FEATURES FOR THE PRACTICAL USE OF SPECIALIZED HORMONAL REFERENCE INTERVALS FOR YOUNG ATHLETES FOR THE DIAGNOSIS OF ENDOCRINE DISEASES
Authors:   Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia, Moscow, Russia, Stolyarova S.A. , Okorokov P.L. ,   Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia, Moscow, Russia, Aksenova N.V. ,   Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia, Moscow, Russia, Isaeva E.P. ,   Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia, Moscow, Russia, Zyabkin I.V. ,   Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia, Moscow, Russia, Korabelnikov D.I. ,   Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia, Moscow, Russia,   Holy Doctor Friedrich Joseph Laurentius Haass Moscow Medical and Social Institute, Moscow, Russia
Published: February 2023

Results of hormonal tests of highly qualified athletes can differ significantly from the general population standards, which makes their interpretation difficult. The purpose of this research was to compare the prevalence of hormonal changes in adolescent athletes according to both the standard and the specialized reference intervals (RI). Materials and methods used: 2550 adolescent athletes, of which 1483 (58.1%) boys and 1067 (41.9%) girls from 28 kinds of sport aged 14 years to 17 years and 11 months old (ME: 16.1±1.1 y/o). All the young athletes have undergone the study of thyroid-stimulating hormone (TSH), free thyroxine (T4 test), cortisol, somatotropic hormone (STH) and total testosterone (chemiluminescent method with Lazurite automatic analyzer by Dynex Technologies Inc., USA) as part of an in-depth medical checkup of athletes in accordance with the Order of the Ministry of Healthcare of Russia No. 134n dated March 01, 2016, on the basis of the Federal Scientific and Practical Center for Children and Adolescents of the Federal Medical and Biological Agency of Russia (Moscow, Russia). The assessment of the hormonal profile was carried out according to both the standard RI and the specialized RI for young athletes. Results: when assessing the endocrine status of young athletes according to the standard RI, the frequency of hormonal changes was 30.6%, and 22.1% according to the specialized RI. When using specialized RI in male athletes, an increase in TSH and cortisol is recorded 2 times less often (p<0.001 for both parameters), an increase and decrease in total testosterone is determined in isolated cases, and hypersecretion of growth hormone is detected 6.5 times more often (p<0.0001). An increase in TSH when assessed using specialized RI in female athletes occurs 2 times less often (p<0.001). Hypersecretion of cortisol and growth hormone is recorded 20% (p=0.34) and 51% (p=0.02) less frequently, respectively. Conclusion: the use of the new RI does allow reducing of the frequency of detection of hormonal changes in adolescent athletes by 8.5% (p=0.03). The use of specialized RI of hormonal parameters in adolescent athletes to interpret TSH levels does not contradict with the modern clinical guidelines when deciding about the appointment of hormone replacement therapy for young athletes with subclinical hypothyroidism. The level of total testosterone, equal to 2.84 nmol/l, in young male athletes aged 16 to 17 y/o cannot be considered as a variant of the norm. The diagnostic value of determining growth hormone and cortisol in highly qualified athletes in adolescence is doubtful due to the high variability of the studied parameters and the complexity of interpreting the results obtained for practical use by a pediatric endocrinologist.