Decreased serum inhibin B/FSH ratio as a marker of Sertoli cell function in male survivors after chemotherapy in childhood and adolescence.
OBJECTIVE
Inhibin B produced by Sertoli cells may be an important marker of seminiferous tubule function in patients treated with chemotherapy (CT). The aim of this study was to evaluate the inhibin B/FSH ratio to detect male gonadal dysfunction in cancer survivors treated in childhood and adolescence.


METHODS
Twenty-one male patients (group A) treated with 6-10 courses of CT for Hodgkin's disease during childhood and adolescence were examined 3-11 years after the conclusion of treatment. Twenty healthy young men (18-23 years old) were used as controls (group B).


METHODS
Serum samples for the determination of inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), sex hormone-binding globulin (SHBG) and semen for analysis were collected.


RESULTS
The median testicular volume of patients of group A was lower than those of group B (p = 0.001) and a positive correlation was found between testicular size and sperm count (r = -0.5, p = 0.01). Semen analysis revealed azoospermia in 11 patients, severe oligospermia in four and normal sperm count in three. No significant difference was found in the median of T, LH, SHBG, inhibin B concentrations and T/LH ratio between the groups. Serum inhibin B was correlated with the serum FSH levels (r = -0.5, p = 0.02). Median FSH was significantly higher (p = 0.0001), and median inhibin B/FSH ratio was significantly lower in group A than in controls (p = 0.0002), but the inhibin B/FSH ratio was higher in the patients with normal sperm count than in those with oligospermia (p = 0.00004).


CONCLUSIONS
These results show that the cytotoxic effects of CT cause severe damage to the germinal epithelium with subtle effects on Sertoli cells. To assess Sertoli cell function in men with primary testicular damage after treatment with CT in childhood and adolescence, the inhibin B level needs to be interpreted in the context of the circulating FSH, especially when normal FSH levels are observed.
Division of Endocrinology and Hematology, National Cancer Institute, State University of Rio de Janeiro, Hospital Pedro Ernesto, Brazil. maliceb@attglobal.net
Maria Alice Neves
MA
Bordallo
Marília Martins
MM
Guimarães
Cencita Hosanha C N
CH
Pessoa
Maria Kadma
MK
Carriço
Trude
T
Dimetz
Helena Mussi
HM
Gazolla
Jane
J
Dobbin
Ilda Akemi Muramoto Alves
IA
Castilho
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006689:Hodgkin Disease / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007265:Inhibins / Q000097:blood*; D008297:Male; D009845:Oligospermia / Q000209:etiology; D009929:Organ Size / Q000187:drug effects; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D011344:Procarbazine / Q000009:adverse effects / Q000627:therapeutic use*; D012708:Sertoli Cells / Q000187:drug effects*; D013076:Sperm Count; D016019:Survival Analysis; D013737:Testis / Q000473:pathology / Q000503:physiopathology*; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use*
D015415:Biomarkers; C422364:inhibin B; D011344:Procarbazine; D007265:Inhibins; D014750:Vincristine; D003520:Cyclophosphamide; D005640:Follicle Stimulating Hormone; D011241:Prednisone