Diagnostic utility of testosterone priming prior to dynamic tests to differentiate constitutional delay in puberty from isolated hypogonadotropic hypogonadism

Abstract

Inhibin B levels or 4 h LH after Triptorelin stimulation are the best discriminatory tests to differentiate CDP from IHH, when performed after withdrawal of 'testosterone priming'.

Serum inhibin B for differentiating between congenital hypogonadotropic hypogonadism and constitutional delay of growth and puberty: a systematic review and meta-analysis

“… Coutant 2010 [ 28 ] a/b/c: The study was classified into three subset studies according to the subgroups of different testicular volume Sukumar 2017 [ 30 ] a/b: The study was divided into two subset studies based on receiving a priming testosterone treatment or not CHH congenital hypogonadotropic hypogonadism, CDGP constitutional delay of growth and puberty, TV testicular volume, OBI Oxford Bio-Innovation reagents, DSL Diagnostic Systems Laboratories, ELISA enzyme linked immunosorbent assay, Gen II ELISA second generation ELISA a Prior sex hormone treatment history was not mentioned b 100 mg Testosterone intramuscular injection monthly for 3 months c Assay method standardized to Gen II ELISA: Gen II = 1.03OBI − 6.77 pg/ml and Gen II = 1.57DSL + 11.29 pg/ml [ 27 ] …”

“…Sukumar 2017 [ 30 ] a/b: The study was divided into two subset studies based on receiving a priming testosterone treatment or not…”

“…Thirdly, the cut-off value is affected by different sampling conditions; a naïve assessment without any intervention treatment, or after testosterone treatment. Sukumar et al [ 30 ] demonstrated that an INHB level >94.7 pg/ml was discriminatory for diagnosing CDGP after withdrawal of testosterone priming, with a sensitivity of 100% and specificity of 100%. On the other hand, basal INHB levels >80 ng/ml prior to testosterone therapy had a sensitivity of 80% and specificity of 96%.…”

ENDO-ERN expert opinion on the differential diagnosis of pubertal delay

“…In fact, recent studies have investigated the diagnostic utility of testosterone priming not only to treat CDGP, but also to differentiate this condition from CHH. This is based on the idea that short-term testosterone treatment (injections, oral, or transdermal) in boys with CDGP would trigger HPG activation, with enlargement of the testis and increase in endogenous production of testosterone as a result [ 41 ]. One of the advantages of this interventional approach is a shorter delay in the diagnosis and consequent treatment, since the “diagnostic test” is also a treatment, with both psychological and physical benefits on growth rate and virilization.…”

“…As a result, more expensive tests could be reserved for those who do not start puberty even after testosterone priming (i.e. CHH patients) [ 41 ]. On the other hand, it has to be considered that it is currently not known if testosterone pretreatment prior to gonadotropin therapy could affect the future fertility potential of male CHH patients [ 43 – 45 ].…”