Serum Anti-Müllerian Hormone in the Prediction of Response to hCG Stimulation in Children With DSD

Abstract Introduction The relationship between serum anti-Müllerian hormone (AMH) and the testosterone response to human chorionic gonadotropin (hCG) stimulation test is unclear. Methods Children who had hCG stimulation tests in one tertiary centre from 2001 to 2018 were included (n = 138). Serum testosterone was measured before (day 1 [D1]) and after 3 days (D4) of hCG stimulation. Sixty-one of these children also had prolonged hCG stimulation for 2 more weeks and serum testosterone measured after 21 days (D22). All children had a serum AMH measured on D1. Results Of the 138 children, D4 testosterone was normal in 104 (75%). AMH was low in 24/138 (17%) children, and 16 (67%) of these had a low D4 testosterone. Median AMH in those who had a normal vs low D4 testosterone was 850 pmol/L (24, 2280) and 54 pmol/L (0.4, 1664), respectively (P < 0.0001). An AMH > 5th centile was associated with a low D4 testosterone in 18/118 (13%; P < 0.0001). Of the 61 children who had prolonged hCG stimulation, D22 testosterone was normal in 39 (64%). AMH was low in 10/61(16%) children and 9 (90%) of these had a low D22 testosterone. Median AMH in children who responded and did not respond by D22 was 639 pmol/L (107, 2280) and 261 pmol/L (15, 1034) (P < 0.0001). Conclusion A normal AMH may provide valuable information on overall testicular function. However, a low AMH does not necessarily predict a suboptimal testosterone response to hCG stimulation.

Download Full-text

Evaluation of human chorionic gonadotropin stimulation tests in prepubertal and early pubertal boys

European Journal of Pediatrics ◽

10.1007/bf01957499 ◽

1995 ◽

Vol 154 (11) ◽

pp. 890-892 ◽

Cited By ~ 5

Author(s):

A. Kauschansky ◽

M. Frydman ◽

M. Nussinovitch ◽

I. Varsano

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Gonadotropin Stimulation ◽

Stimulation Tests ◽

Pubertal Boys

Download Full-text

Human Chorionic Gonadotropin and Testicular Function: Stimulation of Testosterone, Testosterone Precursors, and Sperm Production Despite High Estradiol Levels*

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem-56-4-720 ◽

1983 ◽

Vol 56 (4) ◽

pp. 720-728 ◽

Cited By ~ 36

Author(s):

Alvin M. Matsumoto ◽

C. Alvin Paulsen ◽

Bill R. Hopper ◽

Robert W. Rebar ◽

William J. Bremner

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Testicular Function ◽

Sperm Production ◽

Estradiol Levels ◽

Stimulation Of

Download Full-text

The human chorionic gonadotropin test is more powerful than the gonadotropin-releasing hormone agonist test to discriminate male isolated hypogonadotropic hypogonadism from constitutional delayed puberty

Acta Endocrinologica ◽

10.1530/eje.0.1490023 ◽

2003 ◽

pp. 23-29 ◽

Cited By ~ 33

Author(s):

V Degros ◽

C Cortet-Rudelli ◽

B Soudan ◽

D Dewailly

Keyword(s):

Chorionic Gonadotropin ◽

Human Chorionic Gonadotropin ◽

Testosterone Level ◽

Pubertal Development ◽

Hypogonadotropic Hypogonadism ◽

Serum Testosterone ◽

Serum Testosterone Level ◽

Delayed Puberty ◽

Hcg Test

OBJECTIVE: The effectiveness of biological investigations aiming at discriminating isolated hypogonadotropic hypogonadism (IHH) from constitutional delayed puberty (CDP) in male patients is still controversial. We revisited the diagnostic power of the basal serum testosterone level, the Triptorelin test and the human chorionic gonadotropin (hCG) test in a cohort of 33 boys with delayed puberty. DESIGN: Boys were aged 14.2 to 26.2 Years at referral. A 5-Year-long clinical follow-up after the initial study allowed confirmation of the diagnosis. At the end of the follow-up period, IHH was found in 13 patients while the other 20 had normal spontaneous pubertal development (CDP). RESULTS: At referral, a basal morning testosterone level >1.7 nmol/l was observed in 55% of patients with CDP exclusively (predictive positive value (PPV)=100%; predictive negative value (PNV)=59%). For CDP, the PPV of the LH peak 3 h after Triptorelin was 100% by setting the upper threshold at 14 IU/l and the PNV was 72%. However, no lower threshold could discriminate IHH from CDP in the remaining patients with an LH peak 3 h after Triptorelin <14 IU/l. In CDP patients, the PPV of the serum testosterone increment after hCG stimulation (deltaT/hCG) was 100% for values >9 nmol/l (PNV=72%). In IHH patients, the PPV of deltaT/hCG was 100% for values <3 nmol/l (PNV=82%). Only 29% of the studied population had a deltaT/hCG between these lower and upper thresholds and therefore could not have been classified initially. CONCLUSIONS: (i) Dynamic testing for the diagnosis of delayed puberty is useful only when the basal testosterone level is lower than 1.7 nmol/l; (ii) in that case, the hCG test has better discriminating power than the Triptorelin test and appears as the best cost-effective investigation. It prevents useless and expensive investigations in about one-half of CDP patients with a basal morning testosterone level lower than 1.7 nmol/l.

Download Full-text