-antigen and conjugate complex bound to the well is detected by addition of a luminogenic substrate (AnshLite chemiluminescence substrate solution). The relative light output units are directly proportional to the concentration of LH in the samples.(Unpublished Mayo method)