The informativity of the gonadotropin-releasing hormone stimulation test and the human chorionic gonadotropin stimulation test in diagnosing of constitutional delay of puberty in boys

• Brzhezinskaya Lyubov’ B.

Abstract

Objective - to examined the sensitivity and specificity the gonadotropin-releasing hormone (GnRH) stimulation test and the human chorionic gonadotropin (hCG) stimulation test in diagnosing of constitutional delay of puberty in boys (CDP).

Material and methods. The study included 30 boys with delayed puberty. Patients were examined at the age of 14,5±1 (first medical visit). We evaluated anthropometric indicators, bone age, testicular volume; TSH, prolactin, cortisol, DHEA-s, IGF-1, insulin, inhibin В, anti-mullerian hormone; basal LH, FSH and testosterone; simulated LH and testosterone. All patients were examined after 2 years (second medical visit). We evaluated the stage of a sexual development. The patients were divided into two groups depending on a testicular volume: the first group had >3 cm³, there was a group with constitutional delay of puberty (n=25) and the second group had <3 cm³, there was a group with hypogonadotropic hypogonadism (n=5).

Results. At the first visit all patients had the same height (p=0.1), weight (p=0.1), bone age (p=0.08) and anti-mullerian hormone (p=0.4), TSH (p=0.4), prolactin (p=0.1), cortisol (p=0.4), DHEA-s (p=0.08), IGF-1 (p=0.7), insulin (p=0.3). However, in boys with CDP, testicular volumes were much more (p=0.002) and hormones were significantly higher, such as, LH (p=0.003), FSH (p=0.001), inhibin В (p=0.0006), testosterone (p=0.5), than in boys with hypogonadotropic hypogonadism.

In the first group of patients with CDP true positive results were in 88% (22/25) of cases in the GnRH test and in 91% (20/22) of cases in the hCG test. In the second group of patients with hypogonadotropic hypogonadism 100% boys (5/5) had true negative results in this two tests.

Conclusion. In differential diagnosing of delay of puberty in boys the GnRH test has a sensitivity of 100% and a specificity of 88% and the hCG test has a sensitivity of 100% and a specificity of 91%. The role and place of such indicators as the testicular volume, inhibin B, basal LH, FSH, testosterone requires further study in the diagnosis of constitutional delay of puberty in boys.

Keywords:delayed puberty, gonadotropin-releasing hormone test, human chorionic gonadotropin test, anti-mullerian hormone, inhibin B, testosterone

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