TEK DOZ VE ÇOĞUL DOZ hCG UYARI TESTLERİNİN KARŞILAŞTIRILMASI

Abstract

Amaç: hCG uyarı testi, testis steroidogenezini değerlendirmek için yaygın olarak kullanılmaktadır. Bu test hipogonadizm, 46,XY cinsel gelişim bozukluğu veya mikropenisi olan hastalarda Leydig hücre fonksiyonunu, testise bağlı enzim kusurlarını değerlendirmektedir. Bu çalışmada tek doz 5000 IU/m2 ve 3 gün 1500 IU/ m2 hCG testlerine testosteron yanıtlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya mikropenis, hipospadyas veya inmemiş testisi (Grup 1) olan 18 hasta ile moleküler olarak tanılı androjen reseptör kusuru (%56) ve 5α redüktaz eksikliği (%44) olan 18 hasta (Grup 2) dahil edildi. Hastaların median (çeyrekler aralığı) yaşı Grup 1 için 1,4 (0,8-4,2) yıl, Grup 2 için 0.7 (0,3-0,8) yıl idi. Bazal testosteron düzeyi ölçüldükten sonra ilk gruba tek doz 5000 IU/m2 hCG uygulanarak testosteron düzeyleri 1. ve 4. gün ölçüldü. İkinci gruba ise 3 gün 1500 IU/m2 hCG uygulanarak testosteron düzeyleri 4. gün ölçüldü. Bulgular: Grup 1 ve Grup 2 arasında boy, kilo, vücut kitle indeksi SDS ve bazal testosteron seviyeleri arasında anlamlı bir fark yoktu. hCG uyarısı sonrasında testosteron yanıtlarında da anlamlı fark saptanmadı. Testosteron seviyeleri bazale göre kıyaslandığında 4. günde Grup 1’de 40 kat ve Grup 2’de 40.1 kat artış gösterdi. Grup 1 hastalarında testosteron yanıtı 1. gün ile karşılaştırıldığında 4. günde anlamlı olarak daha yüksek idi (p=0,001). Sonuç: Tek doz ve çoğul doz ile gerçekleştirilen hCG uyarı testlerinin sonucunda testosteron yanıtları benzer çıkmış olup bu sonuç her iki testin de uygulanabilir olduğunu göstermiştir. 5000 IU/m2 testi daha az enjeksiyon gerektirdiği ve uygulaması kolay olduğu için Leydig hücre fonksiyonunu değerlendirmede bu test tercih edilebilir. Yeterli testosteron yanıtı için tek doz 5000 IU/m2 hCG uygulandıktan sonra 4. gün testosteron düzeylerini ölçmeyi önermekteyiz.

Keywords

• Cinsiyet gelişim bozukluğu
• hCG uyarı testi
• testosteron
• 46
• XY

Project Number

37697

COMPARISON OF SINGLE DOSE AND MULTI-DOSE hCG STIMULATION TESTS

Abstract

Objective: The human chorionic gonadotropin (hCG) stimulation test is widely used to assess testicular steroidogenesis. This test evaluates Leydig cell function and helps to evaluate testosterone synthesis in testicular enzyme defects, hypogonadism, 46,XY sexual development disorders (DSD), and micropenis. This study will compare testosterone responses to a single dose of 5000 IU/m2 and three consecutive days of 1500 IU/m2 hCG regimens. Materials and Methods: The study evaluated 18 patients who were admitted with micropenis, hypospadias, or undescended testis (Group 1) and 18 patients with a molecular diagnosis of androgen receptor insensitivity (56%) or 5α reductase deficiency (44%) (Group 2). The median (interquartile range; IQR) age of the patients were 1.4 (0.8-4.2) years for Group 1 and 0.7 (0.3-0.8) years for Group 2. Baseline testosterone levels were checked and after a single dose of hCG 5000 IU/m2 injection into the first group, testosterone levels were observed on day one and day four. In the second group, after the injection of hCG 1500 IU/m2 for three days, testosterone levels were checked on the fourth day. Results: There was no significant difference in height, weight, BMI SDS, and baseline testosterone levels between groups. After hCG, stimulation testosterone responses did not vary among the groups. Testosterone levels were increased 40-fold and 40.1- fold on day four compared to the baseline in Group 1 and Group 2. In Group 1, testosterone response was significantly higher on day four compared to day one (p=0.001). Conclusions: The hCG tests performed with a single dose or multidoses showed that there was no difference between testosterone responses and these two tests were applicable the 5000 IU/m2 hCG test requires fewer injections and is easy to administer, this test may be preferred to an evaluation of the Leydig cell function. For an adequate testosterone response, the researchers suggest measuring testosterone levels on the fourth day after the single dose of 5000 IU/m2 .

Keywords

• Disorders of sex development
• hCG stimulation test
• testosterone
• 46
• XY

Supporting Institution

Scientific Research Projects Coordination Unit of Istanbul University.

Project Number

37697

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