UroToday – Abnormalities in hormonal regulation may have a role in the etiology of cryptorchidism. The objective of this study by Soumi et al was to assess the hypothalamic-pituitary-testicular axis in cryptorchid boys during the postnatal hormonal surge. This was a prospective, longitudinal, population-based study performed at two primary obstetric centers. There were 388 Finnish and 433 Danish boys (88 and 34 with cryptorchidism, respectively). Clinical examinations were performed at 0 and 3 months. Blood samples were taken at 3 months. The main outcome measures were testis position and reproductive hormone levels.

The group found that the Finnish cryptorchid boys had significantly higher FSH and lower inhibin B levels than Finnish control boys. Danish cryptorchid boys had higher FSH levels than controls. Inhibin B levels in healthy Danish boys were lower than those in Finnish boys and were not reduced in Danish cryptorchid boys. Changes in hormone levels were strongest in boys with severe, persistent cryptorchidism, but were also detectable in mild cryptorchidism and retractile testes. Effects on Leydig cell function were subtle, with an increase in LH in Finnish (but not Danish) cryptorchid boys as compared to, but testosterone levels remained within the normal range.

The group concluded that their results support the hypothesis that cryptorchidism is associated with a primary testicular disorder. One can postulate that the cryptorchidism itself may end up playing a primary role since there was low inhibin B production in the Finnish cohort and high gonadotropin drive in both the Finnish and Danish cohorts. Further investigation is warranted to replicate these findings, as they are an important observation to further our knowledge of the undescended testis.

By Pasquale Casale, MD

Reference: A Suomi, KM Main, M Kaleva, IM Schmidt, M Chellakooty, HE Virtanen, KA Boisen, IN Damgaard, C Mau Kai, NE Skakkebжk, J Toppari.
The Journal of Clinical Endocrinology & Metabolism, 91(3): 953-958, March 2006
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