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Olumide OB, Godwin AI, Etukudoh NS, Dutta S, Uchejeso OM, Titilayo JO, Christian IO, Temitope ST, Sengupta P. Evaluation of serum inhibin B and inhibin B/FSH ratio in the diagnosis of non-obstructive azoospermia and oligozoospermia. Horm Mol Biol Clin Investig 2024:hmbci-2024-0054. [PMID: 39427235 DOI: 10.1515/hmbci-2024-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 10/04/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVES Infertility affects approximately 15 % of couples globally, with 50 % cases of male factor infertility. Precise assessment of spermatogenesis is essential for evaluating male infertility. Recent studies suggest serum inhibin B as a promising biomarker for testicular function. This study aims to evaluate the diagnostic utility of serum inhibin B in predicting male infertility, particularly focusing on its relationship with sperm count. METHODS A cross-sectional study was conducted on 80 adult men (mean age 31.4 ± 6.89 years) presenting with infertility at gynecology and urology outpatient departments. Semen analysis was performed following WHO (2010) guidelines, and serum inhibin B levels were quantified. The correlation between serum inhibin B levels and sperm parameters was assessed using Pearson's correlation test. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of serum inhibin B and the inhibin B/FSH ratio for non-obstructive azoospermia (NOA) and oligozoospermia. RESULTS A significant positive correlation was observed between serum inhibin B and sperm count (r=0.94, p<0.001). ROC analysis demonstrated that the inhibin B/FSH ratio had the highest diagnostic accuracy for NOA and oligozoospermia (AUC=0.986), with sensitivity of 100 % and specificity of 91.67 %. Serum inhibin B alone also showed high diagnostic value (AUC=0.965 for NOA and 0.969 for oligozoospermia). CONCLUSIONS Serum inhibin B is a reliable biomarker for assessing male infertility, particularly in evaluating spermatogenic function. The inhibin B/FSH ratio provides superior diagnostic accuracy for NOA and oligozoospermia, offering valuable clinical utility in male infertility diagnosis.
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Affiliation(s)
- Olaniru B Olumide
- Department of Chemical Pathology, Jos University Teaching Hospital Jos, Jos, Plateau State, Nigeria
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Adoga I Godwin
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Nkereuwem S Etukudoh
- Department of Chemical Pathology, Federal School of Medical Laboratory Science Jos, Jos, Plateau State, Nigeria
| | - Sulagna Dutta
- Basic Medical Sciences Department, College of Medicine, Ajman University, Ajman, UAE
| | - Obeta M Uchejeso
- Department of Chemical Pathology, Federal School of Medical Laboratory Science Jos, Jos, Plateau State, Nigeria
- Department of Human Physiology, University of Jos, Jos, Plateau State, Nigeria
| | - Johnson O Titilayo
- Department of Biochemistry, Faculty of Basic Medical Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Isichei O Christian
- Department of Chemical Pathology, Faculty of Clinical Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Selowo T Temitope
- Department of Chemical Pathology, Jos University Teaching Hospital Jos, Jos, Plateau State, Nigeria
| | - Pallav Sengupta
- Department of Biomedical Sciences, College of Medicine, Gulf Medical University, Ajman, UAE
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2
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Kopalli SR, Cha KM, Cho JY, Kim SK, Koppula S. Cordycepin mitigates spermatogenic and redox related expression in H 2O 2-exposed Leydig cells and regulates testicular oxidative apoptotic signalling in aged rats. PHARMACEUTICAL BIOLOGY 2022; 60:404-416. [PMID: 35175170 PMCID: PMC8863333 DOI: 10.1080/13880209.2022.2033275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
CONTEXT Cordycepin (COR), from Cordyceps militaris L., (Cordycipitaceae), is a valuable agent with immense health benefits. OBJECTIVE The protective effects of COR in ageing-associated oxidative and apoptosis events in vivo and hydrogen peroxide (H2O2)-exposed spermatogenesis gene alterations in TM3 Leydig cells was investigated. MATERIALS AND METHODS Male Sprague-Dawley rats were divided into young control (YC), aged control (AC) and COR treated (COR-20) aged groups. COR-20 group received daily doses of COR (20 mg/kg) for 6 months. Cell viability and hormone levels were analysed by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] and enzyme immunoassay kits with COR treated at 1, 5, and 10 μg/mL. Oxidative enzymes, spermatogenic, and apoptotic expression in testis tissues were evaluated by Western blotting and real-time RT-PCR. RESULTS COR treatment (1, 5, and 10 μg/mL) significantly (p < 0.05 ∼ p < 0.001) inhibited the H2O2-induced decrease in the percentage of viable cells (from 63.27% to 71.25%, 85.67% and 93.97%, respectively), and reduced the malondialdehyde (MDA) content (from 4.28 to 3.98, 3.14 and 1.78 nM MDA/mg protein, respectively). Further, the decreased antioxidant enzymes (glutathione-S-transferase mu5, glutathione peroxidase 4 and peroxiredoxin 3), spermatogenesis-related factors (nectin-2 and inhibin-α) and testosterone levels in H2O2-exposed TM3 cells were significantly (p < 0.05 ∼ p < 0.001) ameliorated by COR. In aged rats, COR (20 mg/kg) restored the altered enzymatic and non-enzymatic antioxidative status and attenuated the apoptotic p53 and Bax/Bcl-2 expression significantly (p < 0.05). CONCLUSION COR might be developed as a potential agent against ageing-associated and oxidative stress-induced male infertility.
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Affiliation(s)
- Spandana Rajendra Kopalli
- Department of Bioscience and Biotechnology, Sejong University, Seoul, Republic of Korea
- Department of Integrated Biosciences, College of Biomedical & Health Science, Konkuk University, Chungju, Republic of Korea
| | - Kyu-Min Cha
- Business Incubator Center 406, D&L Biochem, Chungju-Si, Republic of Korea
| | - Jae Youl Cho
- Department of Integrative Biotechnology, Sungkyunkwan University, Suwon, Republic of Korea
| | - Si-Kwan Kim
- Department of Integrated Biosciences, College of Biomedical & Health Science, Konkuk University, Chungju, Republic of Korea
| | - Sushruta Koppula
- Department of Integrated Biosciences, College of Biomedical & Health Science, Konkuk University, Chungju, Republic of Korea
- CONTACT Sushruta Koppula Department of Integrated Biosciences, College of Biomedical & Health Science, Konkuk University, Chungju27381, Republic of Korea
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3
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Turan T, Pekel A, Duvan ZCI, Gönenç A. Serum INHB Levels and ACE Gene I/D Polymorphism with Increased Risk for Unexplained Infertility. J Biochem 2021; 170:245-253. [PMID: 33768251 DOI: 10.1093/jb/mvab036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
ACE has a significant role in the angiogenesis of ovarian endothelium and the resumption of meiosis and folicular growth. However, there is no any study concerning ACE polymorphism and UI. The main aim of this study is that both identify ACE polymorphism and measure the serum ACE, AMH and INHB levels in UI patients and controls in Turkish population. 47 UI patients and 41 controls were involved in this study. To determine the ACE polymorphisms, DNA isolation and PCR were performed. Then, serum ACE, AMH and INHB levels were measured spectrophotometrically. Patients with UI had significantly higher serum INHB levels compared with controls (p < 0.05). Serum ACE levels were decreased, compared to controls, however the decrease were not significant. Serum AMH levels did not significantly differ from controls. When the relationship were analyzed between ACE I/D polymorphism and infertility risk, and ID genotype were chosen as reference, it was found to be 2.33 times more risk of UI that the women have DD genotype (DD vs. ID: odds ratio = 2.33, 95% confidence interval (0,88-6,19); p = 0,086). This finding indicates that DD genotype may be high risk for UI. Further studies are warranted to confirm this finding, especially with a larger population.
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Affiliation(s)
- T Turan
- Gazi University, Faculty of Pharmacy, Department of Biochemistry, Yenimahalle, Ankara, Turkey
| | - A Pekel
- VM Medical Park Ankara Hospital, Andrology Laboratory, Keçiören, Ankara, Turkey
| | - Z C I Duvan
- Medical Park Ankara Hospital, Department of Gynecology and Obstetrics, Batıkent, Ankara, Turkey
| | - A Gönenç
- Gazi University, Faculty of Pharmacy, Department of Biochemistry, Yenimahalle, Ankara, Turkey
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4
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Bongrani A, Elfassy Y, Brun JS, Ramé C, Mellouk N, Fellahi S, Bastard JP, Levy R, Vasseur C, Froment P, Dupont J. Expression of adipokines in seminal fluid of men of normal weight. Asian J Androl 2020; 21:528-530. [PMID: 31115360 PMCID: PMC6732888 DOI: 10.4103/aja.aja_25_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Alice Bongrani
- UMR 85 Unit of Reproductive Physiology and Behaviors, INRA Val de Loire Center, Nouzilly 37380, France
| | - Yaelle Elfassy
- Unit of Biology of Reproduction and Inflammatory and Metabolic Biomarkers, Hôpital Tenon, Research Center Saint Antoine, IHU ICAN, Inserm UMRS 938, AP-HP, UPMC University of Paris 06, Paris 75005, France
| | - Jean Sebastien Brun
- Assisted Medical Procreation Pôle Santé Léonard de Vinci, Chambray-lès-Tours 37170, France
| | - Christelle Ramé
- UMR 85 Unit of Reproductive Physiology and Behaviors, INRA Val de Loire Center, Nouzilly 37380, France
| | - Namya Mellouk
- UMR 85 Unit of Reproductive Physiology and Behaviors, INRA Val de Loire Center, Nouzilly 37380, France
| | - Soraya Fellahi
- Unit of Biology of Reproduction and Inflammatory and Metabolic Biomarkers, Hôpital Tenon, Research Center Saint Antoine, IHU ICAN, Inserm UMRS 938, AP-HP, UPMC University of Paris 06, Paris 75005, France
| | - Jean Philippe Bastard
- Unit of Biology of Reproduction and Inflammatory and Metabolic Biomarkers, Hôpital Tenon, Research Center Saint Antoine, IHU ICAN, Inserm UMRS 938, AP-HP, UPMC University of Paris 06, Paris 75005, France
| | - Rachel Levy
- Unit of Biology of Reproduction and Inflammatory and Metabolic Biomarkers, Hôpital Tenon, Research Center Saint Antoine, IHU ICAN, Inserm UMRS 938, AP-HP, UPMC University of Paris 06, Paris 75005, France
| | - Claudine Vasseur
- Assisted Medical Procreation Pôle Santé Léonard de Vinci, Chambray-lès-Tours 37170, France
| | - Pascal Froment
- UMR 85 Unit of Reproductive Physiology and Behaviors, INRA Val de Loire Center, Nouzilly 37380, France
| | - Joëlle Dupont
- UMR 85 Unit of Reproductive Physiology and Behaviors, INRA Val de Loire Center, Nouzilly 37380, France
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5
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Is inhibin a useful serum marker for postmenopausal women with epithelial ovarian cancer? GINECOLOGIA.RO 2020. [DOI: 10.26416/gine.29.3.2020.4063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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6
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Crisóstomo L, Alves MG, Calamita G, Sousa M, Oliveira PF. Glycerol and testicular activity: the good, the bad and the ugly. Mol Hum Reprod 2017; 23:725-737. [DOI: 10.1093/molehr/gax049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 09/05/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Luís Crisóstomo
- Department of Microscopy, Laboratory of Cell Biology, and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Marco G Alves
- Department of Microscopy, Laboratory of Cell Biology, and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Giuseppe Calamita
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Mário Sousa
- Department of Microscopy, Laboratory of Cell Biology, and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Centre for Reproductive Genetics Professor Alberto Barros, Porto, Portugal
| | - Pedro F Oliveira
- Department of Microscopy, Laboratory of Cell Biology, and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari ‘Aldo Moro’, Bari, Italy
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7
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Li WH, Chen L, Chen SX, Li HJ, Liu Z, Sun LN, Zhao Y, Zheng LW, Li CJ, Zhou X. Polymorphisms in inhibin α gene promoter associated with male infertility. Gene 2015; 559:172-6. [PMID: 25617520 DOI: 10.1016/j.gene.2015.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/27/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
Abstract
Inhibins play important roles in normal gonadal function, including regulation of proliferation, differentiation, and steroidogenesis of Leydig and Sertoli cells via paracrine and autocrine processes. In adult males, circulating inhibin levels are correlated with fertility by regulating the number of Sertoli cells, total sperm count, and testicular volume. Given this important role, inhibin-α subunit (INHA) is a strong candidate gene in male fertility. However, limited data regarding the association of polymorphisms of INHA with male fertility are available. This study was based on the hypothesis that polymorphisms in the promoter of INHA are associated with male fertility. Han Chinese patients with non-normozoospermia (n=153) and normozoospermia (n=72) from Northern China were screened, and genotypes were analyzed by polymerase chain reaction-restriction fragment length polymorphism after INHA promoter was amplified. Statistical analysis results revealed a significant difference in the allele frequency of INHA promoter between males with non-normozoospermia and normozoospermia. For c.-124G>A, males carrying c.-124GG genotype and c.-124GA genotype showed an increased risk of non-normozoospermic syndrome. For c.-16C>T polymorphism, no significant difference in allele frequency was observed between the two groups. Therefore, the haplotype AC possibly displayed a considerable reduced risk of non-normozoospermic syndrome.
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Affiliation(s)
- Wan-Hong Li
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Lu Chen
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Shu-Xiong Chen
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Hong-Jiao Li
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Zhuo Liu
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Li-Na Sun
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Yun Zhao
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China
| | - Lian-Wen Zheng
- The Second Hospital of Jilin University, Reproductive Medical Center, Changchun, Jilin 130062, PR China
| | - Chun-Jin Li
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China.
| | - Xu Zhou
- College of Animal Sciences, Jilin University, 5333 Xian Road, Changchun 130062, PR China.
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8
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Isaksson S, Eberhard J, Ståhl O, Cavallin-Ståhl E, Cohn-Cedermark G, Arver S, Lundberg Giwercman Y, Giwercman A. Inhibin B concentration is predictive for long-term azoospermia in men treated for testicular cancer. Andrology 2014; 2:252-8. [DOI: 10.1111/j.2047-2927.2014.00182.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 01/15/2023]
Affiliation(s)
- S. Isaksson
- Reproductive Medicine Centre; Skåne University Hospital; Malmö Sweden
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - J. Eberhard
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - O. Ståhl
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | | | - G. Cohn-Cedermark
- Department of Oncology; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - S. Arver
- Centre for Andrology and Sexual Medicine; Karolinska University Hospital; Stockholm Sweden
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | | | - A. Giwercman
- Reproductive Medicine Centre; Skåne University Hospital; Malmö Sweden
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9
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DHEA supplementation may improve IVF outcome in poor responders: a proposed mechanism. Eur J Obstet Gynecol Reprod Biol 2013; 168:49-53. [PMID: 23312476 DOI: 10.1016/j.ejogrb.2012.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/13/2012] [Accepted: 12/15/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Dehydroepiandrosterone (DHEA) supplementation for poor responders may improve ovarian response and IVF treatment outcome. This study aimed to determine the mechanism of action of DHEA, and specifically, the stage of folliculogenesis influenced by DHEA. STUDY DESIGN This is a prospective, self-controlled study of poor responders to IVF treatment, comparing day 3 biochemical (anti-Mullerian hormone (AMH), inhibin B and FSH) and ultrasound (antral follicle count (AFC)) ovarian reserve markers and IVF treatment outcome before and after DHEA supplementation of at least 3 months duration. RESULTS Thirty-two women were included. Following DHEA, there was a significant increase in AFC (P=0.0003) without significant changes in the baseline biochemical parameters AMH, inhibin B, or FSH. The enhanced response comprised increased peak estradiol levels (P=0.0005), number of follicles >15 mm, oocytes, MII oocytes and embryos (P=0.004, P=0.00001, P=0.0004 and P=0.0006, respectively) and oocytes number/total FSH dose (P=0.0009). The proportion of cancelled cycles due to very poor response decreased significantly (P=0.02). CONCLUSIONS DHEA does not appear to exert influence via recruitment of pre-antral or very small antral follicles (no change in AMH and inhibin B) but rather by rescue from atresia of small antral follicles (increased AFC).
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10
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Bilandzic M, Stenvers KL. Reprint of: Betaglycan: a multifunctional accessory. Mol Cell Endocrinol 2012; 359:13-22. [PMID: 22521265 DOI: 10.1016/j.mce.2012.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 12/21/2022]
Abstract
Betaglycan is a co-receptor for the TGFβ superfamily, particularly important in establishing the potency of its ligands on their target cells. In recent years, new insights have been gained into the structure and function of betaglycan, expanding its role from that of a simple co-receptor to include additional ligand-dependent and ligand-independent roles. This review focuses on recent advances in the betaglycan field, with a particular emphasis on its newly discovered actions in mediating the trafficking of TGFβ superfamily receptors and as a determinant of the functional output of TGFβ superfamily signalling. In addition, this review encompasses a discussion of the emerging roles of the betaglycan/inhibin pathway in reproductive cancers and disease.
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Affiliation(s)
- Maree Bilandzic
- Prince Henry's Institute, PO Box 5152, Clayton, Victoria 3168, Australia.
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11
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Bilandzic M, Stenvers KL. Betaglycan: a multifunctional accessory. Mol Cell Endocrinol 2011; 339:180-9. [PMID: 21550381 DOI: 10.1016/j.mce.2011.04.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/18/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
Betaglycan is a co-receptor for the TGFβ superfamily, particularly important in establishing the potency of its ligands on their target cells. In recent years, new insights have been gained into the structure and function of betaglycan, expanding its role from that of a simple co-receptor to include additional ligand-dependent and ligand-independent roles. This review focuses on recent advances in the betaglycan field, with a particular emphasis on its newly discovered actions in mediating the trafficking of TGFβ superfamily receptors and as a determinant of the functional output of TGFβ superfamily signalling. In addition, this review encompasses a discussion of the emerging roles of the betaglycan/inhibin pathway in reproductive cancers and disease.
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Affiliation(s)
- Maree Bilandzic
- Prince Henry's Institute, P.O. Box 5152, Clayton, Victoria 3168, Australia.
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12
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Abstract
The endocrinology of the aging male is complex, with multiple hormones along the hypothalamic-pituitary-testicular (HPT) axis interacting with one another in feedback. As men age, there is a small and progressive (not precipitous, as in women) decline in several sex hormones, in particular testosterone and dehydroepiandrosterone, and related increases in luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin. The importance of these changes is wide-ranging because of the ubiquitous role of sex hormones in male physiology. This chapter discusses the endocrinology of the aging male. We provide an overview of the regulation of the HPT axis with an emphasis on the changes that occur with aging and the measurement of gonadal steroids, including hormone pulsatility, within-subject and circadian variations. The difficulties of assessing the symptoms of late-onset hypogonadism are highlighted. There is a comprehensive discussion of the epidemiology of sex hormone changes, including their age associations, prevalence of symptomatic hypogonadism, secular changes, risk factors, and the association of sex hormones with outcomes.
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Affiliation(s)
- Andre B. Araujo
- Director, Epidemiology, New England Research Institutes, Inc., 9 Galen Street, Watertown, MA 02472, Tel: 617.923.7747 x452, Fax: 617.673.9509,
| | - Gary A. Wittert
- Head, Discipline of Medicine, The University of Adelaide, Principal Research Scientist, New England Research Institutes, Inc., Phone: +61 882225502, Fax: +61 882233870,
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13
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Abstract
Inhibins are gonadal peptide hormones belonging to the transforming growth factor-β (TGF-β) superfamily that regulate the pituitary follicle stimulating hormone (FSH) secretion by negative feedback mechanisms. It is evident that the understanding of inhibins function in the hypothalamic-pituitary-gonadal axis will provide insights into physiology and pathology of the gonadal function. In recent years, a great deal of attention has been focussed on clinical relevance of measuring circulating inhibins in normal and disease state. The past few years also have witnessed the emergence and discovery of extra pituitary action of inhibins that might provide further insights into the underlying diseases like cancer especially in the reproductive axis and various other new endocrine target organs. In this review after systematic analysis of literature, we discuss briefly the known and recent advances in function of these hormones highlighting also its structure, production and mechanisms of signal transduction. Also this review discusses about the physiological relevance of inhibin association in the normal function to the development of reproductive cancers. Finally, we describe evidence from various emerging studies that inhibins make an important contribution to other physiological functions apart from reproduction which reveals new endocrine target organs of inhibins. The emerging view is inhibin participates in multiple ways to regulate the function in different cell types and still complete repertoire of its actions is under investigation.
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Affiliation(s)
- Padmanaban S Suresh
- Centre for Biomedical Research, Vellore Institute of Technology (VIT) University, Vellore, India.
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14
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Mah PM, Wittert GA. Obesity and testicular function. Mol Cell Endocrinol 2010; 316:180-6. [PMID: 19540307 DOI: 10.1016/j.mce.2009.06.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 05/13/2009] [Accepted: 06/08/2009] [Indexed: 11/24/2022]
Abstract
Obesity in men, particularly when central, is associated with lower total testosterone [TT], free testosterone [FT] and sex hormone-binding globulin [SHBG], and a greater decline in TT and FT with increasing age compared with lean men. Obesity-related conditions such as obstructive sleep apnea, insulin resistance and type 2 diabetes mellitus are independently associated with decreased plasma testosterone. Possible mechanisms include decreased LH pulse amplitude, inhibitory effects of oestrogen at the hypothalamus and pituitary and the effects of leptin and other peptides centrally and on Leydig cells. Obese men have reduced sperm concentration and total sperm count compared to lean men but sperm motility and morphology appear unaffected. The cause and effect relationships between low plasma androgen levels, obesity and the metabolic syndrome, and associated cardiometabolic risk remain unclear. While weight loss normalizes TT and FT in obese men, androgen replacement in the short term does not significantly improve cardiometabolic risk profile despite reducing fat mass.
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Affiliation(s)
- P M Mah
- School of Medicine, University of Adelaide, Adelaide, Australia
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15
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Stenvers KL, Findlay JK. Inhibins: from reproductive hormones to tumor suppressors. Trends Endocrinol Metab 2010; 21:174-80. [PMID: 20005735 DOI: 10.1016/j.tem.2009.11.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 11/23/2009] [Accepted: 11/23/2009] [Indexed: 11/30/2022]
Abstract
Inhibins are peptide hormones shown originally to be produced by the gonads to regulate the secretion of follicle stimulating hormone by pituitary gonadotropes. Although gonadotropes have been regarded as the canonical inhibin target cells, in recent years extrapituitary actions of inhibins have come into the spotlight. In particular, disruptions to the local actions of inhibins in peripheral tissues might underlie certain diseases, especially cancers of the reproductive tract. This review focuses on recent advances in the inhibin field, with a particular emphasis on the determinants of inhibin availability, mechanisms of inhibin action, and the physiological relevancy of local inhibin actions in the development and progression of reproductive cancers.
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Affiliation(s)
- Kaye L Stenvers
- Prince Henry's Institute of Medical Research, Clayton, Victoria 3168 Australia.
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16
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Segal S, Elmadjian M, Takeshige T, Karp S, Mercado R, Rivnay B. Serum inhibin A concentration in women with polycystic ovarian syndrome and the correlation to ethnicity, androgens and insulin resistance. Reprod Biomed Online 2010; 20:675-80. [PMID: 20231113 DOI: 10.1016/j.rbmo.2010.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 11/19/2009] [Accepted: 01/15/2010] [Indexed: 11/28/2022]
Abstract
A prospective case-series in an academic hospital clinic was performed to determine whether there is a relationship between polycystic ovarian syndrome (PCOS) and ethnicity. Also, serum inhibin A concentrations were compared between PCOS and normal-ovulatory women. The possibility of a correlation between inhibin A, androgens and insulin resistance in PCOS women was evaluated. Serum inhibin A concentrations were measured in anovulatory PCOS patients (n=32) and in control women of reproductive age (n=16). Statistical analysis was performed using the Mann-Whitney U-test. Serum concentrations of inhibin A, follicle-stimulating hormone, LH, prolactin, thyroid-stimulating hormone, fasting glucose, insulin, testosterone, 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulphate (DHEAS) were measured. Inhibin A concentrations were significantly lower (4.5+/-4.8 pg/ml) when compared with the control group (13.2+/-14.4 pg/ml; P=0.003) and were not significantly different between Hispanic and Caucasian women diagnosed with PCOS. There was no correlation between inhibin A concentrations and insulin, testosterone, free testosterone, 17-OHP, or DHEAS concentrations. In PCOS women, inhibin A concentrations are similar between Hispanic and Caucasian women; however, women with PCOS, regardless of ethnicity, have a lower inhibin A concentration compared with normal-ovulatory women. No correlation was observed between inhibin A androgens and insulin resistance in women diagnosed with PCOS.
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Affiliation(s)
- Shimon Segal
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, 234-149th Street, Bronx, NY 10451, USA.
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Nicks KM, Perrien DS, Akel NS, Suva LJ, Gaddy D. Regulation of osteoblastogenesis and osteoclastogenesis by the other reproductive hormones, Activin and Inhibin. Mol Cell Endocrinol 2009; 310:11-20. [PMID: 19615428 PMCID: PMC2951729 DOI: 10.1016/j.mce.2009.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 07/03/2009] [Accepted: 07/07/2009] [Indexed: 01/30/2023]
Abstract
There is both cellular and physiological evidence demonstrating that both Activins and Inhibins regulate osteoblastogenesis and osteoclastogenesis, and regulate bone mass in vivo. Although Activins and Inhibins were initially isolated from the gonad, Activins are also produced and stored in bone, whereas Inhibins exert their regulation on bone cell differentiation and metabolism via endocrine effects. The accumulating data provide evidence that reproductive hormones, distinct from classical sex steroids, are important regulators of bone mass and bone strength. Given the well described dominant antagonism of Inhibin over Activin, as well as over BMPs and TGFbeta, the gonadally derived Inhibins are important regulators of locally produced osteotrophic factors. Thus, the cycling Inhibins in females and diurnal changes in Inhibin B in males elicit temporal shifts in Inhibin levels (tone) that de-repress the pituitary. This fundamental action has the potential to de-repress locally stimulated changes in osteoblastogenesis and osteoclastogenesis, thereby altering bone metabolism.
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Affiliation(s)
- Kristy M. Nicks
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Daniel S. Perrien
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Bone Biology and Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nisreen S. Akel
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Larry J Suva
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Dana Gaddy
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Orthopaedic Surgery, Center for Orthopaedic Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Corresponding Author: Departments of Physiology and Biophysics and Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 505, Little Rock, AR 72205, 501-686-5918, 501-686-8167 FAX,
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Lackner JE, Maerk I, Koller A, Bieglmayer C, Marberger M, Kratzik C, Schatzl G. Serum Inhibin—Not a Cause of Low Testosterone Levels in Hypogonadal Prostate Cancer? Urology 2008; 72:1121-4. [DOI: 10.1016/j.urology.2008.01.066] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 01/30/2008] [Accepted: 01/31/2008] [Indexed: 11/29/2022]
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Lee CJ, Ariztia EV, Fishman DA. Conventional and Proteomic Technologies for the Detection of Early Stage Malignancies: Markers for Ovarian Cancer. Crit Rev Clin Lab Sci 2008; 44:87-114. [PMID: 17175521 DOI: 10.1080/10408360600778885] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Our understanding of the tumor microenvironment continues to evolve and allows for the identification of biomarkers that should detect the presence of early stage malignancies. Recent advances in computational analysis and biomedical technologies have come together to elucidate signatures associated with cancer and that are capable of identifying unique tumor-specific proteins. Within the tumor microenvironment, we continue to characterize the proteophysiology of the different steps associated with tumor progression. The urgent need for biomarkers accurately detecting early-stage epithelial ovarian cancer has prompted us, and others, to engage in a search for specific peptide signatures that may discriminate transformed cells from those of the normal ovarian microenvironment. This endeavor also provides new insights into the biology of the disease, which may not only be applicable to detection but may also help to initiate new therapies and optimize patient care.
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Affiliation(s)
- Catherine J Lee
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA
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Robin G, Marcelli F, Mitchell V, Marchetti C, Lemaitre L, Dewailly D, Leroy-Billiard M, Rigot JM. [Why and how to assess hypospermia?]. ACTA ACUST UNITED AC 2008; 36:1035-42. [PMID: 18801689 DOI: 10.1016/j.gyobfe.2008.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/15/2008] [Indexed: 11/28/2022]
Abstract
Hypospermia is a semen volume lower than 2 mL on at least two semen analyses. The etiologies of hypospermia are many and may be divided into two pathophysiologic sub-groups: disturbances of ejaculation reflex leading to partial retrograde ejaculation and seminal glands and ducts anatomic and functional anomalies. In this last pathologic mechanism, the mutations of CFTR gene, involved in many different forms of cystic fibrosis, represent a possible cause of hypospermia. The molecular anomaly of CFTR gene's screening is very important for the potential descendents and for the patient himself. It must be considered any time clinic and/or paraclinic context is evocative.
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Affiliation(s)
- G Robin
- Service d'andrologie, hôpital Albert-Calmette, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
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Tüttelmann F, Dykstra N, Themmen APN, Visser JA, Nieschlag E, Simoni M. Anti-Müllerian hormone in men with normal and reduced sperm concentration and men with maldescended testes. Fertil Steril 2008; 91:1812-9. [PMID: 18423454 DOI: 10.1016/j.fertnstert.2008.02.118] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 02/12/2008] [Accepted: 02/12/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate serum anti-Müllerian hormone (AMH) in well-characterized men with normal and reduced sperm concentration and in men with a history of or persistent maldescended testes as a possible clinical marker of male factor infertility and/or maldescended testes. DESIGN Retrospective analysis of 199 men selected from our database (Androbase). SETTING The university-based Institute of Reproductive Medicine. PATIENT(S) One hundred eight men with normal and 60 men with reduced sperm concentration without known cause of infertility and additionally 31 infertile men with current or former maldescended testes were evaluated. INTERVENTION(S) Serum AMH was analyzed by an in-house ELISA. MAIN OUTCOME MEASURE(S) Hormone and semen parameters were compared and correlated with AMH. RESULT(S) No significant differences were found in AMH levels. Only in men with maldescended testes did AMH correlate negatively with FSH and positively with testicular volume and sperm concentration. No correlations between AMH and LH or testosterone (T) were found. CONCLUSION(S) Anti-Müllerian hormone serum levels are not significantly affected by impaired spermatogenesis in general but are correlated with spermatogenic parameters in men with current or former maldescended testes. Therefore, AMH measurement does not improve clinical routine diagnostics but should be evaluated further in patients with maldescended testes. Anti-Müllerian hormone might serve as a marker of Sertoli cell number, function, and/or maturation in these men.
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Affiliation(s)
- Frank Tüttelmann
- Institute of Reproductive Medicine of the University, Münster, Germany
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Duvilla E, Lejeune H, Trombert-Paviot B, Gentil-Perret A, Tostain J, Levy R. Significance of inhibin B and anti-Müllerian hormone in seminal plasma: a preliminary study. Fertil Steril 2008; 89:444-8. [PMID: 17681330 DOI: 10.1016/j.fertnstert.2007.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the predictive value of seminal inhibin B and anti-Müllerian hormone (AMH) on the outcome of testicular sperm extraction (TESE) in patients with nonobstructive azoospermia. DESIGN Prospective study. SETTING Reproductive biology department. PATIENT(S) Forty-seven normospermic, 28 oligozoospermic, and 68 azoospermic patients. INTERVENTION(S) Testicular sperm extraction. MAIN OUTCOME MEASURE(S) Seminal inhibin B and AMH measure. RESULT(S) The seminal values of inhibin B and AMH are widely dispersed. Both inhibin B and AMH seminal values are significantly different between the three groups. The average rates of seminal AMH (not inhibin B) differ significantly according to the etiology of the azoospermia. Both seminal markers are correlated. A significant positive correlation could be observed between the seminal inhibin B and the sperm count, but not for AMH. A significant correlation also exists between seminal and serum inhibin B. The predictive value for TESE outcome of each parameter is rather low. Conversely, a logistic regression combining serum FSH, seminal inhibin B, and AMH produced a satisfying area under the curve of 0.985. CONCLUSION(S) Seminal inhibin B and AMH values are proposed. Separately, seminal markers are poor predictors of TESE outcome. A logistic regression model led to a satisfying area under the curve of 0.985.
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Affiliation(s)
- Emma Duvilla
- Laboratoire de Biologie de la Reproduction, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
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Ellingsen DG, Chashchin V, Haug E, Chashchin M, Tkachenko V, Lubnina N, Bast-Pettersen R, Thomassen Y. An epidemiological study of reproductive function biomarkers in male welders. Biomarkers 2007; 12:497-509. [PMID: 17701748 DOI: 10.1080/13547500701366496] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In a cross-sectional study, the serum concentrations of inhibin B and prolactin of 96 male current welders were compared with the concentrations measured in 96 age-matched referents. Also, 23 patients who were all former welders diagnosed as having welding-related manganism were studied. The current welders' geometric mean (GM) airborne exposure to manganese (Mn) was 121 microg m(-3) (range 7-2320). The serum concentrations of prolactin adjusted for age and smoking habits (GM 193 mIU l(-1) vs. 166 mIU l(-1); p=0.047) and inhibin B adjusted for alcohol consumption (arithmetic mean (AM) 151 ng l(-1) vs. 123 ng l(-1); p=0.001) were higher in the welders compared with the referents. The whole blood Mn concentration was associated with the serum prolactin concentrations. Tobacco smoking resulted in lower serum prolactin concentrations. The GM serum prolactin concentrations of the patients did not significantly differ from that of the referents, but their AM serum inhibin B concentration was statistically significantly lower. The results may suggest an effect of Mn on the pituitary that is reversible upon cessation of exposure. Lower inhibin B concentrations in the patients could point to a functional impairment of the testicular Sertoli cells, that may be caused by a welding fume component or other factors in their work environment.
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Abstract
Sex cord markers comprise proteins and hormones that are produced in sex cord-derivatives in normal ovaries and testes as well as in gonadal sex cord-stromal tumors. Sex cord markers (e.g. inhibin-alpha) are used clinically as serum tumor markers. Immunohistochemical staining of sex cord markers may be helpful in the differential diagnosis of ovarian sex cord-stromal tumors versus surface epithelial-stromal tumors, germ cell tumors, other ovarian tumors, and ovarian metastases. Inhibin-alpha has been shown to be the most specific marker of sex cord differentiation. In comparison, calretinin is a somewhat more sensitive albeit less specific marker. Currently, an immunohistochemical panel including inhibin-alpha and calretinin is considered most helpful in the differential diagnosis of ovarian sex cord-stromal tumors. CD99, Müllerian inhibiting substance (MIS), melan A and CD10, being sex cord markers of limited sensitivity and specificity, should only be used as part of an antibody panel in specific diagnostic settings. EMA, CK7 and chromogranin are considered additional markers that may be useful in the differential diagnosis of ovarian sex cord-stromal tumors.
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Affiliation(s)
- F Kommoss
- Institut für Pathologie, Referenzzentrum für Gynäkopathologie, A2/2, 68159 Mannheim, Germany.
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Kumanov P, Nandipati K, Tomova A, Agarwal A. Inhibin B is a better marker of spermatogenesis than other hormones in the evaluation of male factor infertility. Fertil Steril 2006; 86:332-8. [PMID: 16764873 DOI: 10.1016/j.fertnstert.2006.01.022] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 01/12/2006] [Accepted: 01/12/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the role of inhibin B in the evaluation of male factor infertility. DESIGN Prospective study. SETTING Reproductive endocrinology clinic. PATIENT(S) Seventy-five patients with infertility problems (mean age 31.2 +/- 7.5 years) and 12 controls (32.1 +/- 8.8 years) with proven fertility. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Semen analysis was performed according to World Health Organization guidelines. Testicular volume was assessed with the Prader's orchidometer. Serum levels of inhibin B (pg/mL), LH (mIU/mL), FSH (mIU/mL), prolactin (micro IU/mL), and testosterone (nmol/L) were assessed. RESULT(S) The mean +/- SEM inhibin B and testosterone levels were significantly lower in the patients than in the controls (inhibin B: 116.4 +/- 11.7 vs. 181.2 +/- 20.9, P=.008; testosterone: 13.6 +/- 0.9 vs. 25.1 +/- 2.9, P=.008). In general, sperm count and testicular volume in the patients were significantly and positively correlated with inhibin B (sperm count: r = 0.476, P<.0001; testicular volume, right: r = 0.57, P=.0001; left: r = 0.53, P=.0001); the inhibin B-FSH index was negatively correlated with FSH. Inhibin B was more strongly correlated with testicular volume and semen parameters than FSH. Inhibin B in the patients was negatively correlated with FSH (r = -0.723, P=.0001) and LH (r = -0.52, P=.0001) and was positively correlated with testosterone (r = 0.4, P=.0013). CONCLUSION(S) Inhibin B measurement is a better marker of fertility status than FSH and LH. Concentration of inhibin B in patients with infertility may provide useful information on spermatogenesis and possibly serve as a more direct marker of spermatogenesis than FSH.
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Affiliation(s)
- Philip Kumanov
- Clinical Centre of Endocrinology and Gerontology, Medical University, Sofia, Bulgaria
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Larizza D, Calcaterra V, Sampaolo P, Lanati G, Brambilla P, Mondello T, Cesari S. Unusual presentation of juvenile granulosa cell tumor of the ovary. J Endocrinol Invest 2006; 29:653-6. [PMID: 16957416 DOI: 10.1007/bf03344167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We present a case report of juvenile granulosa cell tumor of the ovary (JGCT) with an unusual clinical presentation and hormonal secretion. CASE A 16-yr-old girl had developed spontaneous menarche at the age of 12 yr, but after this initial menstrual bleeding she had no further periods for 4 yr. She had no clinical signs of virilization. Endocrinological studies detected high levels of DHEA, 17 hydroxyprogesterone (17OH-P), insulin and PRL, an exaggerated DHEA response after ACTH stimulation, and low FSH and high LH values after GnRH. An ultrasound examination revealed an irregular structure and increased diameters of her right ovary, due to the presence of a cyst. Because exploratory laparoscopy revealed the presence of a right ovarian mass, her right ovary was removed. JGCT was diagnosed. Ten days after surgery, menstrual bleeding initiated. Endocrinological evaluation after the operation showed that 17OH-P, insulin and basal FSH and LH serum values had returned to normal, while DHEA levels had decreased to within the upper limit of the normal range. Only PRL levels remained unchanged. CONCLUSION Our patient presented some unusual characteristics. She did not have precocious puberty, but secondary amenorrhea. Hormonal secretion consisted mainly of androgens, even though clinical signs of virilization were not present.
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Affiliation(s)
- D Larizza
- Department of Pediatric Sciences, IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
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