The differential diagnosis of constitutional delay of puberty and hypogonadotropic hypogonadism in boys

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Abstract

Abstract


Backgraund: The problem of differential diagnosis of constitutional delay of puberty/CPD and hypogonadotropic hypogonadism/HH in boys is discussed, as boys have similar genetic mechanisms and appearance.

Aims: to determine accuracy of the criteria for the differential diagnosis of CDP and HH.

Materials: The study included 56 boys14,4±0,7 years old with delayed puberty (G1P1-3/testicular volume <3сm3). We excluded patients with hypergonadotropic hypogonadism, treated with sex steroids or gonadotropins for 12 months, with endocrine/somatic diseases affecting puberty.

At the first visit, we evaluated anthropometric data, bone age, testicular volume, hormones and the results of the gonadotropin-releasing hormone test/GnRH agonist test and the human chorionic gonadotropin test/hCG test.

The HH was defined by a testicular volume <3сm3 after 2 years follow-up. The patients were divided into two groups: the first group with CDP and testicles ≥3cm3 (n=50) and the second group with HH and testicles <3cm3 (n=6).

Results: At the first visit in boys with CDP corrected target height was less (Me SDS -1,8 vs -0,4, р=0,02), bone age was less (Ме SDS -2,5 vs - 0,2 р=0,03), testicular volume was more (Ме 1,9 vs 0,5, p=0,0003), hormones were significantly higher, such as, LH (Ме 1,1 vs 0,1mIU/ml, p=0,0002), FSH (Ме 1,9 vs 0,2IU/l, p=0,00007), inhibinB (Ме 142,3 vs 31,3pg/ml, p=0,00009), maxLH (Ме 18,9 vs 0,6mIU/ml, p=0,00007), maxLH/FSH (Ме 2,3 vs 0,4, p=0,0002) on the GnRH agonist test and Δtestosterone (Ме 14,4 vs 1,1nmol/l, p=0,0001) on the hCG test than in boys with HH.

The LH ≥0,3 mIU/ml had 86% sensitivity, 100% specificity; maxLH/FSH≥1- 92% sensitivity, 100% specificity; Δtestosterone ≥2,7 nmol/l on the hCG test - 98% sensitivity, 100% specificity for differential diagnosis of CDP and HH in boys. However, maxLH ≥3,5 mIU/ml on the GnRH agonist test, FSH ≥0,5 IU/l, inhibinB ≥58 pg/ml had 100% sensitivity and specificity for diagnosis of CDP.

Conclusions: The inhibinB ≥58 pg/ml, LH ≥0,3 mIU/ml, FSH ≥0,5 IU/l or maxLH ≥3,5 mIU/ml, maxLH/FSH ≥1,0 on the GnRH agonist test, Δtestosterone ≥2,7 nmol/l on the hCG test have an excellent accuracy for the differential diagnosis of CDP and HH in prepubertal boys with delayed puberty.


About the authors

Oleg Yurevich Latyshev

Russian Medical Academy of Continuous Professional Education, Moscow

Email: elvkasatkina@yandex.ru
ORCID iD: 0000-0002-4690-8095
SPIN-code: 2899-6000

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD, PhD

Lubov Borisovna Brzhezinskaya

Russian Medical Academy of Continuous Professional Education, Moscow

Author for correspondence.
Email: lubov.b.osipova@yandex.ru
ORCID iD: 0000-0003-2136-6426
SPIN-code: 7941-4079

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD

Goar Feliksovna Okminyan

Russian Medical Academy of Continuous Professional Education, Moscow

Email: okminyangoar@yandex.ru
ORCID iD: 0000-0002-1578-5870
SPIN-code: 7969-7844

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD, PhD

Elena Valentinovna Kiseleva

Russian Medical Academy of Continuous Professional Education, Moscow

Email: elvkasatkina@yandex.ru
ORCID iD: 0000-0003-3704-3699
SPIN-code: 3577-0506

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD, PhD

Mikhail Ivanovich Pykov

Russian Medical Academy of Continuous Professional Education, Moscow

Email: pykov@yandex.ru
ORCID iD: 0000-0001-6115-8723
SPIN-code: 3807-6610

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD, PhD, professor

Elvira Petrovna Kasatkina

Russian Medical Academy of Continuous Professional Education, Moscow

Email: elvkasatkina@yandex.ru
ORCID iD: 0000-0003-4108-6878
SPIN-code: 9185-1805

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD, PhD, professor

Lubov Nikolaevna Samsonova

Russian Medical Academy of Continuous Professional Education, Moscow

Email: elvkasatkina@yandex.ru
ORCID iD: 0000-0003-0208-4116
SPIN-code: 7117-0960

Russian Federation, 125993, Russia, Moscow, Barrikadnaya str., 2/1, p. 1

MD, PhD, professor

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Copyright (c) Latyshev O.Y., Brzhezinskaya L.B., Okminyan G.F., Kiseleva E.V., Pykov M.I., Kasatkina E.P., Samsonova L.N.

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