Role of Inhibin B, AMH, GnRHa Test and HCG Stimulation Test to Distinguish Isolated Hypogonadotropic Hypogonadism (IHH) from Constitutional Delay in Growth and Puberty (CDGP).
Sahoo. Bijay K BK; Kumar. Padala Ravi PR; Pattanaik. Sudhi Ranjan SR; Dash. Deepak Kumar DK; Patro. Debasish D; Telagareddy. Radhakrishna R
Key Findings
- 4‑hour post‑triptorelin LH had 100% sensitivity and specificity for detecting IHH
- Basal inhibin B showed good but not perfect accuracy, especially in boys
- Baseline LH, FSH and AMH were poor at distinguishing IHH from normal delayed puberty
Practical Outcomes
- For most biohackers this isn’t a directly usable protocol, as it’s a diagnostic test for a pediatric condition rather than a performance or longevity intervention. The main takeaway is that triptorelin can be a very accurate tool for doctors to diagnose IHH, but it doesn’t suggest a new supplement or dosing strategy for healthy adults.
Summary
The study looked at how well a hormone‑boosting drug called triptorelin can help doctors tell the difference between two reasons why teens might have delayed puberty. It found that measuring LH levels four hours after giving triptorelin perfectly identified a rare condition (IHH), while a blood protein called inhibin B was also useful. Other hormone tests weren’t as helpful.
Abstract
This study aimed to distinguish isolated hypogonadotropic hypogonadism (IHH) from constitutional delay in growth and puberty (CDGP) by various hormonal tests in both sexes. Boys with testicular volume (TV) <4 ml (14-18 years) and girls with breast B<sub>1</sub> stage (13-18 years) were enrolled in this study. A detailed history, clinical examination and hormonal analysis including basal luteinising hormone (LH), follicle-stimulating hormone (FSH), inhibin B, anti-Mullerian hormone (AMH), testosterone (boys), oestradiol (girls), triptorelin stimulation test and 3-day human chorionic gonadotropin (HCG) stimulation test (boys) were performed. All patients were followed for 1.5 years or till 18 years of age. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-offs with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for various hormones to distinguish IHH from CDGP. Of 34 children (male: 22 and female: 12), CDGP and IHH were diagnosed in 21 and 13 children, respectively. 4 hours post-triptorelin LH had the highest sensitivity (100%) and specificity (100%) for identifying IHH in both sexes. Basal inhibin B had good sensitivity (male: 85.7% and female: 83.8%) and specificity (male: 93.3% and female: 100%) for diagnosing IHH. 24 hours post-triptorelin testosterone (<34.5 ng/dl), day 4 post-HCG testosterone (<99.7 ng/dl) and 24 hours post-triptorelin oestradiol (<31.63 pg/ml) had reasonable sensitivity and specificity for identifying IHH. Basal LH, FSH and AMH were poor discriminators for IHH in both sexes. The best indicator was post-triptorelin 4-hour LH followed by inhibin B, which had a reasonable diagnostic utility to distinguish IHH from CDGP in both boys and girls.
Study Information
pubmed
2023
2023-11-24T00:00:00.000Z
10.4103/ijem.ijem_146_23
23