Integrity of hypothalamic-pituitary-testicular axis in exceptional longevity

Hypothalamic integrity increasingly is being recognized as a marker of healthy longevity in rodent models. Insight into hypothalamic function in humans with exceptional longevity can be gained via investigation of the hypothalamic-pituitary-testicular (HPT) axis in men with exceptional longevity. This study aimed to characterize the HPT axis function, defined by levels of testosterone (T) and luteinizing hormone (LH), in 84 Ashkenazi Jewish men aged 90-106 years. We found that 94% of men exhibited preserved hypothalamic-pituitary function, as evidenced by either normal testosterone and LH levels (25%) or an appropriate rise in LH in response to aging-related primary testicular dysfunction (69%), a hormone pattern mirroring female menopause. Total T level was not associated with metabolic parameters or survival. These results demonstrate a high prevalence of testicular dysfunction with preserved hypothalamic-pituitary function in men with exceptional longevity. Thus, the role of hypothalamic integrity and HPT axis in healthy aging warrants further investigation.

A rare case of 46, XX (SRY positive) testicular disorder of sex development with growth hormone deficiency: Case report

RATIONALE

Chromosome karyotype analysis and SRY (sex determined region of Y chromosome) gene detection are routines for the diagnosis of growth hormone deficiency (GHD), but further whole exome gene sequencing occasionally leads to subversive results and unexpected conclusions.

PATIENT CONCERNS

We report a single case of a 7-year-old Chinese boy who had stunted growth since he was 1 year old. He was short in height (height Standard Deviation Score (SDS) was less than 2.9), bilateral scrotal dysplasia and delayed bone age.

DIAGNOSIS

His growth hormone (GH) stimulation tests showed GHD. His karyotype analysis and polymerase chain reaction (PCR) analyses indicated a 46, XX disorder of sex development (DSD) without the presence of the SRY gene. Nevertheless, considering that female gonad was not observed in the chest and abdominal magnetic resonance imaging, the whole exome gene sequencing was performed. Sequencing data confirmed the presence of SRY gene sequence and two copies of chromosome X. Later, using different primer sequences for PCR, it showed that the SRY gene was positive. The final diagnosis was a rare case of "46, XX (SRY positive) testicular DSD with GHD".

INTERVENTIONS

The boy's parents agreed to use recombinant human growth hormone (rhGH) for GHD treatment, the starting dose was 0.035 mg / kg / day. But they disagreed with molecular diagnostics and genomic analysis of the Y chromosome.

OUTCOMES

The boy was treated with rhGH for 3 months and his height increased by 2.2 cm. The patient will be followed-up until the end of his puberty.

LESSONS

In summary, whole exome gene sequencing overturned the preliminary diagnosis results of karyotype analysis and SRY gene detection, and found that there may be a certain correlation between testicular DSD and GHD.

Evaluation of Serum Insulin-like Factor 3 Quantification by LC-MS/MS as a Biomarker of Leydig Cell Function

BACKGROUND

The peptide hormone insulin-like factor 3 (INSL3) is a marker for Leydig cell function and the clinical use of serum INSL3 measurements has been suggested by several groups.

AIM

(1) To establish a reference range for liquid chromatography-tandem mass spectrometry (LC-MS/MS) of serum INSL3 in healthy boys and men; and (2) to compare the associations of serum INSL3 and testosterone (T) to pubertal stage, lifestyle factors, diurnal variation, body composition, and human chorionic gonadotropin (hCG) stimulation.

RESULTS

In a reference range based on LC-MS/MS analysis of serum from 1073 boys and men, INSL3 increased from levels close to the detection limit (0.03 µg/L) in prepubertal boys to a maximum mean level of 1.3 µg/L (95% CI, 0.9-2.7) in young men (19-40 years of age) and decreased slightly in older men (0.1 µg/L per decade). Serum T, but not INSL3, was associated with body mass index or body fat percentage and with alcohol consumption. Smoking was positively associated with serum T, but negatively associated with INSL3. There were significant diurnal variations in both INSL3 and T in men (P < 0.001), but serum INSL3 varied substantially less, compared with serum T (± 11% vs ± 26%). Mean serum INSL3 increased after hCG stimulation, but less than T (+ 17% vs + 53%). In both healthy men and in patients suspected of testicular failure, baseline serum INSL3 was more closely associated to the hCG-induced increase in serum T than baseline T itself.

CONCLUSION

Measurement of serum INSL3 by LC-MS/MS has promise as a marker of testicular disorders.

Rare case of meningococcal sepsis-induced testicular failure, primary hypothyroidism and hypoadrenalism: Is there a link?

Severe illness can lead to multiple transient endocrinopathies. In adult patients, neuroendocrine alterations include sick euthyroid syndrome, an increase in corticosteroid levels, increase in prolactin levels, decreased insulin growth factor 1 levels and hypogonadism. We report the case of a 24-year-old man with meningococcal sepsis with multiple end-organ complications who developed persistent non-autoimmune hypothyroidism, adrenal insufficiency and primary hypogonadism all requiring hormone replacement. While adrenal insufficiency as part of the Waterhouse-Friderichsen syndrome is well described, reports of primary hypothyroidism and persistent primary hypogonadism in severe illness are exceedingly rare. Multiple combined endocrinopathies as in this case have not been reported previously. This case highlights the necessity of screening for endocrine abnormalities in severe illness and the need for treatment if persistent. It also raises a novel concept of meningococcal sepsis causing multiple endocrinopathies possibly via disseminated intravascular coagulopathy-related ischaemic damage.

Leydig cell clustering and Reinke crystal distribution in relation to hormonal function in adult patients with testicular dysgenesis syndrome (TDS) including cryptorchidism

OBJECTIVE

Testicular dysgenesis syndrome (TDS) comprises testicular germ cell cancer, cryptorchidism and some cases of male infertility and hypospadias, which can be linked to impairment of intrauterine gonadal development. Among histological signs of TDS, large Leydig cell (LC) clusters (micronodules) are frequently present. This study aimed to investigate possible associations of LC micronodules with the presence of Reinke crystals and hormonal function of LCs, the latter primarily reflected by serum concentrations of luteinising hormone (LH) and testosterone, in patients with TDS.

DESIGN

A retrospective study of 101 andrological patients with TDS (infertility with and without a history of cryptorchidism or presence of germ cell neoplasia in situ) and 20 controls with normal testis histology and LC-function. Archived testicular biopsies were re-evaluated for the presence of LC micronodules and Reinke crystals and the findings were correlated with testis size and serum concentrations of LH, follicle-stimulating hormone (FSH), testosterone, inhibin B, estradiol and sex hormone binding globulin (SHBG).

RESULTS

TDS patients with bilateral LC micronodules had significantly lower concentrations of LH, FSH and inhibin B, a lower testosterone/LH-ratio and smaller testis sizes compared to TDS-patients lacking this feature. Presence of LC micronodules was correlated with a lower number of Reinke crystals, while cryptorchid testes had a significantly higher number of crystals than normally descended TDS testes.

CONCLUSION

LC micronodules appear to be a compensatory mechanism caused by androgenic failure and are presumably driven by high concentrations of LH. A relative paucity of Reinke crystals in LCs within micronodules in normally descended TDS testes may be a feature of recently renewed immature Leydig cells. The increased number of Reinke crystals in LCs in testes that were either undescended at birth or are persistently undescended could indicate an impairment of LC renewal in cryptorchidism.

Possible Mechanisms Underlying the Testicular Toxicity of Oxfendazole in Rats

To clarify the mechanisms underlying the testicular toxicity of oxfendazole (OX), adult Wistar rats were orally administered a dose of 100 mg/kg/day for 3, 7, or 14 days. Assays of sex-related hormones showed a significant decrease in only the estradiol serum level at days 3 and 7, as compared with the control group. Histopathologically, marked degeneration of meiotic spermatocytes was observed in stage XIV—I seminiferous tubules from day 3 onwards, and these spermatocytes gave positive results on terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling (TUNEL). Abnormalities of spermiogenesis such as megakaryospermatids and binucleated spermatids were also observed in the testes of OX-treated rats. Under the electron microscope, lipid accumulation and dilatation of the endoplasmic reticulum were frequently found in the cytoplasm of the Sertoli cells on day 3. These results strongly suggest that OX induces both apoptosis of meiotic spermatocytes, most probably due to disruption of the microtubules, and degeneration of the Sertoli cells, characterized by distended endoplasmic reticulum and prominent cytosolic lipid accumulation.

Polymorphism rs2274911 of GPRC6A as a Novel Risk Factor for Testis Failure

CONTEXT

The G protein-coupled receptor GPRC6A is an emerging effector with multiple endocrine roles, including stimulation of T production from the testis. Recently, two men with an inactivating mutation (F464Y) of GPRC6A have been identified, and they showed primary testicular failure and deranged spermatogenesis. Furthermore, one of them also reported cryptorchidism at birth. In addition, a polymorphism (rs2274911, Pro91Ser) in GPRC6A is associated with prostate cancer, a typical androgen-sensitive cancer.

OBJECTIVE

To study the possible association between rs2274911 polymorphism and male fertility and/or cryptorchidism. Design, Patients, Settings: A total of 611 subjects, including 343 infertile patients, 197 normozoospermic controls, and 71 cryptorchid newborns, were retrospectively selected.

METHODS

Sequencing analysis for rs2274911 polymorphism and F464Y mutation, and serum levels of FSH, LH, and T were assessed. In vitro functional studies for rs2274911 and F464Y were also performed.

RESULTS

Homozygous subjects for the risk allele A of rs2274911 had a 4.60-fold increased risk of oligozoospermia and 3.52-fold increased risk of cryptorchidism. A significant trend for increased levels of LH in the GA and AA genotypes, compared with GG homozygotes, was detected in men with azoospermia/cryptozoospermia (P for trend = .027), further supporting an association with primary testicular failure. The mutation F464Y was found in one cryptorchid child (one in 71; 1.41%). Functional studies showed that the A allele of rs2274911 and the F464Y substitution were associated with lower exposition of the receptor on the cell membrane and a reduced downstream phosphorylation of ERK1/2 with respect to wild type.

CONCLUSION

Our results suggest that GPRC6A inactivation or sub-function contributes to reduced exposure to androgens, leading to cryptorchidism during fetal life and/or low sperm production in adulthood.

[TESTICULAR DEFICIT SYNDROME IN MEN WITH TYPE 2 DIABETES AND OBESITY]

The aim of the study was to examine the level of sex and pituitary hormones in men of older age groups suffering from type 2 diabetes with visceral-abdominal obesity and without it. The study involved 89 men aged 46-76 years with type-2 diabetes. We analyzed the levels of sex hormones (total and free testosterone, estradiol) and lutenizing hormone levels in the blood of men in the survey, depending on the presence/absence of obesity and androgen deficiency. Average levels total and free testosterone were significantly reduced in patients of all groups surveyed. The lowest level of androgens observed in patients with type 2 diabetes, obesity and androgen. Mid E2 levels only in patients with type 2 diabetes and obesity showed a tendency to increase. Coefficient of T/E2 was significantly reduced in patients with type 2 diabetes and obesity (63,00±8,20) and to a lesser extent in patients with type 2 diabetes without obesity (112,40±8,16) compared the control group (136,40±11,30). The results indicate the presence of not only absolute, but relative androgendeficiency in men with type 2 diabetes.

Precocious puberty and Leydig cell hyperplasia in male mice with a gain of function mutation in the LH receptor gene

The LH receptor (LHR) is critical for steroidogenesis and gametogenesis. Its essential role is underscored by the developmental and reproductive abnormalities that occur due to genetic mutations identified in the human LHR. In males, activating mutations are associated with precocious puberty and Leydig cell hyperplasia. To generate a mouse model for the human disease, we have introduced an aspartic acid to glycine mutation in amino acid residue 582 (D582G) of the mouse LHR gene corresponding to the most common D578G mutation found in boys with familial male-limited precocious puberty (FMPP). In transfected cells, mouse D582G mLHR exhibited constitutive activity with a 23-fold increase in basal cAMP levels compared with the wild-type receptor. A temporal study of male mice from 7 days to 24 weeks indicated that the knock-in mice with the mutated receptor (KiLHR(D582G)) exhibited precocious puberty with elevated testosterone levels as early as 7 days of age and through adulthood. Leydig cell-specific genes encoding LHR and several steroidogenic enzymes were up-regulated in KiLHR(D582G) testis. Leydig cell hyperplasia was detected at all ages, whereas Sertoli and germ cell development appeared normal. A novel finding from our studies, not previously reported in the FMPP cases, is that extensive hyperplasia is commonly found around the periphery of the testis. We further demonstrate that the hyperplasia is due to premature proliferation and precocious differentiation of adult Leydig cells in the KiLHR(D582G) testis. The KiLHR(D582G) mice provide a mouse model for FMPP, and we suggest that it is a useful model for studying pathologies associated with altered LHR signaling.

Prophylactic efficacy of Coriandrum sativum (Coriander) on testis of lead-exposed mice

Lead poisoning is a worldwide health problem, and its treatment is under investigation. The aim of this study was to access the efficacy of Coriandrum sativum (coriander) in reducing lead-induced changes in mice testis. Animal exposed to lead nitrate showed significant decrease in testicular SOD, CAT, GSH, total protein, and tissue lead level. This was accompanied by simultaneous increase in the activities of LPO, AST, ALT, ACP, ALP, and cholesterol level. Serum testosterone level and sperm density were suppressed in lead-treated group compared with the control. These influences of lead were prevented by concurrent daily administration of C. sativum extracts to some extent. Treating albino mice with lead-induced various histological changes in the testis and treatment with coriander led to an improvement in the histological testis picture. The results thus led us to conclude that administration of C. sativum significantly protects against lead-induced oxidative stress. Further work need to be done to isolate and purify the active principle involved in the antioxidant activity of this plant.

[Flow cytometry application in the evaluation of antisperm antibodies in sera samples of infertile people and prepubertal boys with gonadal disorders]

OBJECTIVES

The aim of the following study was to assess antisperm antibodies in sera samples of infertile men and women, as well as from prepubertal boys by means of flow cytometry.

MATERIAL AND METHODS

We tested sera samples of infertile and fertile adult populations, prepubertal boys with gonadal disorders and healthy prepubertal boys. The indirect immunobead test and flow cytometry were used to detect antisperm antibodies.

RESULTS

The comparison of antisperm antibody levels in sera samples of adult infertile versus healthy controls (men and women) evaluated by means of flow cytometry did not reveal statistically significant differences. The only significant correlation found were results obtained by IDIBT and FCM for IgG antisperm antibodies for infertile adult group (r = 0.507, p = 0.012). The comparison of antisperm antibody levels in sera samples from prepubertal boys revealed statistically significant differences for all tested antibody isotypes. Diagnostic values compared for both assays showed markedly better discriminatory ability of flow cytometry for analyzed groups of prepubertal boys than for adult populations.

CONCLUSIONS

Flow cytometry test may be used to verify antisperm antibody levels in prepubertal boys with testicular failures.

A non-endocrine cause of testicular enlargement mimicking precocious puberty: testicular microlithiasis

Untimely bilateral testicular enlargement greater than 3 ml is suggestive of precocious puberty, in which an underlying organic disease is more common in boys than in girls. We describe a 7 1/2 year-old boy presenting with testicular enlargement due to testicular microlithiasis. Following hormonal tests, diagnosis was based on ultrasonographic findings. Three years follow-up of the patient revealed normal pubertal progress and no malignant evolution. Testicular microlithiasis is a rare cause of testicular enlargement and pediatricians should take this disease into account in the differential diagnosis of suspected precocious puberty.

[Change of pulsatile release and luteinizing hormone response to naloxone related to testicle damage]

OBJECTIVE

To compare the pulsatile release of LH, the tone of endogenous opioids and the mass of LH secreted after a naloxone infusion in healthy subjects and patients with normogonadotropic oligospermia (NO) in a model of progressive testicular damage.

PATIENTS AND METHODS

Pulsatile secretion of LH was analyzed in a period of 8 hours in a group of healthy subjects (group 3, n=5), in patients with NO and FSH/LH ratio <1.6 (group 1, n=5) and in patients with NO and FSH/LH ratio >1.6 (group 2, n=5). The area under the curve of LH response after naloxone infusion was also calculated.

RESULTS

Free serum testosterone concentration was lower (p < 0.01) and estradiol concentration higher in patients with NO than control subjects (1 vs. 3: p = 0.01; 2 vs. 3: p = 0.001). Frequency of pulses in group 1 was 3.33 +/- 0.57/8 h, in group 2: 4 +/- 1/8 h; and in group 3: 2.66 - 0.57/8 h (2 vs. 3 p < 0.01; 2 vs. 1 p = 0.05). The area under the curve after naloxone infusion was 19,300.44 +/- 11,403.31 in group 1, 5696.09 +/- 1753.44 in group 2; and 3080.97 +/- 1159.78 in group 3 (1 vs. 3 Anova p = 0.01).

CONCLUSIONS

The data indicate that patients with NO have a subclinical pantesticular failure and that the opioid tone is increased at the initial phase of testicular dysfunction, but it decreases at more advanced stages of testicular damage.

Protection of testicular dysfunctions by MTEC, a formulated herbal drug, in streptozotocin induced diabetic rat

Single injection of streptozotocin (STZ) resulted diabetes mellitus which was reflected here by the levels of fasting blood glucose and serum insulin. Moreover, this experimental diabetes also resulted testicular dysfunctions evaluated by count, viability and motility of sperm as well as by the activities of key enzymes for androgen synthesis. Diabetes induced testicular oxidative stress has been indicated here by the monitoring of testicular peroxidase and catalase activities as well as by quantification of TBARS and CD of testis. Testicular glucose was increased and leydig cell nuclear area was decreased in STZ induced diabetes. Treatment of herbal formulated drug named as MTEC consist of aqueous-methanol extract of Musa paradisiaca, Tamarindus indica, Eugenia jambolana and Coccinia indica to streptozotocin induced diabetic rat at the ratio of 2:2:1:1 at the dose of 60 mg/d for two times a day for 14 d resulted a significant protection in fasting blood glucose and serum insulin levels (p<0.05) along with correction of testicular above parameters towards the control level (p<0.05). This herbal formulated drug has no general toxic effects on the body weight, as well as on the activities of serum glutamate and pyruvate transaminases in serum. The results support the validity of this herbal drug for the management of testicular disorders noted in diabetic state.

Pathological Conditions of the Reproductive Organs of Male Stray Dogs in the Tropics: Prevalence, Risk Factors, Morphological Findings and Testosterone Concentrations

The objective of this study was to estimate the prevalence of and risk factors for pathological conditions of the reproductive organs in stray dogs under tropical conditions. Three hundred and eighteen dogs were examined post-mortem in the period from 1 July 2002 to 30 June 2003. Before killing, a blood sample (from the cephalic vein) for testosterone assay was taken. Pathological conditions of the reproductive organs were found in 135 of the dogs (42.5%) and in 175 of the testes (64.8%). The most frequent pathologies found were testicular degeneration, cryptorchidism, testicular hypoplasia and testicular tumours (in 15.1%, 6.6%, 6.6% and 5.4% of the dogs and 15.1, 4.6, 6.0 and 3.5 of the testes, respectively). Transmissible venereal tumour (TVT) was seen in 5.4% of the dogs. Testicular degeneration was more common in old dogs and underweight dogs (p < 0.05). Testicular tumours were 14.3 times more common in cryptorchid dogs. Age was another important factor for the development of testicular tumours (p < 0.05). Lower levels of testosterone concentration (p < 0.05) were observed in dogs with advanced testicular degeneration (0.7 +/- 0.8 nM), dogs with hypoplastic testicles (0.8 +/- 0.9 nM) and dogs with one degenerated and one retained testis or with bilateral cryptorchidism (1.2 +/- 0.9 nM) compared to dogs with one or two normal testes (7.0 +/- 5.5 nM). Testicular volume and weight were significantly lower in degenerated, hypoplastic and retained testes compared with the contralateral normal testis. Some spermatogenic activity was found in three of the retained testes, producing oligozoospermic smears with a high percentage of sperm abnormalities. No comparable epidemiological data about male pathological conditions of the reproductive organs in the dog is available. The prevalence found in this study, yet, appears high.

Baseline follicle-stimulating hormone is a strong predictor for the outcome of the gonadotrophin-releasing hormone test in young men with unilateral medium- or high-grade varicocele

OBJECTIVE

To investigate whether the gonadotrophin-releasing hormone (GnRH) test is an adequate diagnostic tool to identify testicular dysfunction in men with strictly unilateral varicocele and defined testicular volume; and to identify any peripheral venous variable which would predict the result of the GnRH test.

PATIENTS AND METHODS

In all, 102 GnRH tests were done in men with a left-sided varicocele. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were determined. After intravenous administration of 100 microg GnRH, stimulated LH and FSH levels were measured. FSH levels of >8.2 U/L and LH levels of >51.7 U/L were considered exaggerated.

RESULTS

In all, 50 men had an exaggerated GnRH test result; all had an exaggerated FSH response and six also had an elevated LH response. The baseline FSH levels were higher (P < 0.001) and the testicular volume was smaller (P < 0.01) in men with an exaggerated GnRH test response. All men with a baseline FSH level of >5.6 U/L had an exaggerated GnRH test response.

CONCLUSION

A baseline FSH level of >5.6 U/L is a good predictor of the GnRH test outcome. Leydig cell function seems mainly undisturbed.

Insulin-like factor 3 serum levels in 135 normal men and 85 men with testicular disorders: relationship to the luteinizing hormone-testosterone axis

Insulin-like factor 3 (INSL3) serum levels were measured in 135 andrologically well-characterized normal men and 85 patients with testicular disorders to investigate how the hormone, which is a major secretory product of human Leydig cells, is related to testosterone (T), LH, and semen quality. INSL3 was measured by using a newly developed fluorescence immunoassay. Median (2.5-97.5 percentiles) INSL3 serum levels were as follows: normal men (n = 135), 0.99 (0.55-1.73) ng/ml; infertile men (n = 23), 1.11 (0.60-2.07) ng/ml; anorchid men (n = 21), nondetectable (ND); patients with 47, XXY, Klinefelter syndrome (n = 21), 0.12 (ND-0.78) ng/ml; men with hypogonadotropic hypogonadism and T substitution (n = 11), ND; and men with hypogonadotropic hypogonadism and human chorionic gonadotropin (hCG) treatment (n = 5), 0.36 (0.13-0.73) ng/ml. Before testicular biopsy, two infertile men had blood samples drawn directly from vena spermatica. Here, the serum INSL3 levels were 15-fold higher than in serum from peripheral blood samples (13.84 and 14.00 ng/ml, respectively). In two unilaterally orchiectomized former testis cancer patients, who underwent hCG stimulation test, INSL3 serum levels were unchanged 72 and 96 h after hCG stimulation. In conclusion, we provide a normal range for INSL3 serum levels in adult men and show that the majority, if not all, circulating INSL3 derives from the testes. Furthermore, our data strongly indicate that INSL3 secretion is dependent on the differentiating effect of LH on Leydig cells but independent of the steroidogenic LH-mediated action. Thus, even though T and INSL3 are both dependent on LH, these two Leydig cell hormones are regulated differently.

Azoospermia in testicular sarcoidosis is an indication for corticosteroid therapy

OBJECTIVE

To report improvement of azoospermia and hypogonadism after high-dose corticosteroid therapy in a patient with testicular sarcoidosis.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 27-year-old man with testicular sarcoidosis and azoospermia.

INTERVENTION(S)

High-dose corticosteroid therapy was commenced in an attempt to improve sperm count and restore gonadal function.

MAIN OUTCOME MEASURE(S)

Analysis of sperm count, T, and gonadotropin response to steroid therapy.

RESULT(S)

FSH and LH concentrations decreased and T levels increased in parallel with control of disease activity with steroid therapy. Repeat semen analysis demonstrated a significant increase in sperm count, allowing sperm banking to take place.

CONCLUSION(S)

High-dose corticosteroid therapy may be indicated in testicular sarcoidosis, not only for control of systemic disease activity but also for recovery of gonadal function and spermatogenesis.

A novel circulating hormone of testis origin in humans

Insulin-like factor 3 (INSL3) is a member of the relaxin-insulin family, and it is expressed in pre- and postnatal Leydig cells of the testis. This peptide affects testicular descent during embryonic development, and mutations in INSL3 gene or its receptor LGR8 (leucine-rich repeat-containing G protein-coupled receptor 8)/GREAT (G protein-coupled receptor affecting testicular descent) cause cryptorchidism in humans. The expression of LGR8/GREAT in different tissues and the production of INSL3 also by adult-type Leydig cells suggest additional roles of this hormonal system in adulthood. In this preliminary report we performed the first analysis in humans of INSL3 using a novel RIA kit to measure INSL3 concentrations in serum of normal men and with different testicular pathologies. The results show that INSL3 is circulating in adult men, and it is almost exclusively of testicular origin. Subjects with severe testicular damage, such as men with severe infertility, produce low amount of INSL3, and the concentrations of this hormone seem to reflect the functional status of the Leydig cells. In particular, INSL3 concentrations may be an even more sensitive marker of Leydig cell function than testosterone itself. Analysis of men treated with different combinations of hormones of the hypothalamus-pituitary-testis axis suggests that the production of INSL3 is related to LH in a manner similar to that of the LH-testosterone axis.

Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial

Testicular atrophy is a sequela of inguinal hernioplasty. The purpose of this study was to evaluate the effects of Lichtenstein (LHR) and laparoscopic totally extraperitoneal (TEP) hernia repair techniques on testicular function and volume. This study is a randomized prospective clinical trial with the blind assessment of outcome. A total of 26 patients who underwent elective herniorrhaphy for groin hernia were included in the study. Each patient was randomly assigned into one of two groups: either TEP or LHR (n = 13 for each). Six of the patients had bilateral hernia (n = 3 for each group). Luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone levels, and testicular volume by Doppler ultrasonography were detected just before and 3 months after the operation. LH, FSH levels did not change, when compared preoperative and postoperatively in both groups. Testicular volume and testosterone levels were observed to be significantly decreased after TEP when compared with LHR while no significant preoperative changes were observed between those groups. This affected the testicular volume in normal limits. TEP or LHR could not affect LH, FSH, testosterone values, but TEP could lead a decreasing effect on volume of testis in normal limits.

Investigation of testicular toxicity of nefiracetam, a neurotransmission enhancer, in rats

Testicular toxicity of nefiracetam (N-(2,6-dimethylphenyl)-2-(2-oxo-1-pyrrolidinyl) acetamide), a neurotransmission enhancer, was investigated in male Slc:SD rats. Nefiracetam was orally administered daily at 1500 mg/kg for 4 weeks, and the animals were killed sequentially during the course of administration to determine testicular histopathological changes and sperm head counts (SHC), and hormonal changes. Retention of step 19 spermatids, sporadic degeneration of pachytene spermatocytes and step 7 spermatids in the stage VII seminiferous tubules, and a decrease in SHC were seen as earliest changes after 1 week of administration. These changes gradually advanced up to atrophy of seminiferous tubules with multinucleated-giant-cell formation after 4-week administration. Serum and testicular testosterone levels were decreased, but recovered to the control levels within a day following a single administration, and the decreases were repeated after 1-week administration. These results suggest that nefiracetam-induced earliest changes could be caused by the decreased level of testicular testosterone.

Reversibility of the chronic effects of di(2-ethylhexyl)phthalate

Fischer-344 rats treated with 12,500 ppm (728 and 879 mg/kg/d for male and females, respectively) and B6C3F1 mice treated with 6,000 ppm (1,227 and 1,408 mg/kg/d, respectively) di(2-ethylhexyl)phthalate (DEHP) in the diet for 78 weeks were allowed to recover for an additional 26 weeks on control diet. Blood was analyzed at weeks 78 and 104 from 10 animals per sex per group; animals were sacrificed at weeks 79 and 105 for histopathologic examination. The results are compared with data from animals continuously exposed to these dietary levels for 104 weeks (10, 11). Body weights and food consumption were measured monthly. BUN, albumin, and globulin that were significantly different for rats exposed to DEHP throughout 104 weeks, were comparable to controls for the recovery group. Reversibility of chronic effects on erythrocyte count, hemoglobin, and hematocrit values was apparent only for female rats. Chronic exposure demonstrated effects on liver, kidney, and testes weights. All organ weight effects except for testes for the Recovery group of rats, and all organ weight effects for mice, were reversible. Pigmentation of Kupffer cells and renal tubules present in chronically treated rats were not observed for the Recovery group. Lesions in the testes and pituitary gland were not reversible in rats. This may be a reflection of the senescence of the hypothalamic-gonad axis in rats. Cessation of exposure for mice resulted in amelioration of effects in the kidneys, liver, and testes. The extent of reversibility suggests that many chronic effects may be associated with a metabolic phenomenon such as peroxisome proliferation, which also reverted to control levels after 26 weeks of recovery.

[Testicular artery Doppler flow evaluation in men with degenerative changes of seminiferous tubules]

AIM

The aim of this study was to assess the eventual impact of degenerative changes of seminiferous tubules on Doppler flow parameters in testicular vessels.

MATERIAL AND METHODS

There were 12 men with degenerative changes of seminiferous tubules (diagnosed by testicular biopsy) in study group and 24 healthy men with normal semen parameters in control group. Patients' age in both groups was respectively 32.22 +/- 5.31 and 29.64 +/- 3.17 (ns). Sonographic biometry of testes volume was performed and the values of qualitative flow indices in terminal section of testicular artery were evaluated. The both groups results were compared with themselves by T-test. Also the values of qualitative flow parameters in testis after biopsy and contralateral one were compared. Additionally the correlation between vascular flow parameters and selected hormone levels (FSH, LH, T, E2 and Prl) was determined.

RESULTS

The mean testes volume in the study group was 10.81 +/- 3.77 cm3 and in the control one 14.42 +/- 5.42 cm3 (ns). The values of particular flow indices in both study and control group were respectively: S:D 3.20 +/- 0.95 and 2.92 +/- 0.96 (ns), PI 1.46 +/- 0.46 and 1.23 +/- 0.41 (ns), RI 0.69 +/- 0.09 and 0.66 +/- 0.08 (ns). There were no differences between flow parameters in testis after biopsy and contralateral one. Testosterone was the only hormone correlating with analyzed flow indices (S:D, PI, RI) and the correlation coefficient value was respectively 0.51, 0.49 and 0.52 (p < 0.05).

CONCLUSIONS

The significant influence of degenerative changes of seminiferous tubules on vascular flow in testicular artery was not observed. There were no differences between flow parameters in testis after biopsy and contralateral one. The testosterone was the only hormone significantly correlating with analyzed flow indices.

Antisperm antibodies in prepubertal boys and their reactivity with antigenic determinants on differentiated spermatozoa

PROBLEM

Antisperm antibodies induced in prepubertal boys with testicular failures were characterized by using four techniques of antibody detection. The reactivity of circulating antisperm antibodies in prepubertal boys and the reactivity of antibodies in sera samples of adult fertile and infertile males were compared against the same sperm antigenic pools (live or fixed spermatozoa, or sperm antigenic extracts).

METHOD OF STUDY

The incidence of antisperm antibodies in sera samples of 69 prepubertal boys with testicular failures and 21 samples obtained from adult, male individuals was assessed by indirect immunobead binding test (IDIBT), flow cytometry measurement, enzyme-linked immunosorbent assay, and Western blotting. Immunoblot analysis was performed by using sperm extracts of glycosylated and deglycosylated solubilized membrane antigens.

RESULTS

Sera samples were studied in a group composed of healthy prepubertal boys (n = 7) and prepubertal boys with testicular failures (n = 69). Applied tests of antibody detection revealed striking differences in a group of boys with testicular pathology. With IDIBT, 7% of the sera samples were found positive, whereas with flow cytometry measurement, 48% of the sera samples were positive. Immunosorbent assay (fixed sperm) indicated 32% positive cases in the same group. The sera samples were found to be positive in 65% of immunoblotting reactions with glycosylated antigens and in 70% of immunoblotting reactions with deglycosylated antigens. All applied detection assays were clearly negative on sera samples from fertile, adult males. Western immunoblotting indicated an immunodominant antigenic determinant of 58 kDa.

CONCLUSIONS

Tests of antibody detection with the use of live sperm (IDIBT and flow cytometry measurements) presented low sensitivity (8% and 48%, respectively) in a group of prepubertal boys. This observation underlines the difficulties in assigning the prospective prognosis of future fertility status in prepubertal boys with antisperm antibodies.

[Chronic orchialgia. A diagnostic and therapeutic hypothesis]

OBJECTIVE

The objective of this study is to offer patients with chronic testicular pain and no physico-pathological finding, a likely cause not usually taken into account such as uricemia. The hypothesis of an intracanalicular deposit of uric crystals and/or the resulting alteration in nerve endings is suggested.

METHOD

The study involved a total of 60 patients with chronic orchialgia and no detectable testicular pathology seen over a 5-year period. Mean age 35.6 years. They were all evaluated with routine laboratory tests, uricemia, uricosuria and in specific cases uroculture and Stamey's method. Orchidometry, vascular doppler and ultrasound were used in all cases.

RESULTS

Presence of hyperuricemia was corroborated in 61.6% cases. Based on figures found, patients were divided into three groups. Patients were treated with a low-purine diet plus Allopurinol 300 mg/day, and symptoms receded in 81.06% cases.

CONCLUSIONS

Due to the high incidence of hyperuricemia and the significant symptomatological relief obtained with specific treatment, we believe its determination should become routine.

Specificity of antibodies directed against Env protein of human endogenous retroviruses in patients with germ cell tumors

We report here that 85% of the patients with germ cell tumors (GCTs) produce antibodies directed against Env protein of human endogenous retroviruses. Individuals that received antitumor treatment showed a decrease with time in their antibody titers. Importantly, of the rare cases of non-GCT individuals with Env-antibodies (n= 15, 0.8%), none produced antibodies directed against the transmembrane domain (TM), whereas all tested Env-positive GCT patients (n= 49) generated such antibodies at high titers. TM is required for Env to be expressed at the cell surface. Thus, anti-TM antibodies constitute highly specific markers for GCT and may hint at a function of Env during tumorigenesis.

Intrascrotal sarcoidosis: case reports and review

A review of the English literature revealed 43 cases of histologically proven intrascrotal sarcoidosis. Due to this relative rarity, the difficulty in diagnosis and concern of possible testicular malignancy, 35% of these patients have undergone unnecessary orchiectomy. We present 3 cases of intrascrotal sarcoidosis and propose a testicular-sparing strategy for the appropriate diagnosis and treatment of intrascrotal sarcoidosis.

Correlations between spondylarthropathic inflammatory troubles and gonadal (androgenic) troubles in men. Study on 30 cases with a new methodological analysis

Ankylosing spondylitis (AS) and spondylarthropathies (SAP), proposed immune diseases, present sexual preponderance: men are mostly affected. It is known that androgens are decreased in systemic immune disorders. We have investigated two aspects: gonadal--with 13 parameters, and entheso-osteoarthritic--with 10 parameters, by an original methodological semiquantitative analysis. All the parameters were divided into five degrees; each degree was pointed from 0 to 5, and the total and final scores were obtained. In this way differences and correlations could be performed between all 23 parameters. We have studied 30 SAP patients in inflammatory attack, 4 SAP patients out of the inflammatory attack and 16 control subjects; all were men and in fertile age. Between the gonadal status of SAP patients vs the control group there is a significant difference concerning: the degree of testosterone (1.81 vs 0.22, p < 0.005) and testes trophicity (1.5 vs 0.35, p < 0.01); marked differences have been recorded for integrative scores: total (12.18 vs 6.21, p < 0.02), final (1.07 vs 0.57, p < 0.01) and general degree score (1.7 vs 1.18, p < 0.01). Testosteronemia has been different, too: 7.38 vs 23.25 nmol/l, p < 0.01. Between SAP patients in and out of the inflammatory attack there are no significant differences. A significant positive correlation between gonadal axis status degree and entheso-osteoarthritic status degree has been obtained by Spearman rank test: r = 0.41, p < 0.05. Our new methodological analysis allows to change qualitative criteria in mathematical used quantitative data, for performing correlations between so different fields: rheumatological and endocrinological. SAP patients (in inflammatory attack, and out of the inflammatory attack) have a certain degree of hypogonadism, which does not represent a specific disease but suggests a specific spondylarthropathic background.

Endocrine evaluation of testicular function

This article reviews currently available endocrine tests that are used to evaluate adult testicular function. In many patients, all that is needed is a thorough medical history and physical examination with measurement of total testosterone, FSH, and LH levels. For others, various secondary tests are appropriate. The usefulness and pitfalls of these endocrine tests are discussed.

Reduced inhibin and elevated gonadotropin levels in early pubertal boys with testicular defects

In the prepubertal quiescent period, the control of gonadotropin secretion is assumed to be mediated by neuroendocrine inhibitory mechanisms, whereas little or no effect is thought to be mediated by the gonad. However, in pubertal-aged children with primary gonadal failure, gonadotropins increase to supranormal levels, suggesting that gonadal factors become more important in the control of gonadotropin secretion at that age. These gonadal factors have been poorly characterized so far. To clarify the relationship of inhibin and testosterone to the control of gonadotropin secretion during sexual maturation, we examined serum inhibin, testosterone, LH, and FSH concentrations in 10 boys with testicular defects and in nine healthy boys, in prepuberty and in early puberty. Serum was obtained at 15-min intervals for at least 6 h during the night. Prepubertal-aged boys with testicular defects had only slightly higher FSH levels than healthy boys, and their LH and inhibin levels were no different. In contrast, pubertal-aged boys with testicular defects had higher LH and FSH levels and lower inhibin levels than healthy boys. In prepubertal-aged boys, no correlation was found between individual mean inhibin level and mean FSH or LH level. In contrast, in pubertal-aged boys, an inverse nonlinear relationship between mean inhibin level and mean FSH and LH level was seen. The inverse value for inhibin correlated with FSH (r = 0.74, p < 0.01) and with LH (r = 0.81, p < 0.01). In conclusion, our results suggest that inhibin is a factor involved in the control of gonadotropin secretion in boys, at least in the pubertal period.

Is routine endocrine testing of impotent men necessary?

Endocrine screening of impotent men is performed in an effort to identify a treatable cause of impotence. However, the prevalence of endocrinopathy in this patient population is low. We determined whether any historical or physical findings obtained during the initial office visit would identify a subgroup of patients at risk for endocrinopathy to decrease the cost of endocrine screening. The results of routine endocrine screening of 330 consecutive impotent patients formed the basis of this study. A total of 7 patients (2.1%) had endocrinopathy. Testicular atrophy was observed in 5 of these 7 patients and 6 reported decreased libido. All of the patients with endocrinopathy had either decreased libido or bilateral testicular atrophy. Our results indicate that the cost of impotence evaluation can be decreased by screening only those patients with clinical signs of hypogonadism, that is either decreased libido or bilateral testicular atrophy.

Effects on testosterone, LH and cortisol concentrations, and on testicular ultrasonographic appearance of induced testicular degeneration in bulls

It is well known that heat stress has a detrimental effect on testicular functions. In addition to the alteration of semen quality and testicular damage, reproductive hormone secretion can be altered. The objective of this study was to describe changes in plasma concentrations of testosterone, LH and cortisol, as well as in testicular ultrasonographic appearance after induced testicular degeneration. Four Swedish Red and White bulls, aged 3 years, were used. They were fed according to Swedish standards. The scrotum was covered with an insulation device during 96 h. Semen was collected weekly 3 times before and up to 4 months after insulation. Testicular ultrasonography and clinical genital examination were performed with the same intervals. Heparinized blood samples were taken from the jugular vein at 2 h interval during 24 h every 2 weeks during the study. Blood samples were tested for the content of testosterone, LH and cortisol. Data were analysed, using one way analysis of variance of seminal data, clinical examination data as well as 24 h hormonal output data as percentage of mean individual pretreatment values. The use of a 5 MHz B-mode ultrasound unit did not contribute with an objective estimation of the degree of testicular degeneration. In 3 of the bulls testosterone levels had a tendency to decrease and LH to increase during the time of severe degeneration, whereas an opposite trend was seen during the regenerative phase, changes becoming significant 15 weeks after scrotal insulation. Variation between animals was big. Cortisol levels had a decreasing trend, changes being significant only in individual bulls at 10 and 15 weeks after scrotal insulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Macroorchidism and testicular fibrosis associated with autoimmune thyroiditis

A 16-year-old male with long-standing atrophic chronic lymphocytic thyroiditis was evaluated for macroorchidism. A testicular biopsy prior to treatment revealed peritubular and interstitial fibrosis, reduced spermatogenesis and sparse Leydig cells with nonprominent smooth endoplasmic reticulum. Biological/immunological LH and FSH ratios were reduced, I-LH and FSH response to GnRH was blunted, and levels of testosterone and androstenedione were low. Twenty-two months after thyroid treatment, the testicular size was unchanged, and the degree of fibrosis showed minimal regression. Spermatogenesis with normal morphology was present, Leydig cells with Reinke crystals were present, and surface area and diameter of the seminiferous tubules had increased only slightly. There was a normal I-LH and FSH response to GnRH, and normal levels of testosterone and androstenedione. This study, along with previous reports, suggests that the etiology of the hypothyroid state may influence the development of testicular fibrosis.

Serum inhibin levels in normal men and men with testicular disorders

Serum concentrations of inhibin, FSH and LH were measured in 39 normal men and 127 men with testicular disorders resulting in infertility. The infertile men were divided into groups on the basis of their mean sperm count, FSH levels and karyotype. The mean (+/- S.D) serum concentrations of inhibin in the normal men was 554 +/- 156 U/l and did not differ significantly from those groups with oligospermia, azoospermia or Klinefelter's syndrome. Combined analyses of all groups did not reveal any significant correlation between serum concentrations of inhibin and FSH or with any other parameter measured. Serum concentrations of FSH and LH were positively correlated, and Leydig cell dysfunction, as evidenced by increased serum LH levels, low testosterone levels or a declining testosterone/LH ratio were found with severe spermatogenic damage. The failure of serum concentrations of inhibin to correlate with those of FSH levels or the degree of testicular damage raise questions as to the clinical value of this parameter alone.

Increased levels of serum follicle-stimulating hormone and luteinizing hormone associated with intrinsic testicular hyperthermia in oligospermic infertile men

A Negative correlation between spermatozoa output and serum gonadotropin levels, as well as between scrotal temperature and spermatozoa output, has been found in man. However, no studies have been done on the relationship between scrotal temperature and serum gonadotropin levels. This paper reports such data from 212 infertile men. The upper limit for normal scrotal temperature was defined as the 90th percentile value (35.3 C) of a control group of 64 fertile men whose mean serum FSH and LH levels were 6.0 +/- 0.8 (+/- SE) and 6.4 +/- 0.7 IU/L, respectively. This value for scrotal temperature (35.3 C) was used to classify infertile men into 3 groups: bilateral hyperthermia (n = 56), unilateral hyperthermia (n = 40), and bilateral normothermia (n = 116). In the unilateral and bilateral hyperthermic groups serum LH and FSH levels were significantly increased compared with those in the normothermic group. The mean serum testosterone values were similar in all groups. To study the relationships between serum gonadotropin levels or spermatozoa output and scrotal temperature, the infertile men also were divided into classes according to their spermatozoa output. These classes were subdivided into two groups, normothermic or hyperthermic, according to whether the left scrotal temperature was equal to or less than, or more than 35.3 C. For the infertile men whose spermatozoa output was more than 60 X 10(6) spermatozoa/ejaculate (normospermia), there was no significant difference between the serum gonadotropin levels of the normothermic (n = 42) and the hyperthermic (n = 20) groups. Among the oligospermic men (spermatozoa output, 0.1-60 X 10(6) spermatozoa/ejaculate), the hyperthermic group (n = 65) had significantly higher serum gonadotropin levels and significantly smaller testicular volumes than the normothermic group (n = 71). The two oligospermic groups also had significantly higher serum FSH values than the infertile normospermic groups. These results were not linked to the presence of a varicocele or a history of cryptorchidism, as the prevalence of varicocele and cryptorchidism was equally distributed within the groups studied. We conclude that the increase in serum gonadotropin levels in the case of a decrease in spermatozoa output is significantly greater in the presence of associated scrotal hyperthermia.

A comparative study of testicular involvement in lepromatous and borderline lepromatous leprosy

To measure the comparative prevalence of testicular involvement in borderline lepromatous (BL) and lepromatous (LL) leprosy patients, serum FSH, LH, and total testosterone levels were measured in 42 LL and 21 BL subjects. Serum FSH levels were elevated in 19% of BL and in 86% of LL patients. Serum LH values were increased in 10% of BL and in 79% of LL patients. Total serum testosterone values below the normal limit of 280 ng/dl were not found in BL subjects but were present in 31% (13) of the LL cases. By measuring serum free testosterone in patients with low-normal total values, one BL and an additional five LL patients could be identified as below normal limits, i.e., less than 50 pg/ml. Thus, androgen deficiency was present in 5% of BL and in 43% of LL subjects. All of these differences between the BL and LL patients were statistically significant.

Sertoli cell-only syndrome produced by cold testicular ischemia

This report describes a new method for producing Sertoli cell-only testes in the Lewis rat using 90 min of hypothermic testicular ischemia. The method employs selective occlusion of the testicular blood supply using atraumatic microclips applied with the aid of an operating microscope. The testis is packed in ice-cold saline throughout the ischemic interval, and the deferential artery and vein are ligated. Twelve weeks after the ischemic insult, the testes weigh half that of control testes while there were no differences in prostate or seminal vesicle weights. Microscopic examination of the ischemic damaged testes revealed normal-appearing Leydig and Sertoli cells, but complete absence of germ cells. Assays of testicular enzyme activities indicated that lactic dehydrogenase and sorbitol dehydrogenase were reduced, while alpha-glutamyl transpeptidase activity was normal, consistent with the marked reduction of germ cells. Serum androgen binding protein (rABP) levels were elevated relative to nonischemic controls. By contrast, serum concentrations of testosterone, LH, and FSH were normal. In addition, LHRH elicited identical LH and testosterone responses in control and experimental animals. Testicular blood flow measured with 133Xenon was slightly decreased in Sertoli-cell-only testes. Intratesticular temperatures was normal in all groups. These observations in rats with ischemia-induced Sertoli-cell-only testes are strikingly different from those induced by radiation or genetic defects. Animals with these latter disorders have elevated FSH levels, evidence of altered Leydig cell function as evidenced by elevated LH or abnormal response to LHRH; and normal or low serum rABP levels. We conclude that 1) ischemia produces no abnormalities of the pituitary testicular axis in spite of marked germ cell depletion and 2) Sertoli-cell-only testes of different etiologies can have varied patterns of hormone and rABP secretion.

Sarcoidosis and testicular tumors

A thirty-five-year-old white man presented with hilar adenopathy and elevated alpha-fetoprotein after retroperitoneal node dissection and chemotherapy for mixed embryonal seminomatous testicular tumor. A biopsy completed by mediastinoscopy demonstrated sarcoidosis.

Hormone profiles in Klinefelter's syndrome with and without testicular epidermoid cyst

Hormonal studies were performed in patients of Klinefelter's syndrome with and without testicular epidermoid cyst. Mean levels of plasma gonadotropins were elevated above normal ranges. The mean testosterone level in plasma was abnormally low. The mean prolactin level in plasma was within the normal limit. However, mean plasma levels of these hormones were not significantly different between the two groups. The administration of LH-RH resulted in low response of plasma gonadotropins. The response of plasma testosterone to the administration of hCG was also abnormally low. However, in the LH-RH and hCG tests there were no significant differences between the two groups. These data suggested that the hormonal disturbance in Klinefelter's syndrome is unrelated to the occurrence of testicular epidermoid cyst.

Testicular dysfunction in men with sickle cell disease

In order to assess the role of the gonads and anterior pituitary gland in the production of poor quality semen of males with homozygous sickle cell disease (SCD) serum gonadotrophins, namely follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin and serum testosterone, were assayed radioimmunologically in 33 men with sickle cell disease and in 29 age-matched normal control subjects. Our results show a significantly lower mean serum testosterone, a higher mean FSH and prolactin in SCD subjects than in normal controls. No single SCD subject had significantly low serum testosterone associated with low FSH, LH or prolactin. The tendency for higher gonadotrophins associated with lower testosterone in subjects with SCD suggests that the hypothalamic/pituitary function in these patients is intact and that the primary fault leading to poor sperm production lies in the testes.

Pulsatile secretion of immunoreactive alpha-subunit in man

We compared the secretion of uncombined alpha-subunit with LH secretion, as measured by RIA in six normal men, an agonadal adult man, and an adult woman with testicular ferminization. Blood samples were drawn every 10 min for 12 h to evaluate pulsatile LH and free alpha secretion. Spontaneous alpha pulses occurred every 120 +/- 60 min (mean +/- SD; range, 40-260) in eugonadal men. The mean alpha pulse amplitude was 0.49 +/- 0.11 ng/ml, representing an increase of 60 +/- 18% above the preceding nadir value. alpha pulses were generally associated with LH pulses, and the amplitudes of concordant alpha and LH pulses were highly positively correlated (r = 0.58; P less than 0.01). The absolute amplitude of concordant alpha peaks was 1.5 +/- 0.7% that of corresponding LH peaks. Additional alpha pulses were noted in each subject for which simultaneous LH fluctuations failed to meet the criteria for pulses. Studies in the agonadal man and in the patient with testicular feminization revealed that the frequency of both spontaneous alpha and LH pulses was increased to approximately twice that in normal men. Gel filtration analysis indicated that all alpha radioimmunoactivity in normal male sera coeluted with [125I]alpha. By contrast, in hypogonadal sera, only 50-60% of alpha immunoreactivity coeluted with [125I]alpha, the remaining activity appeared in the region of LH and FSH and resulted from RIA cross-reactivity. We conclude that uncombined alpha-subunit, as well as LH is normally released into the peripheral blood in discrete pulses. In the absence of exposure to androgen, the frequency of these pulses increases, presumably as a consequence of the accelerated release of LRH. However, alpha RIAs overestimate the concentration of uncombined alpha in hypogonadal sera. We propose that the coanalysis of LH and alpha secretory episodes may prove useful in resolving some of the complexities associated with gonadotropin secretory patterns.

Elevated serum follicle-stimulating hormone levels in men with normal seminal fluid analyses

Three men who volunteered as normal subjects were found to have abnormally high levels of serum follicle-stimulating hormone (FSH) despite having normal seminal fluid analyses and fertility. Two of the men had a history of previous orchitis, and one had an atrophic testis. Serum luteinizing hormone and testosterone levels were normal. These cases appear to represent compensated primary testicular disease, with normal sperm counts and fertility maintained at the expense of chronically elevated FSH levels. These results imply that in certain situations, the measurement of serum FSH levels may be a more sensitive index of testicular disease than the performance of seminal fluid analyses.

Specificity and sensitivity of human chorionic gonadotropin radioimmunoassays. A comparison of two different approaches

Two different procedures for determination of HCG in plasma from patients with testicular germ cell tumors, patients with benign disease, and normal controls were applied: (1) measurement of the amount of HCG and its beta-subunit, and (2) assay of the isolated beta-subunit alone. The test which measured the free beta-subunit and the HCG molecule gave 13% more sensitivity in patients with nonseminomatous germ cell tumors. The specificity in blood donors was 100% for both tests. In benign diseases the measurement of the complete molecule gave 100% specificity, whereas the other procedure had a specificity of 95%. For these reasons, the determination of the complete molecule seems to be preferable for patients with nonseminomatous germ cell tumors.

Testicular reserve of testosterone precursors in primary testicular failure

To explore the abnormal steroidogenesis in subjects with primary testicular failure, we measured serum levels of testosterone (T) and its precursors androstenedione (delta 4A) and 17-hydroxyprogesterone (17-OHP) in the basal state and after stimulation by human chorionic gonadotropin (hCG) for 4 hours (acute reserve) or 72 hours (chronic reserve). Subjects with primary testicular failure had decreased mean basal serum T, decreased mean chronic T reserve, and absent mean acute T reserve. In contrast, these subjects had normal mean basal serum 17-OHP and delta 4A, normal chronic 17-OHP reserve, and non-zero mean acute 17-OHP and delta 4A reserve, although mean chronic delta 4A reserve was reduced. Heterogeneity of biochemical abnormalities depending on the etiology of testicular failure was apparent. In primary testicular failure, the testicular reserves of the T precursors 17-OHP and delta 4A are better maintained than is the reserve of T itself, raising the possibility that this disorder might be associated with biochemical blocks in conversion of T precursors to T.