Inhibin B and Antim€ullerian Hormone as Markers of Gonadal Function after Treatment for Medulloblastoma or Posterior Fossa Ependymoma during Childhood

Abstract

Objective To evaluate the roles of hypothalamic-pituitary and spinal irradiations and chemotherapy in gonadal deficiency after treatment for medulloblastoma or posterior fossa ependymoma by measuring levels of plasma in- hibin B and antim€ullerian hormone (AMH). Study design A total of 34 boys and 22 girls were classified as having normal levels of plasma follicle-stimulating hormone (FSH; <9 IU/L), or abnormal levels of FSH (>9 IU/L) and luteinizing hormone (LH; <5 or >5 IUL). Results Two boys had partial gonadotropin deficiency, combined with testicular deficiency in one boy. Six boys had increased levels of FSH, indicating tubular deficiency, combined with Leydig cell deficiency in 5 boys. The 7 boys with inhibin B levels <100 ng/mL included the one with combined deficiencies and the 6 with testicular defi- ciency. Puberty did not progress in 7 girls; 3 had gonadotropin deficiency, combined with ovarian deficiency in one, and 4 had increased FSH levels, indicating ovarian deficiency. Inhibin B and AMH levels were low in the girl with combined deficiencies, in the 4 girls with ovarian deficiency, and in 4 girls with normal clinical-biological ovarian function, including 2 who underwent ovarian transposition before irradiation. Conclusion The plasma concentrations of inhibin B and AMH are useful means of detecting primary gonad de- ficiency in patients with no increase in their plasma gonadotropin levels because of radiation-induced gonadotropin deficiency. (J Pediatr 2011;158:1016-22).