From the Guidelines
Before initiating gonadotropin-releasing hormone (GnRH) agonists in an adolescent, baseline hormone levels including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol should be obtained as clinically indicated by accelerated pubertal progression and growth. When considering the administration of puberty blockers, several key laboratory tests are essential to establish baseline values and monitor potential side effects. These tests include:
- Baseline hormone levels, such as LH, FSH, and estradiol, as recommended by the study published in the Journal of Clinical Oncology 1
- A comprehensive metabolic panel to assess liver and kidney function
- Complete blood count to evaluate for anemia or other blood disorders
- Bone health markers, including vitamin D levels and bone density scans, to monitor the potential adverse effects of GnRH agonists on bone density, as mentioned in the study published in Anaesthesia 1
- Pregnancy testing for those with uterine capacity
- Lipid panels and hemoglobin A1c to monitor metabolic health Regular follow-up labs every 3-6 months during treatment are crucial to monitor hormone suppression and assess for any adverse effects on bone density, metabolic parameters, or other body systems. The most recent study published in Anaesthesia 1 highlights the importance of careful consideration and monitoring when administering puberty blockers, as they can have significant effects on the development of secondary sexual characteristics and overall health. By prioritizing these laboratory tests and regular follow-up, clinicians can ensure the safe administration of GnRH agonists while monitoring the adolescent's overall health during treatment.
From the Research
Laboratory Tests Prior to Initiating GnRH Agonists
The following laboratory tests are recommended prior to initiating gonadotropin-releasing hormone (GnRH) agonists in adolescents:
- Gonadotropins (luteinizing hormone and follicle-stimulating hormone) 2, 3, 4
- Sex steroids (testosterone and estradiol) 2, 3, 4
- Renal function (creatinine) 2
- Liver function 2
Rationale for Laboratory Tests
These laboratory tests are necessary to:
- Assess the suppression of gonadotropic activation and pubertal signs 5, 3
- Monitor the efficacy and safety of GnRH agonist treatment 2, 4
- Evaluate the potential effects of GnRH agonist treatment on body composition and bone density 2
Specific Tests and Frequencies
The specific tests and frequencies may vary depending on the individual patient and the treatment protocol: