Introducción: el 6 % de las mujeres con cáncer de mama es diagnosticado en edad fértil, antes de los 40 años. Los avances en las metodologías que permiten la detección temprana y los tratamientos aplicados a distintos tipos de cáncer hacen que muchas mujeres diagnosticadas y tratadas a edades tempranas de la vida sean sobrevivientes de los mismos. Hay múltiples mecanismos propuestos sobre cómo la quimioterapia afecta los folículos ováricos, que incluyen tanto mecanismos directos como indirectos. El grado de daño producido y el riesgo de infertilidad dependen de la dosis y del tipo de agente quimioterápico utilizados. También está relacionado con la edad en la que se comienza el tratamiento, con mayor riesgo de infertilidad cuanto mayor sea la edad reproductiva de la paciente. Materiales y métodos: se utilizaron distintas bases de datos en línea: PubMed, SciELO. Los términos de búsqueda fueron “hormona antimülleriana”, “marcadores de reserva ovárica”, “tratamiento oncológico y fertilidad” combinados con “diagnostico” y “pronóstico”. Conclusiones: la hormona antimülleriana se considera un marcador pronóstico de la reserva ovárica en pacientes con cáncer que se someten a quimioterapia. Se evidenció que en mujeres con concentraciones de hormona antimülleriana detectable (de al menos 0,16 ng/ml) y edad menor a 40 años es probable que recuperen su función ovárica posquimioterapia. En contraste, las mujeres mayores en peripremenopausia, con niveles muy bajos de hormona antimülleriana, podrían predecir una falla ovárica permanente luego del tratamiento

Salivary cortisol (SC) is a measure of free cortisol and follows diurnal rhythm of serum or plasma cortisol, so it is convenient for collection noninvasively on an outpatient basis. The Endocrine Society recommends measuring MiSC concentrations as a first-line test in screening for Cushing's syndrome. To define its utility as a diagnostic test, it is important to know whether assay techniques or thresholds affect the rate of false-positive results. Revision of literature showed that there are marked differences in sensitivity and specificity, and cutoff values of SC assays. The aim of this study was to compare MiSC results obtained by available immunoassays with different analytical sensitivity (AS) in an Argentinian population, and compare by pairs of methods their Diagnostic Concordance (DC) using individual reported cutoffs (RCO). Material and methods: Salivary samples obtained at 11 PM, from 133 adults subjects (18-74 years), with no corticoid therapy (last 6 months), psychiatric medication, depression, thyroid diseases, statins administration, or smoking. MiSC (nmol/L) were measured by ECLIA Cobas Roche (RCO: 4.9; AS: 1.5); RIA Beckman Coulter (RCO: 0.8; AS: 0.8), CLIA Liaison DiaSorin (RCO: 8.0; AS: 4.4), CLIA Access Beckman Coulter (RCO: 8.3; AS: 0.3) and CLIA Immulite 1000 Siemens (modified methodic) (RCO: 5.0 own data not reported; AS: 1.0). Bland & Altman biases were calculated between methods. Results: Calculated median, range and p95 (nmoL/L) for each method were: ECLIA Cobas (n=131): 1.6 (1.5-14.5) 6.4; RIA (n=90): 1.33 (0.8-7.7) 3.6, CLIA Liaison (n=126): 4.4 (8.4-22.1) 8.2, CLIA Access (n= 125): 4.1 (0.3-28) 15.6, and CLIA Immulite1000 (n: 99): 2.5 (1.4-20) 7.6. Calculated p95 was higher than RCO in all methods, being RIA the highest. ANOVA analysis for paired samples measured by all methods showed significant (p<0.005) differences except for Access and Liaison (p=1,000). Biases (nmol/L) obtained were: Cobas vs Immulite = -1; Access vs Cobas = 3.2; Cobas vs Liaison = -2.8; Cobas vs RIA = 0.9; Access vs Immulite = 2.4; Immulite vs Liaison = -1.8; Access vs Liaison = 0.3; Access vs RIA = 4.1; Liaison vs RIA = 3.6; Immulite vs RIA = 1.9. Lowest bias found was between Access and Liaison, result coincident with ANOVA. %DC between pairs of methods using RCOs was: Cobas vs Immulite = 87%; Access vs Cobas= 84%; Cobas vs Liaison = 95%; Cobas vs RIA = 64%; Access vs Immulite = 85%; Immulite vs Liaison = 90%; Access vs Liaison = 84%; Access vs RIA= 72%; Liaison vs RIA = 63%; Immulite vs RIA = 70%. Lowest %DC was found when RIA was involved in the comparison, which could be due to its low AS and RCO that are the same. Conclusions: Differences in %DC observed could be due to not only differences between methods but differences in composition of the population studied. Validating MiSC cutoff values in individual laboratories is important for good clinical use of results in the diagnosis and follow-up of Cushing’s syndrome. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

El cáncer diferenciado de tiroides (CDT) es el cáncer endocrinológico más frecuente y en las últimas décadas su incidencia ha aumentado. El seguimiento de la enfermedad se efectúa con la medición de tiroglobulina (Tg) sérica, ecografía cervical y barrido corporal total diagnóstico. Los métodos de Tg han evolucionado a través del tiempo. Actualmente, los ensayos inmunométricos de Tg se clasifican en 1.ª y 2.ª generación (1.ª G y 2.ª G). Comprobamos que los ensayos de 2.ª G alcanzan una precisión adecuada para medir valores del orden de 0,1ng/ml y los de 1.ª G de 1ng/ml. La bibliografía señala que en el caso de los pacientes de bajo riesgo, una Tg bajo levotiroxina indetectable por un método de 2.ª G puede evitar la realización de Tg estimulada, sea por la suspensión de la terapia hormonal como por el empleo de la TSH recombinante humana, debido a su mayor sensibilidad. Sin embargo, por su menor especificidad, un valor detectable no asegura la presencia de enfermedad, y debería confirmarse. Para optimizar la utilidad clínica de dicha medición se podrían emplear valores de cortes de acuerdo con la población y el método en lugar de la sensibilidad funcional o límite de cuantificación del mismo. Se señalan también otros aspectos críticos en la medición de Tg como son la discordancia entre distintas metodologías y las interferencias en su medición, principalmente por anticuerpos antitiroglobulina. En presencia de interferencias pierden utilidad los ensayos de Tg de 1.ª y 2.ª G. El seguimiento de los pacientes con Tg interferida tiene limitaciones todavía no resueltas. Es importante consensuar entre médicos y bioquímicos las dificultades técnicas y los criterios de interpretación de los valores de Tg en el seguimiento de los pacientes con CDT.

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.

Background: Glycosylated prolactin (G-PRL) is considered as the major post-translational modification of prolactin (PRL) showing reduced lactotropic and mitogenic activities compared to non-glycosylated prolactin (NG-PRL). Aim: To evaluate the evolution of G-PRL in normoprolactinemic children and adolescents and to analyze possible variations in glycosylated/total prolactin (T-PRL) ratios. Methods: T-PRL, G-PRL and NG-PRL were evaluated in 111 healthy female and male children and adolescents (4.1–18 years), classified as group 1 (Tanner I), group 2 (Tanner II–III) and group 3 (Tanner IV–V). G-PRL and NG-PRL were identified by chromatography on concanavalin-A-Sepharose. Results: G-PRL/T-PRL (median-range): females, group 1: 0.59 (0.17–0.77), group 2: 0.56 (0.31–0.78), group 3: 0.60 (0.38–0.79); males, group 1: 0.64 (0.39–0.80), group 2: 0.61 (0.24–0.79), group 3: 0.62 (0.35–0.90); the p value is not significant among the different groups in both genders. G-PRL/T-PRL ratios do not change when comparing low (first quartile) versus high (third quartile) T-PRL levels in the different groups. Conclusion: Our study would appear to support cosecretion of G-PRL and NG-PRL from childhood to the end of puberty. Such cosecretion would not be dependent on sex steroid levels. It is important to point out that puberty does not change the proportions of G-PRL and NG-PRL.

We critically evaluated the diagnostic value of IGF-I and IGF-binding protein-3 (IGFBP-3) in GH deficiency (GHD) in children and adults using receiver operating characteristic (ROC) plot analysis. Sixty-six children (chronological age, 1.3-15 yr) were studied: 34 GHD and 32 idiopathic short stature (ISS). Ninety-two adults (chronological age, 18-70 yr) were also evaluated: 72 GHD, 34 of childhood onset (AGHD-CO), and 38 of adult onset (AGHD-AO); and 20 healthy volunteers. The SD score (SDS) for IGF-I was calculated from 596 normal subjects (212 children and 384 adults), and the SDS for IGFBP-3 was calculated from 350 normal subjects (212 children and 138 adults). The ROC plot showed that the best IGF-I SDS cut-off line was -1.65 for children [sensitivity (S), 68%; specificity (Sp), 97%, diagnostic efficiency (DEf), 81%], the cut-off line for AGHD was -1.65 for AGHD-CO (S, 91%; Sp, 100%; DEf, 94%), and the cut-off line for AGHD-AO was -1.80 (S, 81%; Sp, 100%; DEf, 88%). For IGFBP-3 SDS, the best cut-off line was 1.80 for children ( S, 90%; Sp, 60%; DEf, 78%); it was -1.45 for AGHD-CO (S, 90%; Sp, 75%; DEf, 82%) and -0.90 for AGHD-AO (S, 90%; Sp, 68%; DEf, 77%). An accurate diagnosis was obtained using IGF-I SDS alone in GHD children 65%; ISS, 97%; AGHD-CO, 92%; AGHD-AO, 86%, with IGFBP-3 SDS alone in GHD children 60%; ISS, 90%; AGHD-CO, 75%; AGHD-AO, 68%. Considering both, an accurate diagnosis was obtained in GHD children 60%; ISS, 87%; AGHD-CO, 71%; AGHD-AO, 64%. In conclusion, our findings support the need to use cut-off lines expressed in SDS obtained using an appropriate statistical methodology for better characterization of the various clinical presentations. IGF-I proved to be more useful because of its good diagnostic efficiency and accuracy in both children and adults, whereas IGFBP-3 did not significantly contribute to the diagnosis of GHD.

The aim of this study was to evaluate the usefulness of basal measurements of gonadotropins in distinguishing between constitutionally delayed puberty (DP) and hypogonadotropic hypogonadism (HH), comparing its diagnostic efficiency with that of the dynamic GnRH infusion test (0.83 microg/min during 120 min). We studied 20 males, chronological age (CA) 14-18 years, with a final diagnosis of DP (n = 8), partial HH (n = 5) and complete HH (n = 7), confirmed by follow-up. We also evaluated basal samples of ultrasensitive LH and FSH in 117 healthy control males (CA 2-19 yr), classified according to Tanner stage. In the control group, ROC plot analysis showed a cutoff to differentiate prepuberty from puberty of 0.65 IU/l for LH (sensitivity: 91%, specificity: 98%). Differences were found (p < 0.05) in basal LH and in maximal responses to GnRH in complete HH in relation to DP and partial HH. The diagnostic efficiency of the GnRH infusion test was 85%. For basal LH, a cut-off limit of 0.65 IU/l showed a diagnostic efficiency of 85% for complete HH and 100% for partial HH and DP. We conclude that, in our experience, basal LH levels above 0.65 IU/l measured by ultrasensitive assay would rule out a complete deficiency. It was not possible to differentiate DP from partial HH, either in basal samples or with the infusion test.

OBJECTIVE:To study hormonal and histological parameters of paediatric-adolescent varicocele in order to know certain aspects of its natural history, in an attempt to find prognostic markers of testicular damage.DESIGN AND METHODS:In a prospective cross-sectional study, we evaluated 93 children and adolescents with left unilateral varicocele and 29 healthy males as control group. All of them were classified according to Tanner stage. Scrotal Doppler in both testes and GnRH and human chorionic gonadotrophin (hCG) tests were performed in all subjects. Surgery was performed in 28 patients and homolateral testicular biopsy in 18.RESULTS:Hormonal measurements of patients with varicocele were compared with a control group for each Tanner stage. Testicular biopsy specimens were analysed by light and electron microscopy. We only observed statistical differences in Tanner III patients in basal FSH (median and range) controls=1.70 (1.10-3.70) IU/l vs varicocele=4.20 (1.00-7.50) IU/l, P<0.05 and in Tanner IV patients in LH post-GnRH: controls=11.0 (7.50-15.0) IU/l vs varicocele=18.0 (5.10-29.0) IU/l, P<0.05 and in testosterone post-hCG: controls=9.50 (7.7-10.0) ng/ml vs varicocele=12.0 (6.2-23.0) ng/ml, P<0.01. No correlation was found between the various clinical grades of varicocele and hormonal measurements for each Tanner stage. No statistically significant differences were found between pre- and post-operative hormonal findings, either in basal levels or in maximal responses. On the other hand, no morphological abnormalities were observed by electron microscopy in germ cells, tubular wall and interstice.CONCLUSIONS:There appears to be no reliable biochemical marker in children and adolescents that may predict impaired testicular function. A significant size discrepancy between both testes, testicular pain and a hyperresponse to GnRH stimulation should continue to be, for the time being, the indications for surgery.

The aim of this preliminary study was to assess variation in thyrotropin (thyroid-stimulating hormone; TSH) levels using an immunoradiometric assay during the first 6 months of life of normal infants. One hundred and five normal newborns (59 females, 46 males) were evaluated for TSH, triiodothyronine and thyroxine at 48 h of life, and TSH was additionally determined at 15 days (n = 42), 30 days (n = 38), 60 days (n = 24), 90 days (n = 28), and 180 days (n = 30). Complete determinations during the total period of the study were obtained in 17 infants. Samples corresponding to the 48-hour period did not exhibit a normal distribution. In this group, percentile 3 corresponded to 0.9 mU/l, the median to 4.2 mU/l and percentile 97 to 17.7 mU/l. Levels of TSH similar to those of the normal adult population were reached between 30 and 60 days of life. Nevertheless, TSH levels of some of the children remained at higher values for a longer period. In summary, our results suggest that high TSH levels might not always indicate an underlying pathology. A critical evaluation of the normality criteria could avoid unnecessary studies and treatments.