Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2011, Vol. 33 ›› Issue (5): 566-570.doi: 10.3881/j.issn.1000-503X.2011.05.017

• Original Articles • Previous Articles     Next Articles

Clinical Values of Single or Repeated Triptorelin Stimulating Test in the Differential Diagnosis between Idiopathic Hypogonadotropic Hypogonadism and Constitutional Delayed Puberty

MAO Jiang-feng, WU Xue-yan, LU Shuang-yu, NIE Min   

  1. Department of Endocrinology, Key Laboratory of Ministry of Health, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
  • Received:2011-02-21 Revised:2011-10-28 Online:2011-10-28 Published:2011-10-28
  • Contact: WU Xue-yan

Abstract: Objective To investigate the values of single or repeated luteinizing hormone (LH) releasing hormone analogue (triptorelin) stimulating test in the differential diagnosis between idiopathic hypogonadotropic hypogonadism (IHH) and constitutional delayed puberty(CDP). Methods Male patients (n=133) without puberty onset after the age of 14 were recruited for triptorelin stimulating test and were followed up for 24 - 48 months until the diagnosis were confirmed: 86 were IHH and the other 47 were CDP. Repeated triptorelin stimulating tests were conducted in 9 IHH patients and 13 CDP patients one year after the first stimulating tests with an attempt to evaluate the dynamic change of hypothalamus-pituitary-testis axis function. The relationship between the final diagnosis and the peak LH value (LHmax), and the changes of repeated LHmax were investigated. Results In the single triptorelin stimulating test, LHmax was (1.9±1.2)U/L in IHH group, which was significantly lower than that in CDP group [(13.7±8.3)U/L] (P<0.01); 75 IHH patients (87.2%) had a LHmax lower than 4 U/L, while only 2 CDP patients (4.3%) had a LHmax lower than 4 U/L. When LHmax<4U/L was used as a criteria for the diagnosis of IHH, the single triptorelin stimulating test had a sensitivity of 87.2%, a specificity of 95.7%, and a positive predictive value of 97.4%. The repeated triptorelin stimulating tests performed one year later showed that the LHmax in the 9 IHH patients increased from (4.7±2.5) U/L to (5.1±3.3)U/L (P=0.78), while that in the 13 CDP patients increased from (10.7±3.3) U/L to (24.5±5.7) U/L (P0.05). Conclusions A single triptorelin stimulating test is highly effective in differentiating IHH from CDP. For some patients without definitive diagnosis, a repeated triptorelin stimulating test performed one year later may provide more valuable information on the dynamic change of the hypothalamus-pituitary-testis axis function.

Key words: triptorelin stimulating test, idiopathic hypogonadotropic hypogonadism, constitutional delayed puberty, hypothala-mus-pituitary-gonad axis function

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