Gonadal response after a single-dose stimulation test with recombinant human chorionic gonadotropin (rhCG) in patients with isolated prepubertal cryptorchidism

Abstract

BackgroundThe evaluation of prepubertal gonadal Leydig cells secretion requires gonadotropin stimulation. Urinary hCG (human chorionic gonadotropin) is currently unavailable in many countries, however, recombinant hCG (rhCG) can be used. Our aim was to evaluate rhCG-stimulated testicular hormones in a group of patients with cryptorchidism.MethodsWe evaluated 31 prepubertal boys (age range, 0.75–9.0 years) presenting with unilateral (n = 24) or bilateral (n = 7) cryptorchidism. Patients with other genital abnormalities, previous use of hCG or testosterone or previous surgeries were excluded. Blood samples were obtained at baseline and 7 days after a single subcutaneous dose of rhCG (Ovidrel® 250 mcg) to measure the testosterone, DHT (dihydrotestosterone), AMH (anti-Mullerian hormone), and inhibin B levels.ResultsrhCG stimulation significantly increased testosterone levels from 10 ng/dl to 247.8 ± 135.8 ng/dl, increased DHT levels from 4.6 ± 0.8 to 32.3 ± 18.0 ng/dl, and increased the T/DHT ratio from 2.2 ± 0.4 to 8.0 ± 3.5. There was also a significant increase in inhibin B (from 105.8 ± 65.2 to 132.4 ± 56.1 pg/ml; p < 0.05) and AMH levels (from 109.4 ± 52.6 to 152.9 ± 65.2 ng/ml; p < 0.01) after the rhCG stimulation.ConclusionsIn this cohort, hormonal responses can be elicited after the rhCG stimulation test, suggesting that rhCG is a promising stimulation test to replace the urinary hCG test during the evaluation of gonadal Leydig cells function. The clinical applicability and adequate performance of rhCG testing must be investigated in future studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12610-016-0039-2) contains supplementary material, which is available to authorized users.

Human Chorionic Gonadotropin Test: Old Uncertainties, New Perspectives, and Value in 46,XY Disorders of Sex Development

“…These data agree with other studies, while others reported lower peak values mainly using single hCG for stimulation [Saenger et al, 1978;Forest, 1979;Balducci et al, 1986;Savage, 1992;De Martino et al, 2003;Oliveira et al, 2016] ( Table 2 ). A stimulated increase <1.1-1.5 ng/mL is considered as a subnormal response [Forest, 1979;Balducci et al, 1986;Savage, 1992;Mendonca et al, 2010;Ishii et al, 2015].…”

“…It is more expensive, but the rhCG shows remarkable batch-to-batch consistency, high specific activity, lack of potential biological risk, and high purity, being free from contaminant proteins [Zegers-Hochschild et al, 1995]. Finally, rhCG permits the test in countries in which uhCG is unavailable [Oliveira et al, 2016].…”

“…Schemes of the uhCG test were summarized by Savage [1992] and De Martino et al [2003] according to clinical experiences and several studies. The rhCG scheme was proposed by Oliveira et al [2016]. At least 3 test protocols using intramuscular (i.m.)…”

Human Chorionic Gonadotrophin Treatment for Sexual Immaturity in a Male Ibex (Capra Pyrenaica)

“…6 Males that produce insufficient testosterone suffer from reduced fertility, but in some mammalian species, this can be improved with hormone therapy. 7,8 For instance, hCG can be used to increase follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, which then stimulates the Leydig cells to secrete testosterone. 8 After injecting hCG into bulls, plasma LH has been reported to increase after a few minutes, stimulating testosterone production.…”

“…7,8 For instance, hCG can be used to increase follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels, which then stimulates the Leydig cells to secrete testosterone. 8 After injecting hCG into bulls, plasma LH has been reported to increase after a few minutes, stimulating testosterone production. 9 The present results suggests that in ibexes, the administration of hCG can induce a temporary increase in plasma testosterone, which can help the testes relocate to the scrotum.…”