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The positive predictive value of using fsh and Inhibin-B serum levels to diagnose gonadotropin insufficiency in bilateral cryptorchid boys is high

  • Simone E. Hildorf
    Correspondence
    Correspondence to: Simone Hildorf, Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark. Tel.: +45 2814 8508; fax: +45 3545 3888
    Affiliations
    Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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  • Erik Clasen-Linde
    Affiliations
    Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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  • Dina Cortes
    Affiliations
    Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Denmark
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  • Magdalena Fossum
    Affiliations
    Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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  • Jorgen Thorup
    Affiliations
    Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

    Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Published:November 02, 2022DOI:https://doi.org/10.1016/j.jpurol.2022.10.031

      Summary

      Aim of study

      Despite early surgery, many boys with bilateral cryptorchidism at surgery have a reduced number of germ cells per tubular cross-section (G/T) in testicular biopsies and/or low inhibin-B with no elevated follicle-stimulating hormone (FSH) as expected based on a normal gonadotropin feed-back mechanism. Such boys have a high risk of later infertility because of insufficient gonadotropin stimulation and may benefit from adjuvant hormonal treatment.
      Testicular biopsies are not always wanted or accepted. The study aim was to investigate the value of a low inhibin-B and normal FSH to identify patients that might benefit from adjuvant hormonal treatment avoiding the need for testicular biopsy.

      Methods

      A series of boys with cryptorchidism were evaluated with serum levels of inhibin-B and FSH in relation to G/T in testicular biopsies, which were compared to previously published age-matched normal control values.

      Results

      A total of 365 boys who underwent bilateral orchidopexy between 0.4 and 7.8 (median: 2) years of age were included. Twenty-seven (7%) patients had increased FSH and low G/T, whereas 11 of these also had low inhibin-B indicating hypergonadotropic hypogonadism. Moreover, 85 (23%) patients between 0.75 and 7.5 (median: 2) years of age had both low G/T (median: 0.3) and low inhibin-B (median: 56 pg/ml) but normal FSH (median: 0.6 U/l) indicating a gonadotropin insufficiency. Three patients with normal FSH and low inhibin B had normal G/T.

      Discussion

      Our study shows that if surgeons prefer to avoid testicular biopsies and only wish to rely on hormonal parameters (low inhibin-B and normal FSH) in order to diagnose a gonadotropin insufficiency as the cause of hypogonadism, they will identify only about 30% of such cases and overlook about 70% of patients sharing the same endocrinopathy. In addition, if surgeons treat patients for gonadotropin insufficiency only based on low inhibin-B and normal FSH they will solely treat patients with gonadotropin insufficiency and would not overtreat patients.

      Conclusion

      Summary figure

      Keywords

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