[The role of disorders of mineralocorticoid function of the adrenal glands in the development of infertility in patients with left-side varicocele].

A combined study, including phlebography, phlebotonometry, orchidometry, morphometric determination of microcirculatory testicular volume, microscopic and biochemical ejaculate studies, determination of peripheral blood levels of adrenocortical mineral glucocorticoid hormones before and after ACTH administration in the blood, sampled from various veins prior to phlebography, assessment of osmolality, pO2 and pCO2 in the blood samples from spermatic venous plexus, left renal vein and intrarenal portion of the vena cava inferior, and determination of plasma renin activity in renal veins, was conducted in 55 patients with varicocele. A considerable increase in orthostatic blood pressure of the left spermatic venous plexus is demonstrated that may be due to retrograde blood flow in the left testicular venous plexus, resulting in a microcirculatory disturbance and gradual atrophy of a testicle. There was a correlation between the severity of varicocele and left-testicular volume which was absent for total testicular volume, while microcirculatory volumes of the testes differed significantly, suggesting the absence of hemodynamic disorders in the contralateral testicle and, consequently, no spermatogenetic impairment due to hemodynamic changes in cases of a unilateral varicocele. Phlebographic and phlebotonometric evidence points to a retrograde blood flow through the central vein of the left adrenal. The results of adrenal functional studies demonstrate a significant tendency to adrenal hypersynthesis of aldosterone and cortisol in patients with varicocele. A correlation demonstrated between peripheral blood cortisol level and the proportion of spermatozoa with abnormal headpiece structure in the ejaculate has suggested a cause-and-effect relationship between adrenal dysfunction and infertility in patients with varicocele.