Cryptorchidism and puberty

Abstract

Cryptorchidism is the condition in which one or both testes have not descended adequately into the scrotum. The congenital form of cryptorchidism is one of the most prevalent urogenital anomalies in male newborns. In the acquired form of cryptorchidism, the testis that was previously descended normally is no longer located in the scrotum. Cryptorchidism is associated with an increased risk of infertility and testicular germ cell tumors. However, data on pubertal progression are less well-established because of the limited number of studies. Here, we aim to review the currently available data on pubertal development in boys with a history of non-syndromic cryptorchidism-both congenital and acquired cryptorchidism. The review is focused on the timing of puberty, physical changes, testicular growth, and endocrine development during puberty. The available evidence demonstrated that the timing of the onset of puberty in boys with a history of congenital cryptorchidism does not differ from that of non-cryptorchid boys. Hypothalamic-pituitary-gonadal hormone measurements showed an impaired function or fewer Sertoli cells and/or germ cells among boys with a history of cryptorchidism, particularly with a history of bilateral cryptorchidism treated with orchiopexy. Leydig cell function is generally not affected in boys with a history of cryptorchidism. Data on pubertal development among boys with acquired cryptorchidism are lacking; therefore, more research is needed to investigate pubertal progression among such boys.

Keywords: Leydig cell; Sertoli cell; germ cell; testicular size; testosterone; undescended testis.

Figure 1

Ultrasound-based mean testicular volume during puberty of boys with a history of bilateral cryptorchidism who underwent orchiopexy in childhood and that of non-cryptorchid controls. During prepuberty, the mean testicular volume of the two groups of boys was similar. After pubertal onset, at the mean time of 11.8 years, the testes of both groups grew rapidly. However, the former group had smaller testes than controls from 1 year after pubertal onset to the end of puberty. Half of the testicular growth occurred by the age of approximately 13.4 years. Data were derived from Rodprasert et al. and Sadov et al. (41, 42) This figure is a simplified illustration of testicular growth in the two groups of boys; it is not for use as a reference of the testicular size of the population. The graph generated from the original data was presented in Rodprasert et al. (42).

Figure 2

The alterations of the hypothalamic–pituitary–gonadal (HPG) axis function in pubertal boys with a history of bilateral cryptorchidism who underwent orchiopexy before puberty. These boys have higher follicle-stimulating hormone (FSH) and lower inhibin B than non-cryptorchid boys, indicating decreased function and/or number of Sertoli cells and germ cells. The levels of luteinizing hormone (LH) and the Leydig cell hormones, testosterone, and insulin-like peptide 3 (INSL3) are similar to those of non-cryptorchid controls (42). The hormone levels as compared with the normal range are indicated by arrow signs: ↔, the levels similar to the normal range; ↑, the levels higher than the normal range; ↓, the levels lower than the normal range.