Replacement of Male Mini-Puberty

Area of Science:

• Pediatric Endocrinology
• Reproductive Medicine
• Neonatal Care

Background:

• Congenital hypogonadotropic hypogonadism (CHH) presents significant clinical management challenges in pediatric endocrinology.
• Neonatal male mini-puberty is crucial for male infant development but is absent in CHH.
• Effective therapeutic strategies for CHH-related anomalies are needed.

Purpose of the Study:

• To evaluate if daily subcutaneous injections of recombinant human luteinizing hormone (LH) and follicle-stimulating hormone (FSH) can replicate physiological male mini-puberty.
• To assess the efficacy of this regimen in treating micropenis and cryptorchidism in infants with CHH.

Main Methods:

• The REMAP study involved ten infants with CHH, bilateral cryptorchidism, and micropenis, who did not exhibit neonatal male mini-puberty.
• Participants received daily subcutaneous injections of Pergoveris® (LH/FSH 75/150 IU) for three months.
• Outcomes measured included restoration of testicular position and function, hormonal levels, and penile length.

Main Results:

• Treatment normalized median LH, FSH, inhibin-b, anti-Mullerian hormone, and testosterone levels.
• Median stretched penile length increased from 2 cm to 3.8 cm.
• All testes descended to the scrotal position within three months, and hormonal profiles normalized, indicating restored Leydig and Sertoli cell function.

Conclusions:

• The studied regimen effectively mimics neonatal male mini-puberty in infants with CHH.
• Daily recombinant human LH/FSH injections provide a successful therapeutic approach for micropenis and cryptorchidism associated with CHH.