Reduction of androstenedione by skin in vitro and serum levels of gonadotrophins and androgens in men with hypospadias

Etiologic classification of severe hypospadias: implications for prognosis and management

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.

Fibroblast androgen receptors in patients with genitourinary anomalies

The etiology of certain disorders of sexual differentiation is unclear. The authors have examined the hypothesis that hypospadias and other disorders compatible with a defect in androgen action, such as cryptorchidism, micropenis, chordee/penile torsion, and ectopic testis, might be explained by androgen receptor abnormalities. Therefore, 25 subjects were studied who were selected only because they had one of these developmental defects, together with a predominantly male phenotype, and no readily ascertainable explanation for the defect. Four of these subjects had mixed gonadal dysgenesis with multiple genito-urinary anomalies. They were included for comparative purposes, since there is no evidence for androgen resistance in this disorder. Patients with testicular regression syndrome (gross testosterone deficiency), impaired testosterone biosynthesis (relative testosterone deficiency), 5 alpha-reductase deficiency (altered T/DHT ratio), and a family history or endocrine profile suggestive of androgen resistance, were all excluded from evaluation. Androgen receptor content (R0) and binding affinity (Kd) were measured in 26 genital or pubic skin fibroblast strains cultured from 25 affected patients using a dispersed, whole cell assay at 22 C. There was no difference in the mean androgen receptor content (approximately 10,000 sites/cell) or binding affinity (approximately 1 nM) between the patients' fibroblasts and those from 26 fibroblast strains established from 26 normal males. Moreover, there were no differences in the nuclear uptake of [3H]dihydro-testosterone into dispersed, intact fibroblasts incubated at 37 C when 11 patient and seven normal male fibroblast strains were compared.(ABSTRACT TRUNCATED AT 250 WORDS)

Androgens and personality in normal men and men operated for hypospadias in childhood

Serum levels of LH, FSH, prolactin and androgens were assayed in 33 adult men operated for a penile malformation (hypospadias) in childhood and in 34 matched controls. Two cases of severe hypospadias had signs of hypergonadotrophic hypogonadism. Three moderately severe cases possibly had a central relative androgen receptor insensitivity. Patients had lower levels of 5 alpha-dihydrotestosterone in serum, unrelated to the severity of the hypospadias. The hypospadias patients have previously been shown to be more neurotic and inhibited both socially and sexually than the controls, which might be related to defective androgenic functioning. Relations between androgen levels and psychological variables were studied. Low testosterone levels were related to higher hostility scores in Rorschach. Relations between androgens and other personality characteristics could not be shown.