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Khanna S, Shankar Raman V, Badwal S, Vinu Balraam KV. Quantification of the Androgen and Estrogen Receptors in the Penile Tissues of Hypospadias in Comparison with Normal Children. Fetal Pediatr Pathol 2023; 42:175-186. [PMID: 35996228 DOI: 10.1080/15513815.2022.2104496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Hypospadias is a common congenital abnormality typified by a proximally placed ectopic urethral meatus along the ventral surface of the penis. Androgen receptor (AR) and estrogen receptor (ER) expression in the hypospadias tissues may be altered in hypospadias. METHODOLOGY We evaluated by immunohistochemistry the AR and ER expression in 75 tissues from hypospadias repair, and compared this expression to that of tissue from 75 patients undergoing circumcision. We also compared the intensity of AR and ER expression between different severities of hypospadias. RESULTS AR quantitative grading score decreased with severity of hypospadias, while the ER score increased as the hypospadias worsened, which was statistically significant (p-value <0.05). CONCLUSION The penile tissue AR expression is decreased and ER expression is increased with increasing severity of hypospadias.
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Affiliation(s)
- Sanat Khanna
- Sr Adv (Surg and Paed Surg) Command Hospital (Western Command), Chandimandir, Haryana, India
| | - V Shankar Raman
- Sr Adv (Surg and Paed Surg) Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Sonia Badwal
- Sr Consultant, Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - K V Vinu Balraam
- Gd Spl (Pathology), Head of Department, Department of Pathology, Military Hospital Shimla, Himachal Pradesh, India
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Khanna S, Raman S, Badwal S, Vinu Balraam KV. Preliminary Reference Interval for 5-Alpha Reductase in Normal Male Children and Its Association with Hypospadias. J Appl Lab Med 2022; 7:1329-1336. [DOI: 10.1093/jalm/jfac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Background
5-alpha reductase (5-AR) enzyme is responsible for conversion of testosterone to dihydrotestosterone (DHT) in humans, which subserves various functions. The aim of the study was to establish a normal reference interval (RI) for blood levels of the enzyme 5-AR.
Methods
We conducted a prospective study on 150 boys, 75 of whom underwent circumcision for various benign conditions or for religious reasons (Group A/controls) and 75 suffering from hypospadias of variable severity (Group B/cases). The plasma levels of 5-AR were measured by enzyme-linked immunosorbent assay (ELISA) in all 150 boys and correlated with the severity of hypospadias.
Results
The 5-AR levels in Group A ranged from 14.6 to 17.3 ng/mL. The enzyme levels decreased in value with increasing severity of hypospadias in Group B (P-value <0.01 - statistically significant). The levels of the enzyme in this group ranged from 0.6 ng/mL (in the most severe variety of hypospadias) to 11.5 ng/mL (mild variety of hypospadias).
Conclusions
There is no record of RI values of 5-AR in the literature. The RI of 5-AR needs to be determined by conducting more studies globally. Its levels falls considerably with clinical severity of hypospadias, reinforcing the importance of the enzyme in the development of male external genitalia.
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Affiliation(s)
- Sanat Khanna
- Department of Pediatric Surgery, Army Hospital (Research & Referral) , New Delhi , India
| | - Shankar Raman
- Department of Pediatric Surgery, Command Hospital (Southern Command) , Pune , India
| | - Sonia Badwal
- Department of Histopathology, Sir Ganga Ram Hospital , New Delhi , India
| | - K V Vinu Balraam
- Department of Pathology, Military Hospital Shimla , Shimla , India
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Arendt LH, Ernst A, Braskhøj Lauridsen LL, Brix N, Olsen J, Ramlau-Hansen CH. Timing of pubertal development in boys born with cryptorchidism and hypospadias: a nationwide cohort study. Asian J Androl 2020; 21:551-556. [PMID: 30950413 PMCID: PMC6859653 DOI: 10.4103/aja.aja_3_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pubertal development may be altered in boys with cryptorchidism and hypospadias, but existing knowledge is inconsistent. Therefore, we investigated the association between cryptorchidism and hypospadias and pubertal development in a large cohort study. Boys in the Puberty Cohort, a cohort nested within the Danish National Birth Cohort, were included in this study. Information on cryptorchidism and hypospadias was retrieved from the Danish National Patient Register. From 11 years until 18 years or full pubertal development, information on physical markers of pubertal development was provided biannually, including Tanner stages, axillary hair, acne, voice break, and first ejaculation. In multivariate regression models for interval censored data, the mean (95% confidence intervals [CIs]) differences in months in obtaining the pubertal markers between boys with and without the anomalies were estimated. Among 7698 boys, 196 (2.5%) had cryptorchidism and 60 (0.8%) had hypospadias. Boys with hypospadias experienced first ejaculation and voice break 7.7 (95% CI: 2.5-13.0) months and 4.5 (95% CI: 0.3-8.7) months later than boys without hypospadias. The age at attaining the Tanner stages for gonadal and pubic hair growth was also higher, though not statistically significant. Pubertal development seemed unaffected in boys with mild as well as severe cryptorchidism. In conclusion, hypospadias may be associated with delayed pubertal development, but pubertal development seems unaffected by cryptorchidism. The relation between hypospadias and later pubertal development may be due to the underlying shared in utero risk or genetic factors.
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Affiliation(s)
- Linn Håkonsen Arendt
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus 8000, Denmark.,Perinatal Epidemiology Research Unit, Department of Paediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus 8000, Denmark
| | - Andreas Ernst
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus 8000, Denmark
| | | | - Nis Brix
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus 8000, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus 8000, Denmark
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Nakamura M, Moriya K, Nishimura Y, Nishida M, Kudo Y, Kanno Y, Kitta T, Kon M, Shinohara N. Prevalence and risk factors of testicular microlithiasis in patients with hypospadias: a retrospective study. BMC Pediatr 2018; 18:179. [PMID: 29843681 PMCID: PMC5975416 DOI: 10.1186/s12887-018-1151-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been described that the incidence of testicular microlithiasis is high in several congenital disorders which may be associated with testicular impairment and infertility. Several reports have shown that a prepubertal or pubertal hormonal abnormality in the pituitary-gonadal axis was identified in some patients with hypospadias that is one of the most common disorders of sex development. However, exact prevalence or risk factors of testicular microlithiasis in patients with hypospadias have not reported so far. In the present study, to clarify the prevalence and risk factors of testicular microlithiasis in patients with hypospadias, a retrospective chart review was performed. METHODS Children with hypospadias who underwent testicular ultrasonography between January 2010 and April 2016 were enrolled in the present study. Severity of hypospadias was divided into mild and severe. The prevalence and risk factors of testicular microlithiasis or classic testicular microlithiasis were examined. RESULTS Of 121 children, mild and severe hypospadias were identified in 66 and 55, respectively. Sixteen children had undescended testis. Median age at ultrasonography evaluation was 1.7 years old. Testicular microlithiasis and classic testicular microlithiasis were documented in 17 children (14.0%) and 8 (6.6%), respectively. Logistic regression analysis revealed that presence of undescended testis was only a significant factor for testicular microlithiasis and classic testicular microlithiasis. The prevalence of testicular microlithiasis or classic testicular microlithiasis was significantly higher in children with undescended testis compared to those without undescended testis (testicular microlithiasis; 43.8% versus 9.5% (p = 0.002), classic testicular microlithiasis; 37.5% versus 1.9% (p < 0.001). CONCLUSIONS The current study demonstrated that the presence of undescended testis was only a significant risk factor for testicular microlithiasis or classic testicular microlithiasis in patients with hypospadias. As co-existing undescended testis has been reported as a risk factor for testicular dysfunction among patients with hypospadias, the current findings suggest that testicular microlithiasis in children with hypospadias may be associated with impaired testicular function. Conversely, patients with isolated HS seem to have lower risks for testicular impairment. Further investigation with longer follow-up will be needed to clarify these findings.
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Affiliation(s)
- Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan.
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Mutsumi Nishida
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan.,Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Kudo
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan.,Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-Ku, Sapporo, 060-8638, Japan
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Ratan SK, Aggarwal SK, Mishra TK, Saxena A, Yadav S, Pandey RM, Sharma A, Dhanwal D. Hormonal profile in children with isolated hypospadias associates better with comprehensive score of local anatomical factors as compared to meatal location or degree of chordee. Indian J Endocrinol Metab 2014; 18:558-564. [PMID: 25143917 PMCID: PMC4138916 DOI: 10.4103/2230-8210.137519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To evaluate if hormonal profile of children with isolated hypospadias (IH) associates better with comprehensive local anatomical factor score (LAFS) than with clinically adjudged urethral meatus location or severity of chordee/k.j. MATERIAL AND METHODS Ninety-nine children with IH were enrolled, as per inclusion criteria. Meatal location was recorded at first clinical examination in OPD; while LAFS was computed per-operatively using indigenously devised scale, except for neonates. Hypospadiacs were first classified into three standard meatal based groups and subsequently into LAFS based two groups (≤19, >19). For all participants, pre HCG and post HCG (96 hour post- injection) estimation of serum gonadotropins, DHEA-S, estrogen (E), progesterone (P), testosterone (T) and Dihydrotestosterone (DHT) was done. Statistical tests were applied to assess significance of hormonal levels with respect to meatal location, chordee and LAFS. RESULTS Only FSH levels differed significantly among meatal based groups; while among LAFS groups, multiple hormonal differences were noted; with poor LAFS associated significantly with higher FSH, LH and lower E, T/DHT. Children with severe degree of chordee had poorer T output and a significantly lower LAFS as compared to those with moderate/mild chordee. CONCLUSION Serotoli cell dysfunction, indirectly indicated by high FSH was found among midpenile hypospadiacs and those with poorer LAFS. Since groups based on LAFS revealed multiple intergroup hormonal differences than what was seen for meatal/chordee based groups; LAFS should be considered a better guide for prognostication and for deciding about hormonal supplementation. Lower androgenic output was particularly noted in children with severe chordee.
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Affiliation(s)
- Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Satish K. Aggarwal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Tarun Kumar Mishra
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Alpna Saxena
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Sangeeta Yadav
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ravindra M. Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Sharma
- Department of Biochemistry, Maulana Azad Medical College, New Delhi, India
| | - Dinesh Dhanwal
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Nistal M, Gonzalez-Peramato P, De Miguel MP. Sertoli cell dedifferentiation in human cryptorchidism and gender reassignment shows similarities between fetal environmental and adult medical treatment estrogen and antiandrogen exposure. Reprod Toxicol 2013; 42:172-9. [DOI: 10.1016/j.reprotox.2013.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 08/06/2013] [Accepted: 08/16/2013] [Indexed: 12/13/2022]
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Endocrine Assessment of Prepubertal Boys With a History of Cryptorchidism and/or Hypospadias: A Pilot Study. J Urol 2011; 185:2444-50. [DOI: 10.1016/j.juro.2011.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Indexed: 11/17/2022]
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Moriya K, Mitsui T, Tanaka H, Nakamura M, Nonomura K. Long-Term Outcome of Pituitary-Gonadal Axis and Gonadal Growth in Patients With Hypospadias at Puberty. J Urol 2010; 184:1610-4. [DOI: 10.1016/j.juro.2010.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 10/19/2022]
Affiliation(s)
- Kimihiko Moriya
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Takahiko Mitsui
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Hiroshi Tanaka
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Michiko Nakamura
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Katsuya Nonomura
- Department of Urology, Hokkaido University Graduate School of Medicine
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Sata F, Kurahashi N, Ban S, Moriya K, Tanaka KD, Ishizuka M, Nakao H, Yahata Y, Imai H, Kakizaki H, Nonomura K, Kishi R. Genetic Polymorphisms of 17β-Hydroxysteroid Dehydrogenase 3 and the Risk of Hypospadias. J Sex Med 2010; 7:2729-38. [DOI: 10.1111/j.1743-6109.2009.01641.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Silver RI. Endocrine abnormalities in boys with hypospadias. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 545:45-72. [PMID: 15086020 DOI: 10.1007/978-1-4419-8995-6_4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The multifactorial etiology of hypospadias is becoming more clearly defined with ongoing investigation. Endogenous endocrine abnormalities identified so far include testosterone biosynthesis defects, 5alpha-reductase type 2 mutations, and androgen receptor mutations (the rarest cause, even in cases of severe hypospadias). Other significant risk factors include IVF (because of progesterone administration or endocrine abnormalities associated with infertility) and environmental agents that can potentially cause testicular dysgenesis, disrupt the male androgen axis, and disturb normal male genital embryology (Table 6). [table; see text] It also seems that the incidence of hypospadias is increasing, both in the United States and in Europe--which may be due to better medical care for those with genital abnormalities and/or infertility problems, as well as environmental endocrine disruptors. Hypospadias is a physical manifestation that may be a consequence of numerous physiological aberrations, and our ability to understand and to potentially prevent this congenital malformation will require a significant amount of additional work. Our challenge for the future remains to identify the various etiologies, provide prenatal counseling for affected families with a history of hypospadias, and minimize or eliminate exposure to environmental agents that may contribute to this problem. Perhaps one day we will be able to offer prenatal therapy to prevent hypospadias when the risk for this birth defect seems high. How might this be possible? Consider the modern management of a family with a child born with the adrenogenital syndrome, another endocrine derangement that can cause abnormal genital development. In this situation, dexamethasone can be administered to the mother in subsequent pregnancies to prevent fetal virilization until the sex of the fetus can be determined or adrenal enzyme mutations can be excluded. Perhaps in the future a similar approach will be taken for those families with strong risk factors for hypospadias.
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Hyun G, Kolon TF. Endocrine evaluation of hypospadias. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 545:31-43. [PMID: 15086019 DOI: 10.1007/978-1-4419-8995-6_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Grace Hyun
- Division of Urology, The Children's Hospital of Philadelphia, PA 19104, USA
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Feyaerts A, Forest MG, Morel Y, Mure PY, Morel-Journel N, Mallet D, Nicolino M, Chatelain P, David M, Mouriquand P. Endocrine Screening in 32 Consecutive Patients with Hypospadias. J Urol 2002. [DOI: 10.1016/s0022-5347(05)64733-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Axel Feyaerts
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Maguelone G. Forest
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Yves Morel
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre-Yves Mure
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Morel-Journel
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Delphine Mallet
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Marc Nicolino
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Chatelain
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Michel David
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
| | - Pierre Mouriquand
- From the Departments of Pediatric Urology, Pediatric Endocrinology and INSERM U329, Biochimie Endocrinienne et Métabolique, Hôpital Debrousse, Hospices Civils de Lyon, Lyon, France
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Albers N, Ulrichs C, Glüer S, Hiort O, Sinnecker GH, Mildenberger H, Brodehl J. Etiologic classification of severe hypospadias: implications for prognosis and management. J Pediatr 1997; 131:386-92. [PMID: 9329414 DOI: 10.1016/s0022-3476(97)80063-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Classification of severe hypospadias employing a broad array of diagnostic tools. Standardization of a diagnostic approach to children with hypospadias. Indentification of patients at risk of having malignancies and endocrine problems. DESIGN Retrospective analysis of patients in a single-center study. SUBJECTS Thirty-three patients with severe (scrotal or penoscrotal) hypospadias, aged 1 to 18 years. METHODS Clinical assessment, ultrasonography, karyotyping, endocrine evaluation including adrenal steroid concentrations, sex hormone-binding globulin test for androgen sensitivity, human chorionic gonadotropin stimulation with determination of testosterone and dihydrotestosterone concentrations to exclude 5 alpha-reductase deficiency, and molecular genetic analysis of the androgen receptor gene and the 5 alpha-reductase gene. RESULTS In 12 patients the cause was clarified. Diagnoses included Drash syndrome with Wilms tumor in infancy (3 patients), partial androgen insensitivity resulting from androgen receptor mutations (2), true hermaphroditism (2), chromosomal aberration (1), deficiency of antimüllerian hormone (1), gonadal dysgenesis (1), partial 5 alpha-reductase deficiency caused by a novel point mutation (1), and XX-male syndrome (1). Twelve patients had associated findings such as cardiac malformations (3 patients), rectal atresia (1), dilation of urinary tract (2), cystinuria (1), and others. CONCLUSIONS Patients with severe hypospadias should be submitted to a standardized set of diagnostic procedures in infancy. A stepwise diagnostic study avoids unnecessary, invasive, and expensive testing. A high proportion of classified causes can be expected. Patients at risk of having malignancies or hormonal disorders must remain under close surveillance.
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Affiliation(s)
- N Albers
- Department of Pediatrics, University of Bonn, Germany
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17
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18
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Aaronson IA, Cakmak MA, Key LL. Defects of the Testosterone Biosynthetic Pathway in Boys With Hypospadias. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64893-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ian A. Aaronson
- From the Departments of Urology and Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Murat A. Cakmak
- From the Departments of Urology and Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Lyndon L. Key
- From the Departments of Urology and Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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19
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Sandberg DE, Meyer-Bahlburg HF, Yager TJ, Hensle TW, Levitt SB, Kogan SJ, Reda EF. Gender development in boys born with hypospadias. Psychoneuroendocrinology 1995; 20:693-709. [PMID: 8848516 DOI: 10.1016/0306-4530(95)00025-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fetal testicular androgens in several mammalian species are responsible for the sexual differentiation of both the genitalia and the brain, the latter effect being related to behavioral sex-dimorphisms. Because prenatal endocrine abnormalities can be inferred from genital defects, studies of individuals born with anomalies potentially elucidate the contribution of androgens to the development of gender-related variation in human behavior. This study concerns the gender-role behavior of middle childhood boys (ages 6-10 years; n = 175) born with hypospadias, an androgen-related genital anomaly. Parents completed standardized gender behavior questionnaires in a postal survey. Hypospadias subjects did not show consistent differences from a community control group (n = 333) in feminine behavior, but significant, small, increases in masculine behavior were found. Severity of the hypospadias was unrelated to gender-role behavior. A number of surgery-related hospitalizations, however, were correlated with increased gender-atypical behavior. It is concluded that the hypoandrogenization associated with hypospadias does not interfere with the development of gender-typical masculine behavior.
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Affiliation(s)
- D E Sandberg
- Department of Psychiatry, State University of New York at Buffalo, USA
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Shima H, Okamoto E, Ikoma F. Pituitary and gonadal functions in patients with chordee without hypospadias. Int Urol Nephrol 1992; 24:69-73. [PMID: 1624246 DOI: 10.1007/bf02552120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pituitary and gonadal functions in 16 prepubertal boys with chordee without hypospadias by stimulation of gonadotropin releasing hormone or human chorionic gonadotropin were compared to those of age-matched normal boys. The patients with chordee without hypospadias had poor follicular stimulating hormone response but pituitary luteinizing hormone reserve function was normal. Testosterone response by stimulation of human chorionic gonadotropin was not impaired in patients with chordee without hypospadias. The results suggested that chordee without hypospadias may also be categorized into hypospadias from the aspect of its pituitary and gonadal functions in addition to the embryogenesis of chordee.
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Affiliation(s)
- H Shima
- Department of Urology, Hyogo College of Medicine, Japan
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Nonomura K, Sakakibara N, Demura T, Mori T, Koyanagi T. Androgen binding activity in the spongy tissue of mammalian penis. J Urol 1990; 144:152-5. [PMID: 2359168 DOI: 10.1016/s0022-5347(17)39399-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The binding of [3H]R1881 to cytosol fractions was determined for the spongy tissues of horse, porcine and human penis. Binding of [3H]R1881 to cytosol fractions from these spongy tissues was found to be specific with high affinities (mean of Kd; 1.8 X 10(-10) M) but with equally low binding capacities (mean of 4.66 fmol/mg. protein). Saturation analysis revealed that the binding capacity was similar for both corpus cavernosum and corpus spongiosum of horse penis. We conclude that a trace amount of androgen receptor is present in spongy tissue of the penis and that there is no difference in cytosolic receptors between corpus cavernosum and corpus spongiosum in adult mammalian penis.
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Affiliation(s)
- K Nonomura
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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Sakashita S, Demura T, Gotoh T, Maru A, Koyanagi T. Postoperative reduction of serum beta-HCG in testicular seminoma. Int Urol Nephrol 1988; 20:281-6. [PMID: 2456999 DOI: 10.1007/bf02549517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Serum beta-HCG and urinary HCG were measured in 17 patients with histologically proved pure seminoma of the testis. The patients have been followed to date for 10 to 74 months after orchiectomy, and have no residual disease or recurrence of their disease. Preoperative urinary HCG levels were abnormal in 9 patients (53%). Serum beta-HCG levels were slightly elevated in 6 out of 12 patients evaluated, and were reduced after orchiectomy even in patients with preoperative normal beta-HCG levels (P less than 0.05). Preoperative levels of the tumour marker in seminoma were far lower than in patients with non-seminomatous germ cell tumours, but it would not be rare to see a small amount of HCG produced by the tumour cells in the seminoma.
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Affiliation(s)
- S Sakashita
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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Shima H, Ikoma F, Yabumoto H, Mori M, Satoh Y, Terakawa T, Fukuchi M. Gonadotropin and testosterone response in prepubertal boys with hypospadias. J Urol 1986; 135:539-42. [PMID: 3080607 DOI: 10.1016/s0022-5347(17)45730-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Serum levels of luteinizing hormone and follicle-stimulating hormone before and after luteinizing hormone-releasing hormone stimulation, and levels of testosterone before and after 3 days of treatment with human chorionic gonadotropin were determined by radioimmunoassay in 98 boys with hypospadias (2 to 8 years old). The doses of luteinizing hormone-releasing hormone and human chorionic gonadotropin were calculated for body surface. The basal and peak levels of serum luteinizing hormone, follicle-stimulating hormone and testosterone in patients with hypospadias were compared with 9 endocrinologically normal boys of the same age without hypospadias. Luteinizing hormone response to luteinizing hormone-releasing hormone stimulation was significantly impaired in boys with hypospadias and also simple hypospadias (no associated anomaly). Basal levels of luteinizing hormone in boys with simple hypospadias and levels of follicle-stimulating hormone in patients with hypospadias were significantly low. The maximum testosterone response to human chorionic gonadotropin stimulation was significantly decreased in boys with severe hypospadias in direct proportion to the degree of hypospadias.
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