Objective: To examine the clinical and hormonal predictors of start pubertal in boys with constitutional delay of puberty (CDP).
Materials and methods: The study included 42 boys with CDP (Tanner1, max LH>10 IU/l of GnRH stimulation test). At the first visit in 14.5±0.7 years we evaluated anthropometric indicators, bone age, testicular volume and hormonal status (TSH, freeT4, prolactin, IGF-1, insulin, DHEAS, cortisol, LH, FSH, estradiol, testosterone, SHBG, free testosterone index, inhibin b, antimullerian hormone). At the second visit after 1 years, we evaluated stage of sexual development on the Tanner scale. The patients were divided into two groups: Tanner 1 (n=9), Tanner 2 (n=33).
Results: At the first visit all patients had the same age (14.6±0.9 vs 14.5±0.7 years old, P=0.8), height (Me Ht-SDS −2.2 vs −1.7, P=0.1), weight (Me SDS-BMI-0.03 vs 0.07, P=0.3), bone age (Me SDS −3 vs −2.5, P=0.3), TSH (Me 2.2 vs 2 mU/l, P=0.9), freeT4 (Me 12.7 vs 13.1 pmol/l, P=0.5), prolactin (Me 201 vs 139.5 mU/l, P=0.1), IGF-1 (Me 187.6 vs 202.4 ng/ml, P=0.8), insulin (Me 4 vs 5.3 mcU/ml, P=0.4), DHEAS (Me 3.2 vs 3.7 nmol/l, P=0.3), cortisol (Me 379 vs 376.5 nmol/l, P=0.8), LH (Me 1.1 vs 1.3 mU/ml, P=0.3), FSH (Me 2.02 vs 2.6 U/l, P=0.7), estradiol (Me 73 vs 67 pmol/l, P=0.4), SHBG (Me 96.6 vs 81.2 nmol/l, P=0.7), free testosterone index (Me 1.0 vs 1.8%, P=0.1). However, in boys with Tanner 2 at the first visit testicular volumes was much more (Me 2.3 vs 1.4 cm3, P=0.001), testosterone (Me 1.4 vs 0.8 nmol/l, P=0.03) inhibinB (Me 144.3 vs 120.9, P=0.03 pg/ml) were significantly higher and antimullerian hormone (Me 22.8 vs 57.3 ng/ml, P=0.03) was significantly lower than in boys with CDP and Tanner1. The most informative predictors of start pubertal in boys with CDP during the first year were: testicular volume>1.7 cm3 (sensitivity 70.4%, specificity 100%), inhibinB>143 pg/ml (sensitivity 57%, specificity 100%), testosterone>0.9 nmol/l (sensitivity 81%, specificity 71.4%). But the combination of inhibinB>143 pg/ ml with testicular volume>1.7 cm3 increased diagnostic value (sensitivity 85%, specificity 100%).
Conclusion: The combination of inhibinB>143 pg/ml with testicular volume>1.7 cm3 had the best sensitivity of 85% and specificity of 100% in predicting the start puberty during the first year in boys with constitutional delay of puberty.
27 Sep 2018 - 29 Sep 2018