Efficacy and safety of pulsatile GnRH pump therapy in male infants with congenital hypogonadotropic hypogonadism.

Abstract

Introduction: To investigate the efficacy and safety of pulsatile gonadotropin-releasing hormone pump therapy in male infants with congenital hypogonadotropic hypogonadism.

Methods: Seven male infants with congenital hypogonadotropic hypogonadism who were treated in a single center between 2019 and 2022 were included. Each patient was treated by subcutaneous infusion of 5 μg/90 min gonadorelin via a pulsatile gonadotropin-releasing hormone pump for 3 to 5 months. Data including age, drug dose, penile length, testicular volume, and cryptorchidism were collected. Serum testosterone, follicle-stimulating hormone, luteinizing hormone, anti-Müllerian hormone, inhibin B concentration, and liver and kidney functions were also measured. Data were analyzed using paired t-test and rank-sum test.

Results: Penile length increased from 1.27±0.71 cm before treatment to 2.43±0.90 cm after treatment, and the testicular volume increased from 0.08(0.04,0.14) mL (left) and 0.08(0.06,0.12) mL (right) to 0.20(0.16,0.20) mL (left) and 0.22(0.18,0.30) mL (right). Inhibin B and anti-Müllerian hormone increased from 53.86±11.54 pg/mL and 34.25±12.48 ng/mL to 218.46±32.34 pg/mL and 72.84±9.24 ng/mL after treatment, respectively. At the end of the treatment, the testes of some children descended (6/13, 46.1%). During follow-up, the testicle of two patients re-ascended to the inguinal region. No obvious adverse reactions were found in all patients before and after treatment.

Conclusion: Pulsatile gonadotropin-releasing hormone pump therapy can increase penile length, testicular volume, anti-Müllerian hormone levels, and serum inhibin B levels in infants with congenital hypogonadotropic hypogonadism without adverse effects. However, its long-term efficacy and safety require further follow-up.