Evaluation of the buserelin stimulation test in diagnosing gonadotropin deficiency in males with delayed puberty.
OBJECTIVE
To assess the efficacy of the gonadotropin-releasing hormone (GnRH) agonist buserelin in a stimulated gonadotropin test for the investigation of delayed puberty in males.


METHODS
Prepubertal males (n = 31; age range, 10.3 to 17.2 years) were studied; buserelin (100 microg) was administered subcutaneously, with blood sampling at 0 and 4 hours for serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH). At follow-up (mean, 4.2 years), 8/31 (26%) failed to progress into puberty, constituting hypogonadotropic hypogonadism (HH), but 23/31 (74%) had testicular enlargement (> or =8 mL) consistent with a normal hypothalamic-pituitary-gonadal (HPG) axis.


RESULTS
Stimulated serum LH response to buserelin was lower in males with HH (mean +/- standard error under the mean for HH, 1.4 +/- 0.5 U/L, compared with a normal HPG axis of 17.4 +/- 2.0 U/L; P < .0001). Stimulated serum FSH response was nondiscriminatory (HH, 7.7 +/- 2.2 U/L; normal HPG axis, 11.5 +/- 1.6 U/L; P = .27). All males with HH had a stimulated serum LH level <5 U/L, whereas only 1/23 with a normal HPG axis had a stimulated serum LH below this level. Using this value as the criterion for diagnosing HH, the buserelin stimulation test yielded a sensitivity of 100%, specificity of 96%, and positive predictive value of 89%.


CONCLUSIONS
The buserelin stimulation test is a highly specific and sensitive GnRH agonist test for the investigation of males with delayed puberty.
Wilson
Dyanne A
DA
Liggins Institute and National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand.
Hofman
P L
PL
Miles
H L
HL
Unwin
K E
KE
McGrail
C E
CE
Cutfield
Wayne S
WS
D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D002064:Buserelin / Q000008:administration & dosage*; D015331:Cohort Studies; D003940:Diagnostic Techniques, Endocrine / Q000592:standards; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000378:metabolism; D007987:Gonadotropin-Releasing Hormone / Q000097:blood; D006062:Gonadotropins / Q000097:blood / Q000172:deficiency*; D013006:Growth Hormone / Q000097:blood / Q000627:therapeutic use; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D009520:New Zealand; D011237:Predictive Value of Tests; D011628:Puberty, Delayed / Q000097:blood* / Q000188:drug therapy; D013739:Testosterone / Q000627:therapeutic use; D016896:Treatment Outcome
D006062:Gonadotropins; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013006:Growth Hormone; D002064:Buserelin