Dynamic Function test Version: 1

CC SOP hCG Stimulation Test

Standard Operating Procedure Review date: 14/08/2009
0033 CC0033
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

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hCG STIMULATION TEST

STANDARD OPERATING PROCEDURE

CC0033

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Page 1 of 3
Last printed: 14 August 2008
 Dynamic Function test Version: 1
CC SOP hCG Stimulation Test
Standard Operating Procedure Review date: 14/08/2009
0033 CC0033
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

hCG Stimulation Test

This test is used in the investigation of-

• an infant with ambiguous genitalia and palpable gonads

• delayed puberty in males and/or undescended testes
• for confirmation of the presence of active testicular tissue

Male newborn infants usually have plasma testosterone concentrations within the low adult range (8-
12 nmol/L) and both LH and testosterone are at adult values during the third and fourth months. If
blood can be obtained during these times, an hCG test may be avoided.

Principle

hCG is a double polypeptide hormone and shares a common subunit with LH. It stimulates testicular
Leydig cells to secrete androgens via the LH receptors. A single injection of hCG is adequate as it has
a long half life (2.5 days) and produces a progressive but modest rise in plasma testosterone for 72-
120 hours.

Side effects

Headaches, tiredness.

Preparation

No patient preparation is required

Procedure

Infants: 1500 units hCG

Children over 2 years: 5000 units hCG

Time Test Sample Sample tube Give dose

volume after sample
Day 0 Testosterone 5ml Plain tube (buff top) for hCG injection
Dihydrotestosterone adults and Li Heparin subcutaneously
Androstenedione (orange tube) for or im
paediatrics
Day 4 Testosterone 5ml Same as above
Dihydrotestosterone
Androstenedione

Do not photocopy this document

Page 2 of 3
Last printed: 14 August 2008
 Dynamic Function test Version: 1
CC SOP hCG Stimulation Test
Standard Operating Procedure Review date: 14/08/2009
0033 CC0033
Author: Document Manager: Authorised by: Version date: 14/08/2008
Swati Bhat Robin Sanham Richard Mainwaring-Burton

Interpretation

T/DHT ratio T/DHT ratio

Testosterone DHT
before hCG after hCG
Normal male adults 8-27 nmol/L < 2.9 nmol/L < 17 < 17
Normal children (6 months -
< 0.9 nmol/L < 0.1 nmol/L < 20 < 27
puberty)
5 -reductase (6 months -
< 0.5 nmol/L < 20 > 27
puberty)

There is a 2-9 fold increase in testosterone in normal pre-pubertal boys. In the absence of testes, no
response in testosterone occurs.

Do not photocopy this document

Page 3 of 3
Last printed: 14 August 2008