Background: Because of episodic secretion of gonadotropins (LH, and FSH), basal levels of these hormones can not objectively be assessed to differentiate delayed puberty in males.
Objective and hypotheses: To assess the efficacy of the GnRH agonist (as spray) in diagnosing of delayed puberty in males.
Method: Prepubertal males (n=18; age range 13.318.5 years) were studied; buserelin 0.15 (spray) μg was administered intranasally, with blood sampling at 0; 1 and 4 h for serum LH and FSH. In 7/19 males had testicular volume (more than 8 ml) consistent with a normal hypothalamicpituitarygonadal axis. In 12/19 males testicular volume were <4 ml suggesting hypogonadotropic hypogonadism (HH) or constitutional delay of growth and puberty (CDGP).
Results: Stimulated serum LH response to buserelin was lower in males with HH (mean±under the mean for HH, at 1 h 3.6±1.2 U/l; 4 h 3.0±1.8 U/l compared with a normal HPG axis 9.4±1.8 U/l at 1 h; 4 h 15.9±0.9 U/l; P<0.0001). Stimulated serum FSH response was 10.0±2.2 U/l at 1 h and 16.1±2.3 U/l. at 4 h in males with normal HPG axis and 4.4±0.8 at 1 h and 3.9±0.6 at 4 h in males with HH. There are no significant difference in basal levels of LH, FSH in both groups (2.6±0.22, /3.6±0.9 for healthy males compared with HH 1.3±0.1/3.2±0.33).
Conclusion: The buserelin (in a spray form) stimulation test may be helpfull in patients with delayed puberty to assess HPG axis.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology