Differential diagnosis of constitutional delay of puberty and hypogonadotropic hypogonadism in boys

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Retarded puberty represents по signs of sexual development in adolescents. This study was undertaken to examine clinical criteria for diagnosing constitutional puberty retardation and hypogonadotropic hypogonadism and to evaluate the diagnostic value of a test using the synthetic analogue of daily action LH-RH busereline in the differential diagnosis of these conditions. Fifty-two male ado­lescents aged 13.5 to 15.5 years who had no clinical and hormonal signs of the onset of pubescence; 5 of these patients had anosmia, which suggested that they had the Kallmann syndrome (secondary hypogonadism). All the patients had a stimulation test using buser­eline. In 7patients (Group 1), including 5 with anosmia, the maximum elevation of the level of luteinizing hormone (LH) in response to stimulation was less than the puberty value (< 8 U/l). In the remaining 45 adolescents, the maximum elevation of LH reached puberty values and ranged from 11.2 to 50.1 U/l, which made it possible to diagnose transient retarded puberty in them (Group 2). All the patients were followed up for 1-3 years. During this period, there was progressive puberty in all the patients of Group 2 and no intrinsic puberty in Group 1 patients. The findings showed the informative value of the test using the long-acting LH-RH analogue busereline for the differential diagnosis of constitutional puberty retardation and secondary hypogonadism in adolescents.