Altered serum inhibin b levels in adolescents with varicocele Carmelo Romeo a, * , Teresa Arrigo b , Pietro Impellizzeri a , Agatino Manganaro a , Pietro Antonuccio a , Giuseppe Di Pasquale b , Maria Francesca Messina b , Lucia Marseglia b , Isabella Formica a , Biagio Zuccarello a a Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, 98124 Messina, Italy b Department of Medical and Surgical Pediatric Sciences, Unit of Pediatrics, University of Messina, 98124 Messina, Italy Abstract Background/Purpose: Different studies have evaluated testicular hormonal dysfunction in adolescent varicocele but with variable results. Recently, inhibin B has been proposed as a marker for spermatogenesis and Sertoli cell function. The aim of the present study was to study in a homogeneous cohort of adolescents inhibin B and other hormones to detect whether untreated varicocele may be associated with any modifications of these factors. Methods: Sixteen adolescents (mean age, 14.5 F 1.0 years), at Tanner stages 4 to 5 with grade II or III left-sided varicocele, underwent hormonal evaluation of inhibin B, basal testosterone, and both baseline and GnRH stimulated FSH and LH levels. Thirteen unaffected adolescents of age-matched and pubertal development were used as controls. Results: Patients with varicocele showed a significant reduction in the testicular volume of the affected side (13.3 F 4.1 vs 15.8 F 4.8 mL; P = .002) and significant reduced levels of inhibin B compared with controls (271.9 F 70.2 vs 327.1 F 34.9 pg/mL; P = .042). Inhibin B levels were significantly correlated with testes volume (r = 0.62; P = .0097). Other hormonal parameters were similar in both varicocele and control groups. Conclusion: Inhibin B is reduced in adolescents with untreated varicocele, and it is positively correlated with testicular volume. This could be an early marker for Sertoli cell damage, with possible implications for spermatogenesis and could represent a new indication for varicocele repair. D 2007 Elsevier Inc. All rights reserved. The prevalence of varicocele in adolescents is about 18% [1], that is, similar to that found in adult populations. The natural history of varicocele at this age seems to differ from that of adults. In adolescents, it seems to a have a progressive deleterious effect on the testis through different pathogenic mechanisms [2]. Nevertheless, it is not generally accepted that surgical treatment of varicocele will protect the testis from ongoing damage. This is usually undertaken 0022-3468/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2006.10.013 Presented at the British Association of Paediatric Surgeons 53rd Annual International Congress, Stockholm, Sweden, July 18-22, 2006. * Corresponding author. Dipartimento di Scienze Pediatriche Mediche e Chirurgiche, Unit of Pediatric Surgery, Policlinico G. Martino - Padiglione NI, Viale Gazzi, 98124 Messina Italy. Tel.: +39 090 2213025; fax: +39 090 2217033. E-mail address: romeoc@unime.it (C. Romeo). Index words: Varicocele; Adolescent age; Inhibin B; Gonadotropins Journal of Pediatric Surgery (2007) 42, 390 – 394 www.elsevier.com/locate/jpedsurg