Sertoli cell markers in the diagnosis of paediatric male hypogonadism

GRINSPON R; LORETI N; D. BRASLAVSKY; BEDECARRÁS P; AMBAO , VERONICA; GOTTLIEB S.; BERGADÁ , IGNACIO; CAMPO S; REY RA

JOURNAL OF PEDIATRIC ENDOCRINOLOGY AND METABOLISM

De Gruyter

Lugar: Berlin; Año: 2012 vol. 25 p. 3 - 11

2191-0251

During childhood, the pituitary-testicular axis is partially dormant: testosterone secretion decreases following LH drop; FSH levels also go down. Conversely, Sertoli cells are most active, as revealed by the circulating levels of anti-Mullerian hormone (AMH) and inhibin B. Therefore, hypogonadism can best be evidenced, without stimulation tests, if Sertoli cell function is assessed. Serum AMH is high from fetal life until mid-puberty. Testicular AMH production increases in response to FSH and is potently inhibited by androgens. Inhibin B is high in the first years of life, then decreases partially while remaining clearly higher than in females, and increases again at puberty. Serum AMH and inhibin B are undetectable in anorchid patients. In primary or central hypogonadism affecting the whole gonad established in fetal life or childhood, all testicular markers are low. Conversely, when hypogonadism only affects Leydig cells, serum AMH and inhibin B are normal. In males of pubertal age with central hypogonadism, AMH and inhibin B are low. Treatment with FSH provokes an increase in serum levels of both Sertoli cell markers, whereas hCG administration increases testosterone levels. In conclusion, measurement of serum AMH and inhibin B is helpful to assess testicular function, without need for stimulation tests, and orientates the aetiological diagnosis of paediatric male hypogonadism.