Role of Inhibin B, AMH, GnRHa Test and HCG Stimulation Test to Distinguish Isolated Hypogonadotropic Hypogonadism (IHH) from Constitutional Delay in Growth and Puberty (CDGP).

Introduction: This study aimed to distinguish isolated hypogonadotropic hypogonadism (IHH) from constitutional delay in growth and puberty (CDGP) by various hormonal tests in both sexes. Methods: Boys with testicular volume (TV) <4 ml (14-18 years) and girls with breast B1 stage (13-18 years) were enrolled in this study. A detailed history, clinical examination and hormonal analysis including basal luteinising hormone (LH), follicle-stimulating hormone (FSH), inhibin B, anti-Mullerian hormone (AMH), testosterone (boys), oestradiol (girls), triptorelin stimulation test and 3-day human chorionic gonadotropin (HCG) stimulation test (boys) were performed. All patients were followed for 1.5 years or till 18 years of age. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-offs with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for various hormones to distinguish IHH from CDGP. Results: Of 34 children (male: 22 and female: 12), CDGP and IHH were diagnosed in 21 and 13 children, respectively. 4 hours post-triptorelin LH had the highest sensitivity (100%) and specificity (100%) for identifying IHH in both sexes. Basal inhibin B had good sensitivity (male: 85.7% and female: 83.8%) and specificity (male: 93.3% and female: 100%) for diagnosing IHH. 24 hours post-triptorelin testosterone (<34.5 ng/dl), day 4 post-HCG testosterone (<99.7 ng/dl) and 24 hours post-triptorelin oestradiol (<31.63 pg/ml) had reasonable sensitivity and specificity for identifying IHH. Basal LH, FSH and AMH were poor discriminators for IHH in both sexes. Conclusion: The best indicator was post-triptorelin 4-hour LH followed by inhibin B, which had a reasonable diagnostic utility to distinguish IHH from CDGP in both boys and girls.

Serum Irisin in Polycystic Ovary Syndrome and its Alteration with Metformin Intervention.

Introduction: Studies investigating the alterations of serum irisin and its change with metformin therapy in patients with polycystic ovary syndrome (PCOS) are conflicting. Our aim is to study serum irisin in PCOS patients and the change of irisin levels with metformin therapy over 6 months. Methods: This is a randomized control study conducted in 187 PCOS cases and 94 age-matched controls aged 18-40 years. Detailed evaluation of anthropometric, biochemical, and hormonal parameters was performed. A subset of 99 overweight/obese patients with body mass index (BMI) ≥23 kg/m2 were stratified into a metformin group (n = 67) receiving 500 mg thrice daily and a lifestyle intervention-only group (n = 32). The effect of metformin therapy on serum irisin levels was measured at the end of 6 months. Statistical analyses were performed with SPSS version 26.0 Software. Results: Serum irisin was higher in PCOS patients than in controls [12.47 (8.1-17.7) vs 8.3 (7.0-9.6) ng/ml, P < 0.001], independent of BMI. Serum irisin showed a significant positive association with BMI (ß =0.168), waist-to-hip ratio (ß =0.166), leutinizing hormone (ß =0.225), TG (ß =0.305), FAI (ß =0.151), and testosterone (ß =0.135). Serum irisin showed a significant positive association with homeostatic model assessment of insulin resistance (HOMA-IR) (ß =0.14, P = 0.04) in overweight/obese PCOS patients only (n = 146) but not in the whole PCOS cohort (n = 187). Metformin reduced the median serum irisin levels significantly (13.9 to 12.1 ng/ml, P < 0.001), and the delta change in irisin levels was associated with HOMA-IR in the metformin group. Conclusion: Serum irisin is increased in PCOS patients independent of BMI. Metformin therapy reduced serum irisin levels in overweight/obese PCOS patients by improving insulin resistance.

Distribution and correlation of radon and uranium and associated hydrogeochemical processes in alluvial aquifers of northwest India.

The spatial and vertical distributions of radon and uranium are evaluated in relation to the hydrogeology, geomorphology, and hydrochemistry of southwest Punjab. Radon activity of the groundwater ranges from 580 to 3633 Bq/m3 (shallow groundwater 580 to 2438 Bq/m3 and deep groundwater 964 to 3633 Bq/m3), and uranium concentration varies from 24.4 to 253 µg/L (shallow groundwater 24.4 to 253 µg/L and deep groundwater 27.6 to 76.3 µg/L). Shallow groundwater shows higher U concentration compared with deeper ones, which can be attributed to the presence of dissolved oxygen (DO) and NO3- as oxidants and HCO3- as stabilizing agent in shallow zone. Unlike uranium, the radon activities were found to be similar in both shallow and deep groundwater. Rnexcess over secular equilibrium was used to confirm the possibility of additional sources of radon, such as secondary minerals present in the subsurface. Surface manifestations show significant influence on radon and uranium distributions in the shallow zone but not in deep zone due to limited hydraulic connectivity. Depth profiles and correlations of radon and uranium with trace elements and hydrochemical parameters indicate that groundwater exhibits different redox characteristics in shallow (younger and oxidizing) and deep zones (older and reducing). The present study provides critical information that can be helpful for planning sustainable groundwater development in this region and other similar regions without contaminating the relatively safer deep aquifers.