Hypophyso-gonadal and hypophyso-adrenal function in boys with discordance between pubic hair and genital development

Abstract

LH-RH tests (50 μg i.v.) and hCG tests (2000 IU/day for 3 days) were carried out in 16 normal boys in stage P1 both for genitalia and pubic hair (group 1); 7 normal boys over 91/2 years in stage P 1 for genitalia and stage P 2–3 for pubic hair (group 2); 9 boys in stage P 2–3 for genitalia but stage P 1 for pubic hair (group 3); 10 boys in stage P 2–3 both for genitalia and pubic hair (group 4). In 10 prepubertal boys in group 1 (group 1a) and in all subjects in groups 2, 3 and 4 the levels of Δ4-androstenedione (Δ4), dehydroepi-androsterone (DHEA), dehydroepiandrosterone sulphate (DHEA-S) and 17-hydroxyprogesterone (17-OH-P) were evaluated under basal conditions. In groups 1 and 2 the mean basal and post-hCG testosterone values, and the basal and post-LH-RH (peak, maximum increase and area of the curve) values for LH and FSH were not significantly different. The values of Δ4, DHEA, DHEA-S for the boys in group 2 were higher (P<0.01, P<0.05, and P<0.01 respectively) than for those in group 1. In the two groups of subjects in stage P 2–3 for genitalia and in different stages for pubic hair, no differences were noted for post-hCG testosterone or for gonadotropins. The basal value of testosterone was higher for the boys in group 4, as was DHEA. The values of Δ4, DHEA, DHEA-S for the boys in group 4 were higher (P<0.05) than those of group 1a. The values of Δ4 and DHEA in the subjects in group 3 were lower (P<0.001 and P<0.01 respectively) than those of the boys of group 2. Our data seem to show that: (a) the appearance of pubic hair without a simultaneous increase in the volume of the testes (even if it occurs in the normal period for pubertal development), and cannot be considered an expression of the activation of the hypothalamopituitary-gonadal axis; (b) adrenarche and maturation of gonadal function are two independent processes which are usually linked in time.