ESPE2023 Rapid Free Communications Pituitary, neuroendocrinology and puberty 1 (6 abstracts)
1Hospital Universitari Vall d'Hebrón, Barcelona, Spain. 2Hospital de Palamós, Palamós, Spain
Objective: To describe efficacy and security of treatment protocol with gonadotropins in adolescents with hypogonadotropic hypogonadism (HH).
Methods: Prospective study of patients with HH who received hGH and rhFSH in puberty. HH diagnosed during first months of life or in adolescence (testicular volume<4cc in >16 year-old with FSH<1.2UI/L, testosterone<40ng/dL and GnRH-test with LH-peak<6UI/L)
Treatment protocol: First phase: rFSH 75IU/twice-weekly during 2-4 months. Second phase*: rFSH 75-150IU/twice-weekly + hCG 250IU/twice-weekly during 6-12 months. Third phase*: rFSH 150IU/thrice-weekly + hCG at increasing doses (500IU/thrice-weekly during 6-12 months, 1000IU/thrice-weekly during 6 months, 1500IU/thrice-weekly during 6 months, adult doses 1500-2500IU). *hCG and rhFSH doses adjusted according to testosterone and inhibin-B levels respectively.
Efficacy:• Testicular volume(TV): mean of both testicles(mL) • Testosterone and inhibin-B levels. • Spermiogarm in phase 3 (OMS2010). •Adult height (AH) Z-score and Δadult-height-mean parental height (MillennialsGrowth2018).
Security: Blood count, biochemistry and hormonal analysis performed periodically. BMD at onset and end.
Results: 6 patients described in Table 1. Patients 1 and 4 began pubertal induction with intramuscular testosterone and afterwards, received gonadotropin treatment. The rest, started and completed pubertal induction with gonadotropins presenting normal pubertal development.
Patient | Etiology (age at diagnosis) | Age at onset(years) | Basal TV (mL) mean* | Basal InhibinB (pg/mL) | Basal testosterone (ng/dL) | Duration (years) | Final TV (mL) mean* | Final InhibinB (pg/mL) | AH (cm) | Z-score ΔH- mean parental H | Spermiogram Nº performance, count and mobility |
1 | Acquired Idiopathic intracranial hypertension(15 years) | 16.6 | 4.5 | 23.8 | <10 | 3.6 | 20 | 188 | 172 | +0.12 | 3rd: 100x10E6/mL, 24% progressively mobile, 2% normal |
2 | Congenital panhypopituitarism (Neonatal) | 12.7 | 2 (inguinal) | 25 | <7 | 4.4 | 7 (scrotal) | 105 | 167 | 0.6 | 1st: Azoospermia |
3 | Kallmann (Neonatal) | 14.7 | 2 | 20 | 18 | 3.4 | 7 | 112 | 146 | 0.4 | 1st, 2nd: Azoospermia |
4 | Acquired Craneofaringioma (14 years) | 17.3 | 3 | 58 | <10 | 0.8 | 8 | 143 | 185 | 0 | Without result |
5 | Congenital panhypopituitarism (Neonatal) | 14.9 | 2 | 31.2 | <7 | 4 | 7 | 77 | 175 | 1.4 | 1st: azoospermia 2nd: 0.34x10E6/mL, 83% no-mobility |
6 | Kallmann (Neonatal) | 12.1 | 1.5 (inguinal) | 20.7 | 39 | 5.5 | 9 | 104 | 161.6 | -0.4 | 1º: 1.06 X10E6/mL 37% mobile, 14% progressively mobile 63% immobile |
*Prader-orchidometer |
Conclusions:• Gonadotropin treatment is secure for pubertal induction. • Testicular volume was increased, although limitedly in severe forms. • Spermatogenic response was scant/null in congenital forms with cryptorchidism (except in one patient). • Clinical parameters (onset and severity of gonadotropin deficiency) may predict treatment response. • Low sample-number limits this study; further research is needed.