Abstract
The objective of this review was to characterize the use of biomarkers of male hypogonadism in childhood and adolescence. The hypothalamic-pituitary-gonadal (HPG) axis is active during fetal life and over the first months of postnatal life. The pituitary gland secretes follicle stimulating hormone (FSH) and luteinizing hormone (LH), whereas the testes induce Leydig cells to produce testosterone and insulin-like factor 3 (INSL), and drive Sertoli cells to secrete anti-Müllerian hormone (AMH) and inhibin B. During childhood, serum levels of gonadotropins, testosterone and insulin-like 3 (INSL3) decline to undetectable levels, whereas levels of AMH and inhibin B remain high. During puberty, the production of gonadotropins, testosterone, and INSL3 is reactivated, inhibin B increases, and AMH decreases as a sign of Sertoli cell maturation. Based on our knowledge of the developmental physiology of the HPG axis, these biomarkers can be used in clinical practice to interpret the physiopathology of hypogonadism. Additionally, these markers can have diagnostic value in different forms of hypogonadism that may appear during childhood and adolescence.
Highlights
Hypogonadism in males is typically defined as a testicular failure characterized by androgen deficiency
Leydig cells secrete insulinlike 3 factor (INSL3) which is in conjunction with androgens and induce the descent of the testis into the scrotal sac [7, 8]
For a definition of male hypogonadism to be applicable to children, diagnosis of a diminished testicular function should be established taking the testicular function expected for the age of the patient as a reference, which may involve Sertoli cells (AMH, inhibin B), Leydig cells, and/or germcells [47]
Summary
Hypogonadism in males is typically defined as a testicular failure characterized by androgen deficiency. Increased levels of intratesticular testosterone induce the maturation of Sertoli cells, which refrain AMH production and stimulate inhibin B secretion [13]. For a definition of male hypogonadism to be applicable to children, diagnosis of a diminished testicular function should be established taking the testicular function expected for the age of the patient as a reference, which may involve Sertoli cells (AMH, inhibin B), Leydig cells (testosterone, INSL3), and/or germcells [47] Considering this principle, male hypogonadism should be classified based on the constituent of the HPG axis primarily affected, and on the period of life and the testicular population primarily affected (Tables 1 and 2). Dissociated gonadal failure Multiple pituitary hormone deficiency Isolated central hypogonadism: TAC3 or TACR3 mutations LHβ mutations
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