Prolonged human chorionic gonadotrophin stimulation as a tool for investigating and managing undescended testes.
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.


METHODS
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.


CONCLUSIONS
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.
Dixon
J
J
Department of Child Health, Royal Hospital for Sick Children, Glasgow, Scotland, UK.
Wallace
A M
AM
O'Toole
S
S
Ahmed
S F
SF
D015067:17-Hydroxysteroid Dehydrogenases / Q000378:metabolism; D000735:Androstenedione / Q000097:blood; D002648:Child; D002675:Child, Preschool; D042944:Cholestenone 5 alpha-Reductase / Q000378:metabolism; D006063:Chorionic Gonadotropin / Q000008:administration & dosage / Q000627:therapeutic use*; D003456:Cryptorchidism / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism; D013196:Dihydrotestosterone / Q000097:blood; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D013737:Testis / Q000187:drug effects / Q000473:pathology; D013739:Testosterone / Q000097:blood
D006063:Chorionic Gonadotropin; D012738:Sex Hormone-Binding Globulin; D013196:Dihydrotestosterone; D013739:Testosterone; D000735:Androstenedione; D015067:17-Hydroxysteroid Dehydrogenases; C044256:3 (or 17)-beta-hydroxysteroid dehydrogenase; D042944:Cholestenone 5 alpha-Reductase