Basal Follicle-Stimulating Hormone and Peak Gonadotropin Levels after Gonadotropin-Releasing Hormone Infusion Show High Diagnostic Accuracy in Boys with Suspicion of Hypogonadotropic Hypogonadism
| Autor: | Horacio Domene, María Gabriela Ropelato, Rodolfo Rey, Alicia Martínez, Silvia Gottlieb, Ana Keselman, María Gabriela Ballerini, Romina P Grinspon |
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| Rok vydání: | 2010 |
| Předmět: |
Male
endocrine system medicine.medical_specialty Adolescent medicine.drug_class Endocrinology Diabetes and Metabolism Clinical Biochemistry Gonadotropin-releasing hormone Biochemistry Hypothalamic disease Diagnosis Differential Gonadotropin-Releasing Hormone Follicle-stimulating hormone Endocrinology Predictive Value of Tests Hypogonadotropic hypogonadism Internal medicine Infusion Procedure medicine Humans Fluorometry Retrospective Studies Puberty Delayed business.industry Hypogonadism Biochemistry (medical) Reproducibility of Results Luteinizing Hormone Reference Standards medicine.disease Follicle Stimulating Hormone Gonadotropin Differential diagnosis business Luteinizing hormone Gonadotropins hormones hormone substitutes and hormone antagonists |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 95:2811-2818 |
| ISSN: | 1945-7197 0021-972X |
| Popis: | Context: Differential diagnosis between hypogonadotropic hypogonadism (HH) and constitutional delay of puberty in boys is challenging. Most tests use an acute GnRH stimulus, allowing only the release of previously synthesized gonadotropins. A constant GnRH infusion, inducing de novo gonadotropin synthesis, may allow a better discrimination. Objective: We evaluated the diagnostic accuracy of basal and peak gonadotropins after GnRH infusion, measured by ultrasensitive assays, to confirm the diagnosis in boys with suspected HH. Design and Setting: We conducted a validation study following Standards for Reporting of Diagnostic Accuracy criteria at a tertiary public hospital. Patients and Methods: A GnRH iv infusion test was performed in 32 boys. LH and FSH were determined by immunofluorometric assay at 0–120 min. Diagnosis Ascertainment: The following diagnoses were ascertained: complete HH (n = 19; testes < 4 ml at 18 yr), partial HH (n = 6; testes enlargement remained arrested for ≥1 yr or did not reach 15 ml), and constitutional delay of puberty (n = 7; testes ≥ 15 ml at 18 yr). Main Outcome Measures: Sensitivity, specificity, positive and negative predictive values, and diagnostic efficiency were assessed. Results: Basal FSH less than 1.2 IU/liter confirmed HH with specificity of 1.00 (95% confidence interval = 0.59–1.00), rendering GnRH infusion unnecessary. In patients with basal FSH of at least 1.2 IU/liter, the coexistence of peak FSH less than 4.6 IU/liter and peak LH less than 5.8 IU/liter after GnRH infusion had high specificity (1.00; 95% confidence interval = 0.59–1.00) and diagnostic efficiency (76.9%) for HH. Conclusions: Basal FSH less than 1.2 IU/liter confirms HH, which precludes from further testing, reducing patient discomfort and healthcare system costs. In patients with basal FSH of at least 1.2 IU/liter, a GnRH infusion test has a high diagnostic efficiency. |
| Databáze: | OpenAIRE |
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