Opiniones y recomendaciones de la Sociedad Argentina de Diabetes. Hemoglobina A1c / Opinions and recommendations of the Argentine Diabetes Society. Hemoglobin A1c

La estandarización de la hemoglobina A1c (HbA1c) permitió en algunos países su uso para el diagnóstico de la diabetes mellitus (DM) y la prediabetes, además de su empleo en el seguimiento del paciente con DM. Es importante recordar que se trata de una medida indirecta del promedio glucémico durante el tiempo de vida media del eritrocito, pudiendo verse afectada por variables no glucémicas, como también por interferencias analíticas según la metodología empleada para su determinación. A continuación, se describen las recomendaciones y consideraciones a tener en cuenta para la determinación de la HbA1c cuando se emplea como criterio diagnóstico de la DM, teniendo en cuenta que al utilizarla para tal fin es necesario que la medida se realice con métodos certificados y estandarizados al ensayo utilizado en el Diabetes Control and Complications Trial (DCCT).

The standardization of hemoglobin A1c (HbA1c) allowed in some countries its use for the diagnosis of diabetes mellitus (DM) and prediabetes, in addition to its use in the follow-up of patients with DM. It is important to highlight that it is an indirect measurement of the glycemic average during the halflife of the erythrocyte, and may be affected by non-glycemic variables, as well as by analytical interferences depending on the methodology used for its determination. The recommendations and considerations to take into account for the determination of HbA1c when it is used as a diagnostic criterion for diabetes are described below. In addition, it is important to emphasize that it is essential that the HbA1c measurement be performed with certified and standardized methods to the Diabetes Control and Complications Trial (DCCT)results.

Opiniones y recomendaciones de la Sociedad Argentina de Diabetes. Glucemia en ayunas alterada: ¿es oportuno utilizar el punto de corte en 100 mg/dl en Argentina? / Opinions and recommendations of the Argentine Diabetes Society. Impaired fasting blood glucose: is it appropriate to use a cut-off point of 100 mg/dl in Argentina?

Establecer el punto de corte entre la glucemia en ayunas normal y la alterada resulta de suma importancia a los efectos de considerar a un paciente en riesgo, tanto de progresar a estdos más avanzados de la enfermedad como de sufrir complicaciones micro y macroangiopáticas. Desde 2006 la Sociedad Argentina de Diabetes (SAD), sobre la base de la evidencia considerada en ese momento, estableció el límite inferior de la glucemia alterada en ayunas (GAA) en 110 mg/dl; posteriormente, durante 2022, la Comisión Directiva de la SAD convocó a un grupo de expertos con el objeto de evaluar si esta recomendación debía mantenerse o, al igual que otras sociedades científicas de prestigio, adoptar a tal efecto 100 mg/dl. En este documento de Opiniones y Recomendaciones se encuentran los fundamentos por los cuales la SAD adoptará, de ahora en más, 100 mg/dl como límite inferior de la GAA, en base a las nuevas evidencias científicas que muestran que desde este punto de corte se produce un aumento en la progresión a la diabetes mellitus y de las complicaciones tanto macro como microangiopáticas.

To establish the cut-off point between normal and impaired fasting glycemia (IFG) is extremely important for the purposes of considering a patient at risk both of progressing to more advanced stages of the disease and of suffering micro- and macroangiopathic complications. Since 2006, the Argentine Diabetes Society (ADS), based on the evidence considered at that time, established the lower limit of IFG at 110 mg/d, laterduring the year 2022, The Board of Directors of the ADS vened a group of experts in order to assess whether this recommendation should be maintained or, like other prestigious scientific societies, adopt 100 mg/dl for this purpose. This Opinions and Recommendations document contains therationale for which the SAD will adopt, from now on, 100 mg/dlas the lower limit of the IFG, based on the new scientific edence that shows that from this cut-off point it produces increase in progression to diabetes and both macro and microangiopathic complications.

La hormona antimülleriana como marcador de función ovárica / Anti-Müllerian hormone as a marker of ovarian function

Por décadas, el significado clínico de la hormona antimülleriana (HAM) ha estado limitado a su papel crítico en el desarrollo sexual fetal. Sin embargo, en los últimos 20 años esta ha surgido también como marcador de función ovárica. La HAM tiene funciones específicas como regulador del crecimiento folicular, desempeñando su papel como señal de retroalimentación negativa. Jugaría un papel importante tanto en la regulación del número de folículos en crecimiento (inhibiendo el reclutamiento), como en su selección para ser ovulados (inhibiendo a FSH). La HAM es sintetizada como una pre-prohormona. En el citoplasma cada monómero es clivado generando un fragmento N-terminal: 110 KDa (región pro) y otro C-terminal: 25 KDa (región madura o nativa), unidos en forma no covalente por 2 puentes disulfuro. El dominio C-terminal es el bioactivo, uniéndose al receptor, pero necesita del fragmento N-terminal para desencadenar respuesta biológica. En circulación podemos encontrar una mezcla de la forma pro-HAM y del complejo C-terminal/N-terminal, que serían medidos por los ensayos disponibles. Distintos autores han demostrado que la HAM es un marcador precoz de la disminución y agotamiento de la reserva ovárica. Muestra una estrecha correlación con la reserva folicular y la capacidad reproductiva, más que la FSH y el estradiol. La revisión realizada no deja lugar a dudas sobre la utilidad de la HAM en la etapa fértil. Ha mostrado ser una excelente herramienta para caracterizar pobres respondedoras en los procedimientos de fertilización asistida, alertar precozmente en mujeres jóvenes sobre reserva ovárica baja, en relación con su edad cronológica y expresar un número de folículos en crecimiento elevado, como en síndrome de ovario poliquístico, para evitar una hiperestimulación ovárica. El creciente número de pacientes que decidieron retrasar su maternidad y su papel en la fisiología ovárica han posibilitado que la HAM integre hoy la evaluación de mujeres con alteraciones de la fertilidad.

For many years, the clinical significance of the anti-Müllerian hormone (AMH) was limited to its critical role in foetal sexual development. However, in the last 20 years it has also emerged as a marker of ovarian function. AMH has specific functions as a regulator of follicular growth, playing its role as negative feedback signal. It may also play an important role in the regulation of the number of growing follicles (inhibiting the recruitment) as well as in their selection to be ovulated (inhibiting FSH). AMH is synthesised as a pre-pro-hormone. In the cytoplasm each monomer is cleaved, generating one N-terminal fragment: 110 KDa (pro region) and another C-terminal fragment: 25 KDa, non-covalently bound by two disulphide bridges. The C-terminal domain is bioactive, binding to the receptor, but requires the N-terminal fragment to trigger a biological response. A mixture of pro-AMH complex and C-terminal/N-terminal complex can be found in the bloodstream, which can be measured by the assays available. Several authors have shown that AMH is an early marker of the decrease and depletion of ovarian reserve. It shows a close correlation with follicular reserve and reproductive capacity more than FSH and oestradiol. This review leaves no doubt about the usefulness of AMH in the fertile phase. It has proven to be an excellent tool in characterising poor responders in assisted reproduction procedures, as an early alert in young women of a low ovarian reserve in relation to their chronological age, as well as in expressing a number of follicles in high growth, as in polycystic ovary syndrome, to avoid ovarian hyperstimulation. The growing number of patients who have decided to delay motherhood and the role of AMH in ovarian physiology has led it to an integral part of the assessment of women with impaired fertility.

Dificultades técnicas en el dosaje de testosterona / Technical difficulties in the measurement of testosterone

Objetivo: Análisis bibliográfico de las limitaciones y dificultades técnicas en el dosaje de testosterona total (TT). Materiales y métodos: Revisión de trabajos publicados en diferentes bases de datos desde 2003 hasta el 2014 (PubMed, Biblioteca Virtual de Salud, Cochrane). Evaluación y comparación del dosaje de TT sérica utilizando métodos disponibles en nuestro país, validados por LC-MS/MS y no validados por LC-MS/MS. Resultados: Elaboración de una monografía en la que se evalúan los problemas técnicos en el dosaje de TT en la actualidad.

Objective: Bibliographic analysis of the constraints and technical difficulties in the total testosterone (TT) assay. Methods: Review of articles published in various databases from 2003 to 2014. (PubMed, Health Library, Cochrane). Evaluation and comparison of serum TT assays using the different methods available in our country, validated or not validated by LC-MS/MS. Results: Development of a monograph in which technical problems are evaluated in current TT assays.

Screening for primary aldosteronism in an argentinian population: a multicenter prospective study

Objectives Primary aldosteronism (PA) is characterized by the autonomous overproduction of aldosterone. Its prevalence has increased since the use of the aldosterone (ALD)/plasma renin activity (PRA) ratio (ARR). The objective of this study is to determine ARR and ARC (ALD/plasma renin concentration ratio) cut-off values (COV) and their diagnostic concordance (DC%) in the screening for PA in an Argentinian population.Design multicenter prospective study.Subjects and methods We studied 353 subjects (104 controls and 249 hypertensive patients). Serum aldosterone, PRA and ARR were determined. In 220 randomly selected subjects, 160 hypertensive patients and 60 controls, plasma renin concentration (PRC) was simultaneously measured and ARC was determined.Results According to the 95th percentile of controls, we determined a COV of 36 for ARR and 2.39 for ARC, with ALD ≥ 15 ng/dL. In 31/249 hypertensive patients, ARR was ≥ 36. PA diagnosis was established in 8/31 patients (23/31 patients did not complete confirmatory tests). DC% between ARR and ARC was calculated. A significant correlation between ARR and ARC (r = 0.742; p < 0.0001) was found only with PRA > 0.3 ng/mL/h and PRC > 5 pg/mL. DC% for ARR and ARC above or below 36 and 2.39 was 79.1%, respectively.Conclusion This first Argentinian multicenter study determined a COV of 36 for ARR and 2.39 for ARC. Applying an ARR ≥ 36 in the hypertensive group, we confirmed PA in a higher percentage of patients than the previously reported one in our population. As for ARC, further studies are needed for its clinical application, since DC% is acceptable only for medium range renin values.

Prueba de supresión con Dexametasona 1mg en una población de individuos con normopeso, sobrepeso y obesidad: Estudio multicéntrico / The Overnight 1mg Dexamethasone Test in Healthy Subjects with Normal Weight, Overweight and Obesity: a Multicentric Study

La prueba de supresión con dexametasona-1mg oral nocturna evalúa la conservación del mecanismo de retroalimentación negativa normal ejercido por los glucocorticoides sobre el eje hipotálamo-hipófiso-adrenal (HH-A), siendo ampliamente utilizada en el algoritmo diagnóstico de sospecha de síndrome de Cushing (SC). Pero la concentración de cortisol sérico matinal postinhibición que define la supresiblidad normal ha sido motivo de controversia, con valores variables desde el original =5 ug/dl (=138 nmol/L) hasta una cifra =1,8 ug/dl (=50 nmol/L) últimamente. Asimismo, es controvertida la respuesta en la obesidad, donde está descripta una alteración del eje H-H-A. Por lo tanto, el Departamento de Suprarrenal de SAEM llevó a cabo este estudio multicéntrico con el objetivo de definir la concentración de cortisol sérico obtenida luego de la administración de dexametasona 1mg nocturna, en una población de sujetos sanos de nuestro país con peso normal; concomitantemente, se evaluaron individuos con sobrepeso y con obesidad simple para comparar su respuesta respecto de los sujetos normopeso. Se estudiaron 80 individuos sanos, 60 mujeres y 20 hombres, de 15 a 66 años de edad, que fueron divididos en tres grupos según el índice de masa corporal (IMC): Normopeso, IMC=19-24,9 kg/m2, n=39; Sobrepeso, IMC=25-29,9 Kg/m2, n=21; y Obesos, IMC = 30 kg/m2, n=20. Se administró dexametasona 1 mg vía oral a las 23 hs. y se determinó la cortisolemia a las 8hs. de la mañana siguiente. Las determinaciones se centralizaron en un solo laboratorio y fueron realizadas por el equipo de radioinmunoensayo (RIA) de DSL, sensiblidad analítica de 0,5 ug/dl. Paralelamente en 10 sujetos, se determinó la cortisolemia postinhibición en las mismas muestras con otro equipo analítico, RIA-DPC. Resultados: Los resultados de la cortisolemia postsupresión en los tres grupos estudiados se expresan como X± DS (rango): en el grupo normopeso fue de 2,10± 0,77 ug/dl (0,78-3,40); en el sobrepeso, 1,94± 0,66 ug/dl (0,962,90); y en los obesos, 1,86 ± 0,63 ug/dl (0,85-3,30), no observándose diferencias significativas entre los tres grupos estudiados (test de Kruskall Wallis Dunn, p=0,319). En los 10 sujetos cuyas muestras fueron simultáneamente analizadas por RIA-DSL y por RIA-DPC, se observaron marcadas diferencias en 8/10, siendo la mediana de cortisol sérico obtenida por RIA-DPC de 0,5µg/dl, significativamente menor a la obtenida por RIA-DSL, de 2,2 µg/dl (test de Wilcoxon, p=0,002). Conclusiones: Debemos destacar que este es el primer estudio multicéntrico que evalúa la respuesta a la inhbibición con dexametasona 1 mg en nuestro medio. En esta primera etapa, demostramos que una concentración de cortisol sérico post 1 mg de dexametasona oral nocturna = 3,4 µg/dl (= 93,8nmol/l), determinada por RIA-DSL, caracteriza la respuesta normal de nuestra población de sujetos sanos. Ello es independiente del peso corporal, ya que los sujetos con normopeso, sobrepeso y obesidad suprimieron a valores similares. No se observó falta de supresión en ningún caso estudiado. Por otra parte, dadas las marcadas diferencias de valores halladas en las mismas muestras cuando son analizadas por equipos diferentes de RIA, es fundamental referir los resultados al método y equipo utilizados y estandarizar las pruebas clínicas con la metodología específica empleada en cada laboratorio.

The overnight oral dexamethasone test assesses the normal negative feedback of cortisol on the hypothalamic-pituitary-adrenal axis (H-P-A) 1. It is widely used in the screening of Cushing’s Syndrome (CS) 3,4,5. But the cut-off values for the normal response remains controversial: originally it was considered as 5 ug/dl and in the last years it was reported as 1.8 ug/dl 4. Likewise, there is no agreement about the suppression values in obesity, where a hyperactivity of the H-P-A axis has been reported. Therefore, the Adrenal Department of the Argentine Society of Endocrinology and Metabolism (SAEM) studied 80 healthy subjects recruited from ten hospitals of Buenos Aires in order to assess the normal response in our population. Sixteen women and twenty men, aged 15-66 years old (X = 39.2ys), were classified into three groups, according to their body mass index (BMI): normal weight, BMI- 19-24.9 kg/m2 (n= 39); overweight, BMI- 25-29.9 kg/m2 (n=21) and obese subjects, BMI> 30 kg/m2 (n=20). They had to be euthyroid and free of corticosteroid treatment, contraceptive pills, hormone replacement therapy, rifampicin and psychotropic drugs at the time of the study. Subjects referring drug abuse, alcoholism, depression, cardiovascular, and renal disorders and,obviously, adrenal diseases were excluded from the study. Dexamethasone 1mg per os was administered at 11p.m. and blood was withdrawn at 8 a.m. on the next morning to determine plasma cortisol concentration. Determinations were centralized in one laboratory and the RIA-DSL (Diagnostic System Laboratories-radioimmunoassay) was used. Additionally, in ten subjects plasma cortisol was also determined in the same blood samples by another radioimmunoassay kit, RIA-DPC (Diagnostic Products Corporation). The Kruskall-Dunn test was used to compare the plasma cortisol levels post-1mg dexamethasone among the three groups studied. In the 10 patients whose determinations were made in the same blood samples by two different RIA-kits (DSL and DPC),the Wilcoxon test was used to compare the results of plasma cortisol between RIA-DSL and RIA-DPC. Results: The results are expressed as X ± SD ug/dl (range). Plasma cortisol levels after 1mg-dexamethasone were: 2.10 ± 0.77 ug/dl ( 0.78- 3.40 ug/dl) in the normal weight goup; 1.94 ± 0.66 ug/dl (0.96-2.90) in the overweight group and 1.86 ± 0.63 ug/dl (0.85-3.30) in the obese subjects (Table I); no significant differences were observed among the three groups (p=0.319). According to these results, the cut-off value for plasma cortisol post-dexamethasone in the normal weight subjects was considered as = 3.4 ug/dl (93.8 nmol/L) using RIA-DSL. Similar suppression values were obtained in the overweight and obese subjects - 2.9 and 3.3 ug/dl, respectively. No false positive results were observed, either individually or in each group (Fig 1). In the 10 subjects whose blood cortisol was simultaneously determined in the same samples by RIA-DSL and RIA-DPC, the median for plasma cortisol was 2.2 ug/dl for the first and 0.5 ug/dl for the latter, respectively, with a significant difference between both RIA kits (p=0.002). (Table II). Conclusions: In this first stage, the present multicentric study shows that a plasma cortisol level post - 1mg dexamethasone suppression of = 3.4 ug/dl ( 93.8 nmol/L) defines our normal population response, with no significant differences among normal weight,overweight and obese subjects. Furthermore, we wish to point out that the cortisol values must be referred to the method and commercial kits used in each laboratory, since significant differences can be observed in the same blood samples when different kits are used, such as we and other authors have observed. We wish to remark the importance of our study, which is the first in its characteristics in Argentina. Furthermore, in a second stage, we plan to enlarge the sample number and to determine blood cortisol in the same samples by using different methods, in order to obtain a standardized cortisol suppression level. We also plan to study patients with confirmed CS and pseudocushing states in order to assess the sensitivity and specificity of the 1mg-dexamethasone suppression test in our population.

Hiperprolactinemia en niños y adolescentes, conceptos e interrogantes actuales / Hyperprolactinemia in children and adolescents, current questions and concepts

La hiperprolactinemia constituye la alteración endocrina más común del eje hipotálamo-hipofisario, aunque su prevalencia en la población infantojuvenil no está aún claramente definida. Además de la Prolactina (PRL) nativa (23Kda), se han descripto numerosas variantes moleculares (PRL glicosilada, fosforilada, sulfatada, deaminada, BIG PRL, BIG BIG PRL, etc.), algunas de ellas con menor o ausente actividad biológica. El recién nacido presenta inmadurez fisiológica del eje prolactínico, alcanzando niveles de hasta 800 ng/mL en las primeras horas de vida. Posteriormente, cualquier proceso que interrumpa la secreción de dopamina, interfiera con su liberación hacia los vasos portales hipofisarios o bloquee los receptores dopaminérgicos de las células lactotróficas, puede causar hiperprolactinemia. La patología tumoral constituye el diagnóstico de mayor relevancia. Los prolactinomas poco frecuentes tienen, por su presentación clínica en niños y adolescentes, algunas características destacables. De acuerdo a nuestra experiencia, el retraso puberal puede observarse en aproximadamente el 50 % de las pacientes de sexo femenino y en más del 25 % de los varones. La mayor prevalencia de macroadenomas en varones coincide con los hallazgos en adultos y no dependería de un mayor retraso en el diagnóstico. En pacientes con hiperprolactinemia asintomática debe evaluarse la presencia de proporciones alteradas de isoformas de PRL. La cromatografía en columna con sephadex G100, la precipitación con suspensión de proteína A o con PEG y la ultracentrifugación constituyen los métodos más frecuentemente empleados para la detección de las distintas isoformas de PRL. En nuestra experiencia la B PRL constituyó el 6,6 - 32,6 % de la PRL total y la BB PRL constituyó el 40 y el 72 % de la misma en este grupo de pacientes. Por su efectividad y tolerancia, los agonistas dopaminérgicos constituyen la terapia inicial de elección en pacientes en edad pediátrica. La bromocriptina y la cabergolina han sido empleadas y con resultados similares a los de los pacientes adultos. La adquisición de nuevos conceptos y la mejor comprensión de la fisiología y la fisiopatología de los estados hiperprolactinémicos en niños y adolescentes, han modificado las alternativas diagnósticas y terapéuticas

Hyperprolactinemia is the most common endocrine alteration of the pituitary-hypothalamic axis, although its prevalence in the pediatric and adolescent population is not clearly defined yet. Apart from native (23Kda) Prolactin (PRL), many molecular variants (glycosylated, phosphorilated, sulphated, deaminated PRL, BIG PRL, BIG BIG PRL, etc) have been described, some of them with less or no biological activity. Newborns have physiological immaturity of the prolactin axis, attaining levels of as much as 800 ng/mL during the first hours after birth. Subsequently, any process that discontinues dopamine secretion, interferes with its secretion to the pituitary portal vessels or blocks dopaminergic receptors of lactotrophic cells, may cause hyperprolactinemia. Tumor disease is the major diagnosis. Prolactinomas, though rare, have some noticeable features, given their clinical presentation in children and adolescents. Based on our experience, pubertal delay occurs in approximately 50 % of females and in over 25 % of males. The larger prevalence of macroadenomas in males is consistent with findings in adults and would not be related to a later diagnosis. In patients with asymptomatic hyperprolactinemia, the presence of altered proportions of PRL isoforms should be evaluated. G100 Sephadex column chromatography, precipitation with a protein A suspension or PEG and ultracentrifugation, are the most common methods for detection of PRL isoforms. In our experience, B PRL accounted for 6.6 - 32.6 % of total PRL and BB PRL accounted for 40 to 72 % of total PRL in this group of patients. Because of their effectiveness and tolerance, dopaminergic agonists are the initial therapy of choice in pediatric age patients. Bromocriptine and cabergoline have been used with similar results to those obtained in adults. The new concepts gained and the better insight into the physiology and pathophysiology of hyperprolactinemic conditions in children and adolescents have brought about a change in diagnostic and therapeutic alternatives

Reproducibility and variability of the arginine test in normal adults: comparison between sexes

The biochemical diagnosis of growth hormone deficiency in adults (AGHD) remains controversial, mainly as regards stimulation tests and suggested cut-off lines. The insulin tolerance test proved to be the most effective growth hormone (GH) secretagogue in normal males, but a poor intra-individual reproducibility has been reported. Given the safety of the arginine (AST), we decided to evaluate the incidence of false negatives (non responder normal subjects), its reproducibility and variability. Twenty five healthy non-obese volunteers (16 males, 9 females) with a chronological age range between 19 and 40 years, (mean: 29.8) were evaluated. AST was performed (0.5 g/kg IV infusion for 30 min), measuring GH (IRMA) at baseline (B), 30, 60 and 90 minutes, and it was repeated in the same subject 7 to 30 days later; in females both tests were performed in the early follicular phase. Results (median and range) were: 1st test B: 0.61 (0.35-22.60) mug/L; maximal response (Mx Resp) 10.00 (0.48-48.80 mug/L 2nd test B:0.50 (0.38-27.0) mug/L; Mx Resp 11.00 (0.50-47.70) mug/L. The statistical evaluation (Wilcoxon signed rank test) showed no differences between B vs. B and Mx Resp vs Mx Resp. Separated by Sex, males showed: 1st test: B 0.45 (0.35-4.30) mug/L; Mx Resp 6.30 (0.48-48.80) mug/L. 2nd test B 0.46 (0.38-8.80) mug/L; Mx Resp 10.90 (0.50-47.70) mug/L, while females showed 1st test: B 5.20 (0.50-22.60) mug/L; mx Resp 14.00 (3.50-36.70) mug/L 2nd test B 3.60 (0.75-27.00) mug/L; Mx Resp 13.00 (3.70-28.10) mug/L. The statistical comparison (Mann Whitney test) showed significant differences between both sexes in basal values of the first and second test (p<0.001), and in the naximal response of the first test (p<0.03). The statistical analysis did not show significant differences in delta increases between males and females, neither in the first AST nor in the second one. Considering GH values =3 mug/L as a positive response, 4 males exhibited insufficient responses in both tests and other 2 males showed discordant results between tests 1 and 2. All females evaluated produced responses above 3 mug/L in both tests. The results of the present study demonstrate that, particularly in men, AST has no clear limit of normality while it shows good intra-individual reproducibility. In conclusion, at present the biochemical diagnosis of AGHD requires a clear and precise standardization which includes all variables that can modify the GH response to the stimulus used.

Varicocele in prepubertal boys: evaluation of clinical, doppler and hormonal findings

Hormonal, clinical and scrotal Doppler findings were assessed in 16 prepubertal patients having unilateral varicocele. As already described in pubertal patients, Doppler studies made it possible to detect patterns of prolonged, intermittent or permanent reflux. An LH-RH test and an hCG test measuring LH, FSH and testosterone (T) were performed in all cases. patients with varicocele showed (median and range): LH B (mlU/ml): 0.40 (0.40-2.1); LH Mx.: 3.7 (1.1-15); FSH B (mlU/ml); 1.95 (0.40-4.5); FSH Mx.: 4.9 (3.1-10); T B (ng/ml): 0.2 (0.1-1.5): T Post.: 2.25 (0.82-11.5). The control group showed: LH B (mlU/ml): 0.40 (0.4-0.85); LH Mx.: 2.15 (0.63-12) FSH B (mlU/ml): 1.45 (0.4-3); FSH Mx.: 4.25 (2.6-5.9); T B (ng/ml): 0.1 (0.1-0.3); T Post.: 3.26 (1.0-5.6). No significant differences were found between the hormonal results of the different groups classifed according to the scrotal findings. Basal LH and FSH in grade 3 varicoceles were found to be significantly higher (p < 0.05) than those of the control group. Basal T, as well as the maximal response of both gonadotropins to LH-RH, and T response to hCG showed no significant differences with reference to the control group. Our findings provide indirect support to the notion that the gonadal damage would become detectable from puberty onwards.