The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles

Response to: The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles

The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles

Hildorf et al in their article titled “The Majority of Boys Having Orchidopexy for Congenital Nonsyndromic Cryptorchidism during Minipuberty Exhibited Normal Reproductive Hormonal Profiles” propose that the majority of cryptorchid boys undergo normal mini-puberty.[1] In 1976 in Stresa (Italy), we reported that when the high infertility risk (HIR) and low infertility risk (LIR) patient groups were merged, the basal and stimulated gonadotropin values were within the normal range, in agreement with the observation of Hildorf et al. However, when hormonal values are analyzed according to the presence or absence of Ad spermatogonia, the patients can be grouped into two categories. One group is the HIR patients whose testes lack Ad spermatogonia (indicating abnormal mini-puberty) and who show low hypogonadotropic basal and stimulated luteinizing hormone (LH) plasma levels.[2] The other group is the LIR patients whose testis contain Ad spermatogonia and who show normal LH and follicle stimulating hormone plasma values.[2] If pathological testicular changes were caused by a primary gonadal defect, one would not expect to find low plasma LH levels in patients with the most pronounced testicular pathology.[3] In fact, low gonadotropin levels in HIR patients prove that they suffer from hypogonadotropic hypogonadism.[2] [3] Notably, among boys with cryptorchidism, the estimated incidence of abrogated mini-puberty has been reported to be as high as 50 and 70%.[3] [4] In contrast, Hildorf et al found that 74% of infants had normal Ad spermatogonia and gonadotropin levels, with not even one lacking Ad spermatogonia to be qualified as an HIR patient. This raises questions regarding their histological methodology and patient selection criteria. Therefore, the conclusion that the majority of cryptorchid patients undergo normal mini-puberty is incorrect and misleading.

Publication History

Received: 14 December 2021

Accepted: 17 January 2022

Article published online:
09 March 2022

• References

• 1 Hildorf S, Hildorf AE, Clasen-Linde E. et al. The majority of boys having orchidopexy for congenital nonsyndromic cryptorchidism during minipuberty exhibited normal reproductive hormonal profiles. Eur J Pediatr Surg 2021; 32(1): 26-33 DOI: 10.1055/s-0041-1739416.
• 2 Hadziselimovic F, Girard J, Herzog B. Lack of germ cells and endocrinology in cryptorchid boys from one to six years of life. In: Bierich JR, Giarola A. eds. Cryptorchidism. London: Academic Press; 1979: 129-134
• 3 Verkauskas G, Malcius D, Eidukaite A. et al. Prospective study of histological and endocrine parameters of gonadal function in boys with cryptorchidism. J Pediatr Urol 2016; 12 (04) 238.e1-238.e6
• 4 Hadziselimovic F, Hoecht B. Testicular histology related to fertility outcome and postpubertal hormone status in cryptorchidism. Klin Padiatr 2008; 220 (05) 302-307