Willemse P H, Sleijfer D T, Schraffordt Koops H, Pratt J J, Sluiter W J, Doorenbos H
Int J Androl. 1983 Dec;6(6):497-508. doi: 10.1111/j.1365-2605.1983.tb00341.x.
In two groups of patients with disseminated testicular carcinoma the effect of combination chemotherapy on the pituitary-gonadal axis was evaluated, after unilateral orchiectomy: The two groups comprised 15 patients without hCG-producing metastases (group A), and 14 patients with hCG-producing metastases (group B). Seven patients who had received no chemotherapy were studied one year after unilateral orchiectomy as a control group (group C). In group A, serum levels of testosterone and oestradiol increased during chemotherapy, as did the levels of LH and FSH. The serum LH and FSH response to LHRH was increased following chemotherapy, whereas the serum testosterone increase after hCG stimulation remained unchanged. A rise of 316% in SHBG binding capacity was found after chemotherapy. This presumably accounted for the elevated steroid levels in the presence of high gonadotrophin levels, but unaltered Leydig cell response. The elevated serum levels of testosterone and oestradiol and the suppressed serum FSH levels normalized during disappearance of ectopic hCG production in group B patients. Leydig cell refractoriness to hCG and the FSH response to LHRH also reverted to normal. After chemotherapy, FSH, but not LH levels exceeded those of group C patients, presumably as a result of the azoospermia induced by chemotherapy. The hormonal changes associated with chemotherapy are best explained by an increase in serum binding proteins, notably SHBG.
在两组播散性睾丸癌患者中，在单侧睾丸切除术后评估了联合化疗对垂体 - 性腺轴的影响：两组包括15例无产生hCG转移灶的患者（A组）和14例有产生hCG转移灶的患者（B组）。7例未接受化疗的患者在单侧睾丸切除术后一年作为对照组进行研究（C组）。在A组中，化疗期间血清睾酮和雌二醇水平升高，LH和FSH水平也升高。化疗后血清LH和FSH对LHRH的反应增强，而hCG刺激后血清睾酮的升高保持不变。化疗后发现SHBG结合能力升高了316%。这可能解释了在促性腺激素水平高的情况下类固醇水平升高，但睾丸间质细胞反应未改变的原因。B组患者异位hCG产生消失期间，血清睾酮和雌二醇水平升高以及血清FSH水平受抑制的情况恢复正常。睾丸间质细胞对hCG的不应性和FSH对LHRH的反应也恢复正常。化疗后，FSH水平超过了C组患者，但LH水平未超过，这可能是化疗诱导无精子症的结果。与化疗相关的激素变化最好用血清结合蛋白，特别是SHBG的增加来解释。
