Single versus repeated dose human chorionic gonadotropin stimulation in the differential diagnosis of hypogonadotropic hypogonadism.
The responses of serum testosterone (T), 17 alpha-hydroxyprogesterone, and 17 beta-estradiol (E2) to four im injections of hCG (5000 IU/1.7 m2) given on days 0, 4, 7, and 10 were studied in 10 prepubertal and 10 pubertal boys with hypogonadotropic hypogonadism (groups O and P, respectively). Serum was obtained before each injection and on day 14. The results were compared with those of controls, 16 prepubertal boys with incomplete testicular descent and 6 pubertal boys with constitutional delay of puberty. Serum T levels increased significantly in groups O and P to 2.0 and 4.6 nmol/liter, respectively, after the first injection, then progressively to 5.8 and 11.2 nmol/liter. Basal T levels of group O did not differ from those of the controls, but were subnormal for group P (P less than 0.001). Stimulated T levels were subnormal in both groups (P less than 0.01 and P less than 0.001), but repeated doses increased the difference from the control value only in group P. A difference in E2 response between patients and controls appeared in puberty; only the pubertal control boys had substantial increases in E2 (P less than 0.001). Our results show that the optimal protocol for a diagnostic hCG test in prepubertal boys is a single dose of hCG, with determination of T levels 4 days later. In puberty, if the basal T levels are inconclusive, repeated doses of hCG should be given with determination of both T and E2. These findings also suggest that the full inhibitory effect of E2 on T synthesis results from a pubertal maturation process, possibly induced by endogenous gonadotropins, which cannot be induced by two weeks of hCG stimulation in prepubertal boys or those with hypogonadotropic hypogonadism.
D019326:17-alpha-Hydroxyprogesterone; D000293:Adolescent; D000328:Adult; D002648:Child; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D004958:Estradiol / Q000097:blood; D006065:Gonadotropins, Pituitary / Q000172:deficiency*; D006801:Humans; D006908:Hydroxyprogesterones / Q000097:blood; D007006:Hypogonadism / Q000097:blood / Q000209:etiology*; D008297:Male; D013739:Testosterone / Q000097:blood
D006063:Chorionic Gonadotropin; D006065:Gonadotropins, Pituitary; D006908:Hydroxyprogesterones; D013739:Testosterone; D004958:Estradiol; D019326:17-alpha-Hydroxyprogesterone