Hormonal changes in urine and plasma in patients with various testicular tumours before and after treatment. I. Seminoma

Testicular failure in patients with extragonadal germ cell tumors

Eight patients with mediastinal or retroperitoneal germ cell tumors who had undergone testicular biopsy or orchiectomy were retrospectively analyzed for primary testicular abnormalities, subfertility, and abnormal sex hormone levels. Testicular tissue was abnormal in all patients, revealing peritubular fibrosis (six), decreased spermatogenesis (eight), interstitial edema (five), Sertoli cells only (one), and Leydig cell hyperplasia (two). Detailed hormone analysis in five patients revealed elevations of luteinizing hormone in four, decreased serum testosterone in two, elevations of estradiol in two, and elevation of human chorionic gonadotropin in one patient. A history of infertility was documented 2 months to 13 years before presentation in four patients and suspected in another. Extragonadal germ cell tumors, like their testicular counterparts are associated with primary germ cell defects, some of which seem to be independent of gonadotropin production by the tumor. In addition, the rather high incidence of antecedent infertility suggests that either a congenital or acquired primary germ cell defect contributes to defective spermatogenesis and the development of cancer in incompletely migrated germ cells.

Endocrine and exocrine profiles of men with testicular tumors before orchiectomy

In 15 patients with germ cell testicular tumors serum hormone profiles and semen analysis before orchiectomy were evaluated to determine the incidence of defective spermatogenesis associated with testicular tumors. Defective spermatogenesis was noted in 10 patients (66 per cent) on the basis of low sperm concentration, motility or semen volume. Of the 10 patients 7 had sperm concentrations less than 10 million per cc. Endocrine abnormalities occurred in 10 patients, the most common of which were elevations in serum human chorionic gonadotropin and estradiol, and a relative decrease in follicle-stimulating hormone. Three patients who presented with subfertile semen analyses were treated with orchiectomy alone. Repeat semen analyses 4 to 12 months after orchiectomy showed improvement in spermatogenesis and 2 patients achieved a normal semen analysis. Endocrine abnormalities and defective spermatogenesis are common in patients with testicular tumors. These abnormalities precede orchiectomy and imply that a primary germ cell defect exists in these patients.

Serum testosterone, LH, and FSH in patients with testicular cancer before and after radio- and chemotherapy

Serum levels of testosterone, luteinizing hormone and follicle-stimulating hormone were measured in 73 patients with germ cell testicular cancer in stages I and II. Blood samples were taken after unilateral orchidectomy but immediately before irradiation and chemotherapy, and again 1 to 3 years after cessation of therapy. No difference was found between pre- and post-treatment testosterone values. Patients who received radiotherapy only, had similar pre- and post-treatment luteinizing hormone values, whereas the patients who received chemotherapy in addition to irradiation still had elevated luteinizing hormone values 1 to 3 years after cessation of therapy. These values fell towards the pretreatment levels during the follow-up period. Levels of follicle-stimulating hormone were already higher than normal before treatment and increased further during treatment.

Biochemical markers in advanced testicular tumors: serum lactate dehydrogenase, urinary chorionic gonadotropin and total urinary estrogens

Twenty-seven patients with advanced testicular tumors were screened for serum lactate dehydrogenase (LDH) concentration, and 24-hour urinary excretion of human chorionic gonadotropin (hCG) and total estrogens. The investigation indicates an overall correlation between serum LDH concentration and cancer burden and an overall correlation between the maximum serum LDH and prognosis. It indicates an overall ocrrelation between the hCG determined within 2.5 months after the orchiectomy and prognosis. The relation between total estrogens and cancer burden or prognosis does not support the hypothesis that total urinary estrogens are a biochemical marker in testicular tumors.

Endocrine studies in testicular tumor patients with and without gynecomastia: a report of 45 cases

Prolactin (PRL), human placental lactogen (hPL), the beta-subunit of human chorionic gonadotropin (betahCG), testosterone (T), estrone (E1), and estradiol (E2) were measured in blood samples from 45 patients with testicular tumors, 27 of whom had gynecomastia at some stage of their disease. Forty-two of the 45 patients had at least one abnormal hormone level. The most common abnormality was that of plasma estrone: it was elevated in 32 out of 42 (76%) patients in whom it was measured, suggesting a useful role for E1 as a testicular tumor marker. Prognosis was notably worse in patients with embryonal carcinoma, teratocarcinoma, and choriocarcinoma, in those with gynecomastia and, particularly, galactorrhea. Such patients also had the highest incidence of hormonal abnormalities as well as the most extreme absolute values. Hormonal mechanisms were implicated in the development of gynecomastia and galactorrhea. Prolactin, betahCG, E1, and E2 levels in all permutations correlated significantly among patients with gynecomastia, but not among those without, while estrogen to testosterone ratios were elevated in patients with galactorrhea.