Subscribe to RSS
DOI: 10.1055/s-0041-1739416
The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles
Funding This work was supported by the Novo Nordisk Foundation (grant no.: NNF SA170030576) and the Australian National Health and Medical Research Council (grant no.: APP1144752).![](https://www.thieme-connect.de/media/ejps/202201/lookinside/thumbnails/10-1055-s-0041-1739416_215904oa-1.jpg)
Abstract
Introduction The activation of the hypothalamic–pituitary–gonadal axis that occurs in male minipuberty during the first 5 months of life is important for early germ cell development. Orchidopexy during minipuberty may improve fertility potential as the germinative epithelium may benefit from the naturally occurring gonadotropin stimulation. We hypothesize that most boys with congenital nonsyndromic cryptorchidism display normal reproductive hormonal profiles and histological findings during minipuberty.
Methods We included boys with congenital nonsyndromic cryptorchidism who underwent orchidopexy at less than 160 days of age, having no potential for spontaneous resolution clinically. At surgery, testicular biopsies and reproductive hormones were collected and compared with normal reference values. We measured the germ cells (G/T) and type A dark spermatogonia number per tubule.
Results Thirty-five boys aged 37 to 159 (median age: 124) days at orchidopexy were included, five were bilateral. G/T was below the normal lower range in 26% (9/35) of the cases. In six of these cases, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were above 97.5 percentile, whereas one case had FSH below 2.5 percentile. Totally, 97% (33/34, one FSH was missing) exhibited a normal LH/FSH ratio. LH was more often above 97.5 percentile than FSH: 34% (12/35) versus 3% (1/34, p < 0.001). Inhibin B was below 2.5 percentile in 17% (6/35) of cases who all proved FSH above normal mean and four had LH above normal mean.
Conclusion Generally, reproductive hormonal profiles of the cryptorchid boys exhibited normal minipubertal pattern. Thus, 26% of the boys had reduced germ cell number, and transient hypogonadotropic hypogonadism could be suspected in few cases.
Keywords
cryptorchidism - minipuberty - reproductive hormones - hypothalamic-pituitary-gonadal axis - germ cellsPublication History
Received: 17 July 2021
Accepted: 06 September 2021
Article published online:
30 November 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Ritzén EM, Bergh A, Bjerknes R. et al. Nordic consensus on treatment of undescended testes. Acta Paediatr 2007; 96 (05) 638-643
- 2 Radmayr C, Dogan HS, Hoebeke P. et al. Management of undescended testes: European Association of Urology/European Society for Paediatric Urology Guidelines. J Pediatr Urol 2016; 12 (06) 335-343
- 3 Kolon TF, Herndon CD, Baker LA. et al; American Urological Assocation. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol 2014; 192 (02) 337-345
- 4 Hildorf S, Clasen-Linde E, Cortes D, Fossum M, Thorup J. Fertility potential is compromised in 20% to 25% of boys with nonsyndromic cryptorchidism despite orchiopexy within the first year of life. J Urol 2020; 203 (04) 832-840
- 5 Acerini CL, Miles HL, Dunger DB, Ong KK, Hughes IA. The descriptive epidemiology of congenital and acquired cryptorchidism in a UK infant cohort. Arch Dis Child 2009; 94 (11) 868-872
- 6 Hildorf S, Clasen-Linde E, Fossum M, Cortes D, Thorup J. The fertility potential is impaired in boys with bilateral ascending testes. J Urol 2021; 205 (02) 586-594
- 7 Kuiri-Hänninen T, Koskenniemi J, Dunkel L, Toppari J, Sankilampi U. Postnatal testicular activity in healthy boys and boys with cryptorchidism. Front Endocrinol (Lausanne) 2019; 10: 489
- 8 Rusnack SL, Wu HY, Huff DS. et al. The ascending testis and the testis undescended since birth share the same histopathology. J Urol 2002; 168 (06) 2590-2591
- 9 Osterballe L, Clasen-Linde E, Cortes D. et al. The diagnostic impact of testicular biopsies for intratubular germ cell neoplasia in cryptorchid boys and the subsequent risk of testicular cancer in men with prepubertal surgery for syndromic or non-syndromic cryptorchidism. J Pediatr Surg 2017; 52 (04) 587-592
- 10 Johannsen TH, Main KM, Ljubicic ML. et al. Sex differences in reproductive hormones during mini-puberty in infants with normal and disordered sex development. J Clin Endocrinol Metab 2018; 103 (08) 3028-3037
- 11 Laboratory methods and reference, Department of Growth and Reproduction. Copenhagen University Hospital Rigshospitalet: Accessed date June 26, 2021 at: https://hormlabvejl.regionh.dk/Metodeliste.asp
- 12 Masliukaite I, Hagen JM, Jahnukainen K. et al. Establishing reference values for age-related spermatogonial quantity in prepubertal human testes: a systematic review and meta-analysis. Fertil Steril 2016; 106 (07) 1652-1657.e2
- 13 Hildorf S, Cortes D, Thorup J. et al. During infancy low levels of follicle-stimulating hormone may result in high rate of germ cell apoptosis. J Pediatr Surg 2021; (e-pub ahead of print) DOI: 10.1016/j.jpedsurg.2021.02.012.
- 14 Dinkelbach L, Lehnick D, Shavit S, Szavay P, Zundel S. Acquired undescended testis: when does the ascent occur?. J Pediatr Surg 2020; (e-pub ahead of print) DOI: 10.1016/j.jpedsurg.2020.11.007.
- 15 Cortes D, Thorup JM, Beck BL. Quantitative histology of germ cells in the undescended testes of human fetuses, neonates and infants. J Urol 1995; 154 (03) 1188-1192
- 16 Cortes D, Thorup JM, Beck BL, Visfeldt J. Cryptorchidism as a caudal developmental field defect. A new description of cryptorchidism associated with malformations and dysplasias of the kidneys, the ureters and the spine from T10 to S5. APMIS 1998; 106 (10) 953-958
- 17 Hildorf S, Dong L, Thorup J, Clasen-Linde E, Yding Andersen C, Cortes D. Sertoli cell number correlates with serum inhibin B in infant cryptorchid boys. Sex Dev 2019; 13 (02) 74-82
- 18 Kollin C, Stukenborg JB, Nurmio M. et al. Boys with undescended testes: endocrine, volumetric and morphometric studies on testicular function before and after orchidopexy at nine months or three years of age. J Clin Endocrinol Metab 2012; 97 (12) 4588-4595
- 19 Suomi AM, Main KM, Kaleva M. et al. Hormonal changes in 3-month-old cryptorchid boys. J Clin Endocrinol Metab 2006; 91 (03) 953-958
- 20 Hamza AF, Elrahim M, Elnagar, Maaty SA, Bassiouny E, Jehannin B. Testicular descent: when to interfere?. Eur J Pediatr Surg 2001; 11 (03) 173-176
- 21 Gendrel D, Roger M, Job JC. Plasma gonadotropin and testosterone values in infants with cryptorchidism. J Pediatr 1980; 97 (02) 217-220
- 22 Job JC, Toublanc JE, Chaussain JL, Gendrel D, Roger M, Canlorbe P. The pituitary-gonadal axis in cryptorchid infants and children. Eur J Pediatr 1987; 146 (Suppl. 02) S2-S5
- 23 Pierik FH, Deddens JA, Burdorf A, de Muinck Keizer-Schrama SM, Jong FH, Weber RF. The hypothalamus-pituitary-testis axis in boys during the first six months of life: a comparison of cryptorchidism and hypospadias cases with controls. Int J Androl 2009; 32 (05) 453-461
- 24 Thorup J, Petersen BL, Kvist K, Cortes D. Bilateral vanished testes diagnosed with a single blood sample showing very high gonadotropins (follicle-stimulating hormone and luteinizing hormone) and very low inhibin B. Scand J Urol Nephrol 2011; 45 (06) 425-431
- 25 Habre W, Disma N, Virag K. et al; APRICOT Group of the European Society of Anaesthesiology Clinical Trial Network. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe. Lancet Respir Med 2017; 5 (05) 412-425
- 26 Arana Håkanson C, Fredriksson F, Engstrand Lilja H. Attention deficit hyperactivity disorder and educational level in adolescent and adult individuals after anesthesia and abdominal surgery during infancy. PLoS One 2020; 15 (10) e0240891
- 27 Ho D, Keneally JP. Analgesia following paediatric day-surgical orchidopexy and herniotomy. Paediatr Anaesth 2000; 10 (06) 627-631
- 28 Walther-Larsen S, Aagaard GB, Friis SM, Petersen T, Møller-Sonnergaard J, Rømsing J. Structured intervention for management of pain following day surgery in children. Paediatr Anaesth 2016; 26 (02) 151-157
- 29 Walsh P, Rothenberg SJ, Bang H. Safety of ibuprofen in infants younger than six months: a retrospective cohort study. PLoS One 2018; 13 (06) e0199493