Decreased serum inhibin B/FSH ratio as a marker of Sertoli cell function in male survivors after chemotherapy in childhood and adolescence.

OBJECTIVE: Inhibin B produced by Sertoli cells may be an important marker of seminiferous tubule function in patients treated with chemotherapy (CT). The aim of this study was to evaluate the inhibin B/FSH ratio to detect male gonadal dysfunction in cancer survivors treated in childhood and adolescence. PATIENTS: Twenty-one male patients (group A) treated with 6-10 courses of CT for Hodgkin's disease during childhood and adolescence were examined 3-11 years after the conclusion of treatment. Twenty healthy young men (18-23 years old) were used as controls (group B). METHODS: Serum samples for the determination of inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), sex hormone-binding globulin (SHBG) and semen for analysis were collected. RESULTS: The median testicular volume of patients of group A was lower than those of group B (p = 0.001) and a positive correlation was found between testicular size and sperm count (r = -0.5, p = 0.01). Semen analysis revealed azoospermia in 11 patients, severe oligospermia in four and normal sperm count in three. No significant difference was found in the median of T, LH, SHBG, inhibin B concentrations and T/LH ratio between the groups. Serum inhibin B was correlated with the serum FSH levels (r = -0.5, p = 0.02). Median FSH was significantly higher (p = 0.0001), and median inhibin B/FSH ratio was significantly lower in group A than in controls (p = 0.0002), but the inhibin B/FSH ratio was higher in the patients with normal sperm count than in those with oligospermia (p = 0.00004). CONCLUSIONS: These results show that the cytotoxic effects of CT cause severe damage to the germinal epithelium with subtle effects on Sertoli cells. To assess Sertoli cell function in men with primary testicular damage after treatment with CT in childhood and adolescence, the inhibin B level needs to be interpreted in the context of the circulating FSH, especially when normal FSH levels are observed.

Espectro ultra-sonográfico no hiperandrogenismo: ovários policísticps x ovários multicísticos / Sonographic spectrum in the hyperandrogenism: polycystic ovaries x multicystic ovaries

O objetivo deste estudo foi determinar as principais diferenças clínicas e ultra-sonográficas entre ovários policísticos (OP) e multicísticos (OM). Selecionamos 39 mulheres com hiperandrogenismo e/ou anovulaçao crônica de causa nao definida (HACND) e realizamos dosagem dos androgênios, hormônio luteotrófico (LH), hormônio folículo estimulante (FSH) e ultra-sonografia pélvica (USG). Na ultra-sonografia pélvica, quando encontramos dez ou mais cistos, classificamos em: OP - volume ovariano maior do que 10cm3 ou quando o estroma era hiperecogênico e OM - volume ovariano menor do que 10 cm3 ou ausência da intensidade do eco do estroma. Em quatro pacientes, a USG foi considerada normal. Nas demais, utilizando o parâmetro estroma, 27 pacientes apresentavam OP e 8 OM. Comparando OP x OM, o volume ovariano e a freqüência de ciclos irregulares foi maior no OP (p<0.05). Quando utilizamos o parâmetro volume ovariano, 21 pacientes apresentavam OP e 14 OM. Comparando os dois grupos, a freqüência de ciclos irregulares foi maior no OP e encontramos correlaçao entre testosterona e volume ovariano (r=0.36, p<0.05). Portanto, consideramos que a classificaçao entre OP e OM, independente do parâmetro ulttra-sonográfico utilizado - volume ovariano ou estroma -, pode representar um amplo espectro clínico e hormonal presente em mulheres com HACND e por isso deveria ser utilizada como rotina.