Cortes Dina, Holt Rune, de Knegt Victoria Elizabeth
Department of Pediatrics, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
Eur J Pediatr Surg. 2016 Oct;26(5):409-417. doi: 10.1055/s-0036-1592415. Epub 2016 Sep 19.
A normal functioning hypothalamic-pituitary-testicular axis is required for normal testicular descent. The percentage of cases that result from a disturbance in this axis remains controversial. Much has yet to be learnt about cryptorchidism, but is seems that the existence of A dark spermatogonia (Ad spermatogonia) is essential for later fertility. Bilateral cryptorchid patients have a high risk of later infertility, even though they undergo early surgery for cryptorchidism. It is possible today to distinguish-to a certain extent-between three different groups of cryptorchid patients based on testicular histology, gonadotropins, and inhibin B at the time of early surgery: Group 1, patients suspected of prepubertal transient hypothalamic-pituitary-testicular hypofunction and a high risk of later infertility; Group 2, patients with hypergonadotropic hypogonadism and a primary testicular dysfunction; and Group 3, patients with normal histology and normal serum levels of inhibin B and gonadotropins at the time of early surgery and a low risk of later infertility. Given the potential adverse effects of hormonal treatment, attention should be directed toward small doses of adjuvant gonadotropin-releasing hormone (GnRH) treatment for those who might benefit the most, that is, bilateral cryptorchid boys at early surgery without evidence of normal maturation of gonocytes into Ad spermatogonia. Optimally, gonadotropin levels in such patients should be measured to ensure that levels are not compensatory elevated, thereby supporting the suspicion of hypothalamic-pituitary-testicular hypofunction. Studies of GnRH-supplementary treatment should include testicular biopsy at surgery and at follow-up in childhood as well as examinations of fertility potential in adulthood.
正常的睾丸下降需要下丘脑 - 垂体 - 睾丸轴功能正常。该轴功能紊乱导致的病例所占百分比仍存在争议。关于隐睾症仍有许多未知之处，但似乎暗型精原细胞（Ad精原细胞）的存在对后期生育至关重要。双侧隐睾患者后期不育风险很高，即使他们接受了隐睾早期手术。如今，根据早期手术时的睾丸组织学、促性腺激素和抑制素B，在一定程度上可以区分三种不同类型的隐睾患者：第1组，怀疑青春期前下丘脑 - 垂体 - 睾丸功能短暂减退且后期不育风险高的患者；第2组，高促性腺激素性性腺功能减退且原发性睾丸功能障碍的患者；第3组，早期手术时组织学正常、抑制素B和促性腺激素血清水平正常且后期不育风险低的患者。鉴于激素治疗的潜在不良反应，应关注小剂量辅助促性腺激素释放激素（GnRH）治疗那些可能受益最大的患者，即早期手术时无生殖母细胞正常成熟为Ad精原细胞证据的双侧隐睾男孩。最佳做法是测量此类患者的促性腺激素水平，以确保其水平不会代偿性升高，从而支持下丘脑 - 垂体 - 睾丸功能减退的怀疑。GnRH补充治疗的研究应包括手术时和儿童期随访时的睾丸活检以及成年期生育潜力检查。
