FSH-stimulated Inhibin B (FSH-iB): A Novel Marker for the Accurate Prediction of Pubertal Outcome in Delayed Puberty

J Clin Endocrinol Metab. 2021 Aug 18;106(9):e3495-e3505. doi: 10.1210/clinem/dgab357.

Abstract

Background: Clinicians have long been struggling to find an effective tool to predict onset of puberty.

Objective: To explore stimulability of inhibin B after exogenous FSH and its potential role for prediction of onset of puberty.

Design and participants: Study subjects were enrolled into "exploratory cohort" (n = 42) and "validation cohort" (n = 19). The exploratory cohort was further divided into group 1 (healthy children with spontaneous puberty [SP], n = 26) and group 2 (patients with hypogonadotropic hypogonadism [HH], n = 16). The validation cohort included children who presented with complaints of delayed puberty.

Intervention and outcome: Participants were subjected to FSH stimulation test and GnRH analogue stimulation test. Cutoffs derived from the exploratory cohort for basal and FSH stimulated inhibin B (FSH-iB) were applied on the validation cohort. Basal LH, GnRH analogue-stimulated LH, basal inhibin B, and FSH-iB were compared with clinical outcomes on a prospective follow-up for prediction of onset of puberty.

Results: There was statistically significant increment in inhibin B after exogenous FSH in group 1 (SP) in both male (188.8 pg/mL; P = 0.002) and female (1065 pg/mL; P = 0.023) subjects. The increment was not statistically significant in group 2 (HH) in both sexes. FSH-iB at a cutoff of 116.14 pg/mL in males and 116.50 pg/mL in females had 100% sensitivity and specificity for labelling entry into puberty. On application of these cutoffs on the validation cohort, FSH-iB had 100% positive predictive value, negative predictive value, and diagnostic accuracy for prediction of pubertal onset.

Conclusion: Inhibin B was stimulable in both male and female subjects. FSH-iB can be considered a novel and promising investigation for prediction of onset of puberty. Future studies are required for further validation.

Keywords: FSH stimulated inhibin B; constitutional delay in growth and puberty; delayed puberty; hypogonadotropic hypogonadism; inhibin B.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cohort Studies
  • Female
  • Follicle Stimulating Hormone / blood*
  • Humans
  • Hypogonadism / complications
  • Inhibin-beta Subunits / blood*
  • Luteinizing Hormone / blood
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Puberty
  • Puberty, Delayed / blood
  • Puberty, Delayed / diagnosis*
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Triptorelin Pamoate / pharmacology
  • Young Adult

Substances

  • INHBB protein, human
  • Triptorelin Pamoate
  • Luteinizing Hormone
  • Follicle Stimulating Hormone
  • Inhibin-beta Subunits

Associated data

  • CTRI/CTRI/2019/10/021570