Vigersky R A, Chapman R M, Berenberg J, Glass A R
Am J Med. 1982 Oct;73(4):482-6. doi: 10.1016/0002-9343(82)90325-4.
Gonadal function was examined in 19 young men with Hodgkin's disease before therapy and compared with that of 11 men with other malignancies, 13 men with primary testicular failure, and 19 normal men of similar age. Total (p less than 0.01) and free (p less than 0.05) testosterone levels were decreased in Hodgkin's disease. In those with advanced (stage III + IV) and symptomatic (B), Hodgkin's disease serum testosterone levels were indistinguishable from those in primary testicular failure, yet serum levels of luteinizing hormone were normal. Moreover, the acute response of serum testosterone to exogenous human chorionic gonadotropin (HCG) was significantly greater in Hodgkin's disease than in primary testicular failure (p less than 0.03). These data and the finding that basal serum follicle-stimulating hormone levels are significantly lower than normal in Hodgkin's disease (p less than 0.05) suggest that the cause of pretreatment hypogonadism in Hodgkin's disease is not simple primary testicular failure. Total sperm count was decreased in 40 percent of men with Hodgkin's disease but in none of the men with other malignancies (p less than 0.05), suggesting specific seminiferous tubular dysfunction in Hodgkin's disease. However, motility was abnormal in 69 percent of men with Hodgkin's disease and 60 percent of those with other malignancies, suggesting that this is a nonspecific effect of cancer. Serum prolactin levels were significantly higher than normal in Hodgkin's disease (p less than 0.05) but not in other malignancies. Our findings suggests that the cause of testicular dysfunction that is present before treatment of Hodgkin's disease is complex, perhaps involving both pituitary and gonadal abnormalities.
对19名霍奇金病青年男性患者在治疗前进行性腺功能检查，并与11名患有其他恶性肿瘤的男性、13名原发性睾丸功能衰竭男性以及19名年龄相仿的正常男性进行比较。霍奇金病患者的总睾酮水平（p<0.01）和游离睾酮水平（p<0.05）均降低。在晚期（III + IV期）且有症状（B期）的霍奇金病患者中，血清睾酮水平与原发性睾丸功能衰竭患者的水平无差异，但促黄体生成素的血清水平正常。此外，霍奇金病患者血清睾酮对外源性人绒毛膜促性腺激素（HCG）的急性反应明显大于原发性睾丸功能衰竭患者（p<0.03）。这些数据以及霍奇金病患者基础血清促卵泡生成素水平显著低于正常水平（p<0.05）的发现表明，霍奇金病治疗前性腺功能减退的原因并非单纯的原发性睾丸功能衰竭。40%的霍奇金病男性患者精子总数减少，而其他恶性肿瘤男性患者无一减少（p<0.05），这表明霍奇金病存在特定的生精小管功能障碍。然而，69%的霍奇金病男性患者和60%的其他恶性肿瘤男性患者精子活力异常，这表明这是癌症的非特异性影响。霍奇金病患者血清催乳素水平显著高于正常水平（p<0.05），而其他恶性肿瘤患者则不然。我们的研究结果表明，霍奇金病治疗前存在的睾丸功能障碍原因复杂，可能涉及垂体和性腺异常。
