Prognostic study of suspected dual CHH patients treated with gonadotropins

Qin Zhang; Bingyan Cao; Yi Wang; Chunxiu Gong

doi:10.1530/endoabs.110.P837

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Endocrine Abstracts (2025) 110 P837 | DOI: 10.1530/endoabs.110.P837

ECEESPE2025 Poster Presentations Pituitary, Neuroendocrinology and Puberty (162 abstracts)

Prognostic study of suspected dual CHH patients treated with gonadotropins

Qin Zhang ¹ , Bingyan Cao ² , Yi Wang ¹ & Chunxiu Gong ¹

Author affiliations

¹Department of Endocrinology, Genetics, and Metabolism, Beijing Children’s Hospital, Capital Medical University, National Children’s Medical Center, Beijing 100045, China, Beijing, China; ²Department of Endocrinology, Children’s Hospital Affiliated to the Capital Institute of Pediatrics, Beijing, China

JOINT1383

Objective: This study aimed to investigate the treatment outcomes and predictive indicators in suspected dual congenital hypogonadotropic hypogonadism (CHH) patients treated with GnRH or hCG/hMG.

Methods: A total of 37 male dual CHH patients who received GnRH or hCG/hMG treatment from January 1, 2010 to the present were included. Clinical data including age, height, weight, LH, FSH, T, AMH, and INHB were collected from the medical records. Based on their treatment response, patients were divided into two groups: typical response (n = 20) and atypical response (n = 17). The diagnostic criteria for dual CHH are as follows:1) Testosterone (T) levels remain below 100 ng/dl after an hCG prolongation test. 2) T levels remain below 100 ng/dl after six months of GnRH treatment (5-10 mg/90 min, 16 pulses/day). Patients in the atypical response group had serum T levels below 200 ng/dl within six months of treatment or did not produce sperm during the treatment period. Patients not meeting these criteria were classified as having a typical response.

Results: 1. Compared with the typical response group, the atypical response group had a higher incidence of cryptorchidism (40.0% vs 76.5%, P = 0.065), lower baseline ultrasound-measured testicular volume (TV) (0.43±0.34 vs 0.18±0.09 ml, P = 0.046), lower AMH level (15.39±5.60 vs 6.84±4.62 ng/ml, P = 0.000), and lower T level after hCG prolongation test (70.52±20.21 vs 28.80±19.30 ng/dl, P = 0.000).

2. The AUC for predicting typical response in suspected dual HH patients was as follows: AMH: 0.950±0.055, with a cut-off of 10.65 ng/ml (sensitivity 80%, specificity 100%); T after hCG prolongation test: 0.883±0.088, with a cut-off of 66.65 ng/dl (sensitivity 66.7%, specificity 100%); Combined AMH and T after hCG prolongation test: 1.0 (sensitivity 93.3%, specificity 100%).

4. For cumulative doses of HCG (24,000-40,000 units), HMG (0-3,375 U), and GnRH (4-4.8 mg), the AUC for T was 0.918±0.058, with a cut-off of 135.8 ng/dl (sensitivity 80%, specificity 100%). The combined prediction of T and TV had an AUC of 0.945±0.056 (sensitivity 90%, specificity 100%).

Conclusion: Gonadotropin therapy promotes testicular development and sperm production in patients suspected of having dual CHH. Patients with AMH levels below 10.65 ng/ml and T levels below 66.65 ng/dl after an hCG prolongation test may be considered for a diagnosis of dual CHH.