Geração de inibina A após estímulo gonadotrófico: novo método de detecção de tecido ovariano em pacientes com anomalia da diferenciação sexual / Inhibin A generation after gonadotropin stimulus: a new method to detect ovarian tissue in true hermaphrodites

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Introduction: True hermaphrodism (TH) is characterized by the presence of ovarian and testicular tissue in the same patient comprises 5% of the intersex cases. A large spectrum of phenotypical variation is observed, ranging from normal female genitalia to normal male genitalia, covering a wide range of intermediary presentations, it becomes very difficult to make the diagnosis of TH on clinical basis. The detection of testicular tissue is well stablished but there is no available test to demonstrate the presence of ovarian tissue. Objectives: 1. To evaluate the effectiveness of the LH/FSH gonadal stimulation in demonstrating ovarian functiom 2. To evaluate the presence of ovarian tissue in intersex patients under gonadotropic stimulation and 3. To make the TH diagnosis before the surgical procedure. Patients and Methods: Ten patients with congenital adrenal hyperplasia (CAH), 10 with unilateral cryptorchidism, 13 intersex patients with no defined etiology, and seven TH patients have been included in the study. All the patients had a gonadotropic stimulation test with human menopausal gonadotropin (menotropin-hMG),150 IU, intramuscular, for three consecutive days. LH, FSH, estradiol, testosterone, and Inhibin A were measured before (0 time), 24h after the first gonadotropin dose, and 24h after the third gonadotropin dose. Results: LH did not show any significant increase in the four groups studied. FSH increased in the four groups in a similar way. Estradiol increased in CAH pacients (p=0.005) and in TH patients (p=0,031), while testosterone increased in patients whit unilateral cryptorchidism (p=0.027) as well as in the intersex patients without defined etiology. Inhibin A levels increased in CAH patients (p=0.005) and in the TH patients (p=0.043). Conclusion: The LH/FSH stimulation test demonstrated to be a useful method to diagnose the presence of ovarian tissue in CAH patients as well as in TH patients, becoming an important tool to diagnose TH even before the surgical procedure and histologic studies of the gonads.

ASSUNTO(S)

hermafroditismo estradiol/uso diagnóstico ovary menotropina inibinas/uso diagnóstico inhibins/diagnostic use menotropins ovário hermaphroditism estradiol/diagnostic use

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