FSH stimulated inhibin B (FSH-iB): A novel marker for the accurate prediction of pubertal outcome in delayed puberty.

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Clinicians have long been struggling to find an effective tool to predict onset of puberty.To explore stimulability of inhibin B after exogenous FSH and it's potential role for prediction of onset of puberty.Study subjects were enrolled into "exploratory cohort"(n=42) and "validation cohort"(n=19). "Exploratory cohort" was further divided into Group-1(Healthy children with spontaneous puberty: SP, n=26) and Group-2 (Patients of hypogonadotropic hypogonadism: HH, n=16). "Validation cohort" included children who presented with complaints of delayed puberty.Participants were subjected to FSH stimulation test and GnRHa stimulation test. Cut-offs derived from "exploratory cohort" for basal and FSH stimulated inhibin B(FSH-iB) were applied on "validation cohort" .Basal LH, GnRHa stimulated LH, basal inhibin B and FSH-iB were compared with clinical outcome on prospective follow-up for prediction of onset of puberty.There was statistically significant increment in inhibin B after exogenous FSH in Group 1(SP) in both male(188.8 pg/ml;p-value-0.002) and female (1065 pg/ml;p-value-0.023) subjects. The increment was not statistically significant in Group 2(HH) in both genders. FSH-iB at a cut-off of 116.14 pg/ml in male and 116.50 pg/ml in female had 100% sensitivity and specificity for labelling entry into puberty. On application of these cut-offs on "validation cohort", FSH-iB had 100% PPV, NPV and diagnostic accuracy for prediction of onset of puberty.Inhibin B was stimulable in both male and female subjects. FSH-iB can be considered as novel and promising investigation for prediction of onset of puberty. Future studies are required for further validation.

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Authors: Shakun Chaudhary, Rama Walia, Anil Bhansali, Devi Dayal, Naresh Sachdeva, Tulika Singh, Sanjay Kumar Bhadada


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