Long-term outcome of pituitary-gonadal axis and gonadal growth in patients with hypospadias at puberty.
OBJECTIVE
Reports of pubertal hormonal and gonadal status in patients with hypospadias are scarce. We evaluated the pituitary-gonadal axis and gonadal growth in patients with hypospadias at puberty.


METHODS
We retrospectively reviewed serum luteinizing hormone, follicle-stimulating hormone, testosterone and testicular volume at puberty (age 15 years or greater) in the medical charts of patients with hypospadias treated since 1986 and followed at our institution.


RESULTS
Enrolled in this study were 43 patients with a mean age at evaluation of 17.6 years (range 15.1 to 22.8). Of these patients 14 and 29 were treated for mild and severe hypospadias, respectively. Six patients with severe hypospadias underwent bilateral orchiopexy for bilateral undescended testes. All patients were Tanner stage 4 to 5 at evaluation. Of 14 mild hypospadias cases we noted hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, decreased luteinizing hormone and decreased testosterone in 1 each (7% each). Of 23 severe hypospadias cases without bilateral undescended testes we noted hypergonadotropic hypogonadism, partial androgen insensitivity syndrome and decreased testosterone in 2 (9%), 1 (4%) and 1 (4%), respectively. Of 6 patients with severe hypospadias and bilateral undescended testes we noted hypergonadotropic hypogonadism in 1 (17%) and increased luteinizing hormone with normal testosterone in 2 (33%). Testicular volume less than 10 ml with increased follicle-stimulating hormone was identified in 7 of 43 patients, including 1 of 14 (7%) with mild hypospadias, 3 of 23 (13%) with severe hypospadias without bilateral undescended testes and 3 of 6 (50%) with severe hypospadias and bilateral undescended testes.


CONCLUSIONS
Our study revealed endocrine dysfunction in patients with mild and severe hypospadias at puberty even without an undescended testis. Of these patients those with severe hypospadias and an undescended testis may be at higher risk for impaired spermatogenesis.
Moriya
Kimihiko
K
Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo 060-0824, Japan. k-moriya@med.hokudai.ac.jp
Mitsui
Takahiko
T
Tanaka
Hiroshi
H
Nakamura
Michiko
M
Nonomura
Katsuya
K
D000293:Adolescent; D006801:Humans; D007021:Hypospadias / Q000097:blood / Q000503:physiopathology*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D009929:Organ Size; D010902:Pituitary Gland / Q000503:physiopathology; D011627:Puberty; D012189:Retrospective Studies; D013737:Testis / Q000254:growth & development* / Q000502:physiology; D013739:Testosterone / Q000097:blood; D013997:Time Factors; D055815:Young Adult
D013739:Testosterone; D007986:Luteinizing Hormone