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Prolonged human chorionic gonadotrophin stimulation as a tool for investigating and managing undescended testes
J Dixon1, A M Wallace, S O'Toole
1Department of Child Health, Royal Hospital for Sick Children, Glasgow, Scotland, UK.
Insights
Prolonged human chorionic gonadotrophin (hCG) stimulation in boys with undescended testes (UDT) showed varied testosterone responses. Some boys may need extended hCG treatment to assess androgen production and sensitivity, potentially reducing surgery needs.
Area of Science:
- Pediatric Endocrinology
- Andrology
- Reproductive Medicine
Background:
- Undescended testes (cryptorchidism) affect male reproductive health.
- Hormonal management with human chorionic gonadotrophin (hCG) is a treatment option.
- Assessing androgen production and sensitivity is crucial for managing cryptorchidism.
Purpose of the Study:
- To evaluate the outcomes of prolonged hCG stimulation in prepubertal boys with undescended testes.
- To assess the impact of hCG on serum testosterone and other androgen levels.
- To explore the potential of hCG therapy to reduce the need for surgical intervention.
Main Methods:
- Retrospective review of 16 prepubertal boys receiving intramuscular hCG.
- hCG administration: 1500 U on Days 1-3, then twice weekly for 2 weeks.
- Serum hormone analysis (testosterone, SHBG, DHT, androstenedione) at Days 1, 4, and 22.
Main Results:
- Peak testosterone rise occurred by Day 4 in 44% and by Day 22 in 31% of boys.
- Testosterone:androstenedione ratio increased significantly by Day 4.
- Testosterone:SHBG ratio, a marker of androgen sensitivity, was analyzed.
- 20% of boys with available data showed testicular descent, avoiding immediate surgery.
Conclusions:
- A 3-day hCG regimen may identify certain enzyme deficiencies but prolonged stimulation is needed for others.
- Extended hCG protocols can help assess androgen production and sensitivity in cryptorchidism.
- Prolonged hCG stimulation may decrease the necessity for orchidopexy, warranting further research.
Objective:
To observe the outcome in a group of children with undescended testes (UDT) given prolonged human chorionic gonadotrophin (hCG) stimulation as part of their management.
Study Design:
Retrospective review of 16 prepubertal boys given intramuscular hCG, 1500 U, on Days 1, 2 and 3 and then twice a week for 2 weeks with assessment of serum testosterone (T), SHBG, dihydrotestosterone (DHT) and androstenedione (A) on Days 1, 4 and 22.
Results:
In seven boys (44%), peak rise in T was by Day 4; in 5 boys (31%), the rise was by Day 22 and in the remainder, serum T stayed low. The median Day1 testosterone : androstenedione (T : A) ratio rose from 0.4 (range 0.2-1.5) to 1.7 (range 0.2-5.3) at Day 4 (P < 0.05) with no further rise by Day 22. The median dihydrotestosterone : testosterone ratio (DHT : T) at Day 1 and Day 4 remained unchanged. SHBG levels were more likely to be lower at Day 22 than at Day 4. The mean testosterone : SHBG (T : SHBG) ratio as a marker of androgen sensitivity was 0.2 (1SD 0.1). Bilateral testicular descent deemed immediate surgery unnecessary in 3 out of 15 (20%) boys where outcome data were available.
Conclusion:
Whilst a 3-day hCG stimulation regimen may exclude 17beta-hydroxysteroid dehydrogenase-3 and 5alpha-reductase deficiencies, some boys with cryptorchidism may require more prolonged stimulation to assess androgen production and sensitivity. The possibility that this regimen leads to a reduced need for orchidopexy requires further exploration.
