ESPE Abstracts

Introduction: Cryptorchidism has usually been managed using a surgical approach, with little attention to the underlying pathophysiology.

Objectives: To assess gonadal function before treatment in prepubertal boys with cryptorchidism.

Methods: In a cross-sectional study we reviewed all clinical charts of patients encoded with the diagnosis of cryptorchidism in the database of a paediatric tertiary hospital, between 2000 and 2017. Inclusion criteria were normal virilization and assessment at prepubertal age and before orchidopexy. Patients with other known disorders affecting the gonadal axis were excluded. Serum AMH at first visit, measured by ELISA, was used to define testicular function (Sertoli cell component). Gonadotropins were also evaluated.

Results: After sample size calculation, random samples of 124 of 1033 patients with unilateral cryptorchidism and 186 of 524 patients with bilateral cryptorchidism available in our database were analysed. Median AMH SDS was below 0 in both the bilaterally (Wilcoxon signed rank test, P<0.0001) and the unilaterally (P=0.0052) cryptorchid groups. AMH was undetectable, thus indicative of anorchidism, in 9 patients with bilateral cryptorchidism (4.8% of all patients with bilateral cryptorchidism and 26.5% of those with nonpalpable gonads). AMH levels were below the normal range (<3^rd percentile for age) in 14.3% of the boys with bilateral cryptorchidism aged 1–5.9 months, 36.5% boys aged 6 months-1.9 years, 18.6% boys aged 2–8.9 years and 9.5% in boys older than 9 years. In the group with unilateral cryptorchidism, AMH levels were below the normal range in 16.7% boys 1–5.9 months, 7.1% aged 6 months-1.9 years, 7.2% aged 2–8.9 years and 6.3% older than 9 years. The prevalence of AMH below the normal range was greater in patients with bilateral cryptorchidism than in boys with unilateral cryptorchidism between 6 months and 1.9 years (Fisher’s exact test, P=0.006) and in boys between 2 and 8.9 years (Fisher’s exact test, P=0.043). Sixteen out of 17 boys (94.2%) with micropenis had AMH levels below the normal range. In 5, the diagnosis of central hypogonadism could be certified. Orchiopexy was performed in 151 patients. Serum AMH levels were available in 76 patients before and after surgery. A statistically significant increase was observed in AMH levels after orchiopexy. Serum gonadotropin levels were within the normal range in the vast majority of patients with unilateral or bilateral cryptorchidism independently of age (all prepubertal).

Conclusion: Hypogonadism, reflected by Sertoli cell dysfunction, is a relatively common feature at the time of diagnosis in prepubertal boys with cryptorchidism.