title: Accuracy of Endocrine Tests for Detecting Hypogonadotropic Hypogonadism in Girls.
abstract: OBJECTIVE
  To assess the accuracy of inhibin B and the gonadotropin releasing hormone agonist test for the diagnosis of hypogonadotropic hypogonadism (HH).
  
  
  METHODS
  We performed a retrospective analysis of data collected 2009-2014 using a strict clinical protocol. All prepubertal nonunderweight girls, aged 13-17.5 years with Tanner breast stage B1/B2 and low estradiol levels, were tested and re-examined at 6-month intervals (n = 21). Constitutional delay of growth and puberty was defined by spontaneous menarche; HH was identified by association with specific causes of HH or no spontaneous progress of puberty during follow-up. Inhibin B was measured using enzyme-linked immunosorbent assay, and follicle-stimulating hormone and luteinizing hormone (basal and stimulated by triptorelin) were measured using a chemiluminescence immunoassay.
  
  
  RESULTS
  The cohort comprised 12 girls with constitutional delay of growth and puberty and 9 girls with HH. The causes of HH included hypopituitarism (n = 3), Prader-Willi syndrome, chromosomal aberration, intellectual disability syndrome with ataxia, and idiopathic causes (n = 2). Each measurement, basal inhibin B <20 pg/mL or stimulated follicle-stimulating hormone (4 hours) <11 IU/L, demonstrated a sensitivity and a specificity of 100% for the detection of HH. Stimulated luteinizing hormone (4 hours) <9 IU/L showed 100% sensitivity but only 83% specificity.
  
  
  CONCLUSIONS
  Inhibin B seems to be the ideal measurement for detecting HH in girls. The gonadotropin releasing hormone agonist test is an alternative diagnostic modality, although this approach is more invasive and laborious.
authors.affiliation: Department of Pediatric Endocrinology, University Children's Hospital, Tuebingen, Germany. Electronic address: gerhard.binder@med.uni-tuebingen.de.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Binder
authors.affiliation: Department of Pediatric Endocrinology, University Children's Hospital, Tuebingen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Schweizer
authors.affiliation: Department of Pediatric Endocrinology, University Children's Hospital, Tuebingen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Haber
authors.affiliation: Department of Clinical Epidemiology and Applied Biometry, University of Tuebingen, Tuebingen, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Blumenstock
authors.affiliation: Department of Pediatric Endocrinology, University Children's Hospital, Tuebingen, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Braun
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D007006:Hypogonadism / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007265:Inhibins / Q000097:blood*; D008163:Luminescent Measurements; D007986:Luteinizing Hormone / Q000097:blood*; D011628:Puberty, Delayed / Q000175:diagnosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone