HCG stimulation test in children with abnormal sexual development

Area of Science:

• Pediatric Endocrinology
• Reproductive Medicine
• Clinical Chemistry

Background:

• Disorders of sexual development (DSD) require accurate assessment of testicular function.
• Plasma testosterone levels are a key indicator of Leydig cell function.
• Human chorionic gonadotropin (HCG) stimulation is a standard method to assess the testosterone production capacity of testes.

Purpose of the Study:

• To evaluate the efficacy of HCG stimulation for assessing plasma testosterone levels in children with DSD.
• To compare the diagnostic utility of a 3-day versus a 5-day HCG stimulation protocol.
• To analyze testosterone response patterns in various DSD conditions.

Main Methods:

• Radioimmunoassay was used to measure plasma testosterone levels.
• Sixty children with DSD underwent HCG stimulation testing.
• A subset of 21 children had their testosterone levels compared after 3 and 5 days of HCG injections.

Main Results:

• A strong correlation (r=0.93) was observed between 3-day and 5-day HCG tests, indicating no significant advantage of the longer protocol.
• Boys with normal genital development showed a testosterone increment of 2.0-8.5 nmol/L after 3 HCG injections.
• Children with anorchia exhibited a minimal response, while those with other DSDs (micropenis, cryptorchidism, hermaphroditism, etc.) displayed variable testosterone responses to HCG.

Conclusions:

• The 3-day HCG stimulation test is a reliable and efficient method for evaluating testosterone production in children with DSD.
• HCG testing can aid in diagnosing conditions like anorchia and assessing testicular function in diverse DSD presentations.
• This study supports the use of shorter HCG protocols for testosterone assessment in pediatric DSD evaluations.