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HCG stimulation test in children with abnormal sexual development
Insights
The human chorionic gonadotropin (HCG) test effectively assesses testosterone levels in children with disorders of sexual development. A 3-day HCG stimulation test is as reliable as a 5-day test for evaluating testosterone response.
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.
Abstract:
Plasma testosterone was estimated by radioimmunoassay in 60 children with disorders of sexual development before and after stimulation with human chorionic gonadotrophin (HCG). In 21 children the testosterone levels after 3 and 5 daily injections of 1000 units HCG were compared and good correlation was found between the paired results (r =0-93), suggesting that the 5-day HCG test has no advantage over the 3-day test. In 7 boys with apparently normal genital development the increments in plasma testosterone ranged from 2-0 to 8-5 nmol/1 after 3 injections of HCG. 10 boys with anorchia showed little response to HCG stimulation, but in patients with other disorders, such as micropenis (10), cryptorchidism (8), hermaphroditism (3), male pseudohermaphroditism (13), hypospadias (3), and sex chromosome anomalies (6), there was considerable variation in the plasma testosterone level after HCG. In 2 boys with suspected anorchia the results suggested that testes were present and this was confirmed at operation.
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