Scrotal inflammatory disease: color Doppler US findings

A study of 45 patients with 51 cases of hemiscrotal inflammatory disease was done to determine the color Doppler ultrasonographic appearance of scrotal inflammatory disorders. The diagnosis was ultimately established by means of appropriate response to antibiotic treatment (47 cases) or surgery (four cases). In all cases, there was evidence of hyperemia: an increased number and concentration of detectable vessels in the affected portion of the scrotum. In 17 cases, the gray scale images were normal, and the only evidence of inflammation was the presence of hypervascularity. Abnormally decreased epididymal vascular resistance was detected in 14 cases of epididymitis; abnormally decreased testicular vascular resistance was detected in six cases of orchitis. Spontaneous venous flow was present in 18 patients. The authors conclude that color Doppler can demonstrate the hyperemic response to scrotal inflammatory disease and that, in the proper clinical setting, it can supplement the gray scale findings and increase diagnostic confidence.

Testicular function following cyclophosphamide treatment for childhood nephrotic syndrome: long-term follow-up study

Testicular function of 17 males treated in childhood or adolescence for nephrotic syndrome (NS) with cyclophosphamide (CY) for a mean time of 240 days (mean total dosage of 16.4 g or 641 mg/kg body weight) was evaluated at a mean time of 11.8 years after treatment. Five were azoospermic, 1 oligospermic, and 11 normospermic. There was a significant inverse correlation of sperm density with CY dosage and duration of treatment. All patients had undergone normal pubertal development and had normal sexual characteristics. Both basal and gonadotropin-releasing hormone-stimulated follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations were significantly raised in oligo- and azoospermic patients. Raised basal and peak FSH and LH concentrations in normospermic patients with a sperm count of less than 40 x 10(6)/ml were in keeping with impairment of two testicular components. However, mean basal plasma testosterone levels and mean peak plasma testosterone responses to human chorionic gonadotropin (HCG) did not differ significantly between patients and controls. Although LH responses to gonadotropin-releasing hormone suggested compensated Leydig cell failure in patients with testicular tubular damage, secretory reserve capacity of these cells, estimated by a HCG stimulation test, was preserved. Further follow-up is required to ascertain whether in these patients Leydig cell failure will develop with time.

Testicular damage induced by megadoses of pyridoxine

Pyridoxine hydrochloride, 125 mg/kg, 250 mg/kg, 500 mg/kg or 1,000 mg/kg, daily, was intraperitoneally injected into Wistar male rats and its effects on weights and mature spermatid or sperm counts in the testis and the epididymis were investigated. After six weeks administration, weights of the testis and the epididymis in the 500 mg/kg and 1,000 mg/kg groups dramatically decreased and weights of the epididymis in the 125 mg/kg and 250 mg/kg groups also decreased significantly. Mature spermatid counts in the testis and sperm counts in the epididymis decreased in the 500 mg/kg and 1,000 mg/kg groups, and sperm counts in the tail plus body of the epididymis also decreased in the 250 mg/kg group. From these results, it was elucidated that megadoses of pyridoxine induced testicular damage in rats.

[Andrological findings in hemicastration, lack of a testis, and reduced testicular volume]

In a catamnestic study an analysis of the clinical results as well as of the spermatograms are reported on 545 andrological patients with "atrophy" (that means reduced testis volume) or absence of one testis and a contralaterally normal developed testis. It can be demonstrated that there do not exist any differences concerning the size and consistency of the present testis and with regard to absence or lost of one testis (hemicastration). In case of testicular atrophy exists a more disadvantageous reproductive function. In case of tumor as a reason for hemicastration the teratoma shows better conditions for the quality of the spermatograms and for reproduction. Accordingly the histological findings of the testis after hemicastration/absence are not so large in the present remained testis. In cases of one-sided orchitis the spermatogram quality is better than in one-sided varicocele with atrophy at the same side.

Mechanistic approaches in the study of testicular toxicity: toxicants that affect the endocrine regulation of the testis

This review will expand on the themes presented by Heindel and Treinen (1988). As a prelude to describing where selected compounds act on the endocrine regulation of the testis and the theories about their mechanisms, we will briefly review some of the central pathways that underlie this control. After reviewing some studies that define the site of action of lead on the reproductive system, we will discuss the "signature" lesion caused by androgen deficiency, and then move on to an evaluation of the effects of an antiandrogen (flutamide) on the male reproductive system. Finally, some consideration will be given to alterations in hepatic function which modify circulating levels of androgens.

Mechanistic approaches in the study of testicular toxicity: agents that directly affect the testis

Toxicants which affect the male reproductive system can act indirectly via alteration of the complex hormonal control of the testes, or directly by virtue of their chemical reactivity. Both categories of agents may require metabolic biotransformation to attain activity, and the site of activation may play a significant role in the modulation of testicular toxicity. The modes of action of 2 well known direct-acting male reproductive toxicants are discussed here. The use of a combination of in vivo and in vitro systems to distinguish the site and mechanism of action of these chemicals, ethylene glycol monomethyl ether and dinitrobenzene, is described. Because of the complexity of the reproductive process and of the interaction between gonadal and extragonadal metabolism, the use of multiple endpoints and multiple test systems can lend a greater degree of precision and confidence to our conclusions.

Strain-dependency of procarbazine-induced testicular toxicity

Three strains of rat were used to examine strain-dependency of procarbazine-induced testicular toxicity. CCFHB and CCFY1 outbred albino rats and inbred PVG piebald variegated rats were treated weekly with procarbazine (200 mg/kg/dose x 4). Fifty-six days later, the rats were killed and reproductive parameters evaluated. Strain-related differences in body, testis, prostate, seminal vesicle weights, testis sperm, intratesticular testosterone, and [125I]hCG binding to testicular LH receptors were observed. Although treatment with procarbazine affected testis function in all strains, significant interactions occurred between treatment and strain. LH receptor binding and stem-cell survival were more severely affected in the inbred strain than in outbred strains. Serum testosterone increased in the outbred strain but decreased in the inbred strain, generating an interaction that obscured possible main effects. Significant strain-related differences in within-group variances demonstrated that measurements were more variable in the outbred strains than in the inbred strain. Testes of the inbred strain appeared to be more sensitive to the effects of procarbazine than those of the outbred strains. These data illustrate two important toxicologic phenomena: differences in response variability and differences in target-organ sensitivity, both of which were explained by genetic variability.

[Psychotropic substances and endocrine mechanisms: the effect on gonadal function]

Psychotropic drugs of different classes exhibit the ability to interfere in the sexual sphere. This is evidenced by clinical observations and the latest data concerning experimental research on pharmacological sensitivity of the central mechanisms controlling gonadal function. Both trend and stability of endocrine changes depend significantly on the profile of the neurotransmitter action of the drugs. Such changes can in turn influence the character of the specific activity and degree of side effects of the drugs. The above data prompt to pay more attention to the possibility of the sexual gland function disturbances during the course of psychopharmacotherapy.

[Pathophysiology of primary testicular dysfunction]

This review summarizes the most important forms of primary testicular dysfunction with particular reference to new pathophysiological concepts that may lead to a better understanding of primary testicular dysfunctions. The observed abnormalities can be used as a model to understand the multiple interactions of the different gonadal compartments.

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.

Dose and time relationships in the endocrine response of the irradiated adult rat testis

The dose- and time-dependent responses for the interstitial and tubular compartments in irradiated adult rat testes are described. Leydig cell dysfunction, as indicated by increased serum LH (to a maximum of 385% of control after 5 Gy) and decreased serum T (to a minimum of 30% of control after 10 Gy), was observed at 8 weeks postirradiation. Subsequent recovery of Leydig cell function was then observed, so that after 9 months serum T was normal but LH was still marginally elevated. The dysfunction, with a threshold of about 4 to 5 Gy, was associated with a loss of Leydig cells from the testis. Spermatogenic damage was observed; after doses of 3 Gy and above a marked dose-response was recorded as assessed by counts of tubule cross sections exhibiting spermatogenesis. Reduced serum levels of androgen binding protein indicated Sertoli cell dysfunction at 8 weeks after 3 Gy and above, with values of less than one half of those seen in the controls. Serum FSH also was elevated to between 150% and 200% of control, and after 9 months closely reflected androgen binding protein changes. Unlike the Leydig cell, no recovery with time was observed for this aspect of Sertoli cell function.

Changes induced by manganese in fish testis

Exposure of Colisa fasciatus, a freshwater teleost, to 2500 mg/l manganese sulphate for 90 h caused decreased spermatogenic activity and hemorrhage in the testes.

Dissociation between sleep-related and TRH-induced prolactin secretion in seminiferous tubule failure

Prolactin (PRL) secretion has been measured during sleep and following TRH administration in 8 patients aged 24-39 yr with seminiferous tubule failure and 36 controls. Basal LH levels were 25.7 +/- 14.7 mIU/ml in the patients compared to 11.5 +/- 4.2 mIU/ml in the controls (p less than 0.01) Corresponding FSH levels were 26.2 +/- 10.7 mIU/ml and 5.9 +/- 2.1 mIU/ml (p less than 0.001) Mean estradiol 17B and testosterone levels were similar in the 2 groups. The mean PRL secretion during sleep was 16.5 +/- 11.7 ng/ml in the patients and not different in 11 of the controls (12.4 +/- 3.2 ng/ml). One patient had a mean nocturnal PRL concentration of 44.1 ng/ml. In both groups, the mean sleep related PRL concentration was greater than that during waking hours. The average number of peaks in the 2 groups was similar. In the same patients, the peak PRL response to TRH (200 ug IV) was 81.9 +/- 18.8 ng/ml as compared to 32.1 +/- 10.7 ng/ml in the controls (p less than 0.001). It is concluded that PRL concentrations following pharmacological stimulation are increased in seminiferous tubule failure, whereas levels are normal in relation to the physiological stimulus of sleep.

[Congenital or acquired obstructions of the human epididymis: study of the motility of the spermatozoa above the obstruction]

Azoospermia is frequently due to an obstruction of genital pathways. In this work, concerning 22 patients submitted to surgical investigation for sterility, we made a systematic histological investigation of the lesions, and we studied the motility of epididymal spermatozoa. We observed with an unexpected frequency abnormalities of junctions either between seminiferous tubules and efferents ducts - leading to disappearance of rete testis - or between efferent ducts and epididymis. In each case a fibrosis of the epididymis was discovered, the consequence was either an interruption or, more frequently a simple narrowing of the lumen of the epididymal duct. The presence of spermiophages which destroyed all spermatozoa, was also systematically observed. The origin of the lesions (congenital, inflammatory, ischemic... ) could not be determined by simple histological study. Motility of spermatozoa was generally observed in the initial portion of the epididymal duct, but motile spermatozoa were sometimes still observed in the efferent tubules. Motility could be initiated by caffeine while other compounds as albumin, seminal plasma and different organic substrates, had no effects.

Prolactin response to metoclopramide and chlorpromazine in primary testicular failure and isolated gonadotrophin deficiency

The aim of the present study was to measure the PRL response to metoclopramide (MET) and chlorpromazine (CPZ) in seventeen patients with primary testicular failure and eight patients with isolated gonadotrophin deficiency (IGD). The responses were compared with those to TRH. Basal gonadotrophins and peak responses to LHRH were increased in testicular failure and reduced in IGD. Basal PRL levels were normal in both groups of patients. However, when compared with controls, the PRL response to both MET and CPZ as well as to TRH was exaggerated in primary testicular failure, whereas the responses wee decreased in IGD. In both patient groups, as well as in the controls, the PRL response to MET exceeded that to TRH and CPZ. It is suggested that alterations in the steroid milieu are responsible for the exaggerated PRL response to MET, CPZ and TRH in primary testicular failure and the reduced response observed in IGD.

Prolactin pulsatility in patients with gonadal dysfunction

Serum prolactin concentrations have been measured at 15 min intervals for 2 h on 240 occasions in 227 patients with symptoms which could have been due to hyperprolactinaemic gonadal dysfunction. Of the 227, 138 had at least one elevated random prolactin level. Overall, 22% showed no significant fluctuation in prolactin. In 38% the levels fell progressively from the start of the sampling period, this pattern being found most commonly in patients complaining of infertility. The sampling method yielded a basal or unstressed prolactin concentration which was, on average, 27% lower than random prolactin concentrations. However, a comparison with clinical data, the radiological appearances of the pituitary fossa, and the response to bromocriptine therapy, has shown that there is no predictive information in the multiple sampling results that could not have been obtained from two or three random prolactin levels.

On the role of dihydrotestosterone in regulating luteinizing hormone secretion in man

The effect of dihydrotestosterone [17 beta-hydroxy-5 alpha-androstone-3-one (DHT) in the negative regulation of LH was studied throughout 3 months of percutaneous administration of this steroid to six normal male volunteers and six patients with primary testicular hypogonadism. In addition, testosterone (T) was administered according to the same protocol to the six hypogonadal patients. Plasma T, DHT, estradiol, sex hormone-binding globulin, and LH levels were measured by RIA before and weekly during treatment. In normal men, plasma DHT rose regularly from 0.5 +/- 0.2 to 3.3 +/- 0.9 ng/ml after 3 months of treatment. Concurrently, T decreased from 5.5 +/- 2.0 to 2.9 +/- 0.3 ng/ml, and sex hormone-binding globulin levels decreased from 1.2 +/- 0.1 to 0.9 +/- 0.05 mg/liter. Mean basal LH levels remained stable between 1.9 +/- 1.3 and 3.1 +/- 1.1 mIU MRC, LH 68/40 per ml throughout treatment. In hypogonadal men after DHT treatment, basal LH levels were not suppressed. In contrast, after T administration, plasma LH decreased from 19.8 +/- 5.4 mIU/ml to normal levels (3.4 +/- 2.7 mIU/ml). From these studies, we conclude that 1) high levels of plasma DHT, maintained over a long period, were unable to lower plasma LH in either normal or hypogonadal patients, and 2) in contrast, during the same length of time, high levels of plasma T were perfectly capable of achieving feedback regulation of LH secretion. From these data, it seems unlikely that circulating DHT plays an important role in the physiological regulation of LH secretion.

[The prehypophyseal-gonadal system in the normal male and in some forms of testicular dyscrinism. Evaluation studies in basic conditions and after stimulation]

The secretion values of the two seric gonadotropins and of plasmatic testosterone have been estimated in a casuistry of normal males subdivided in groups of 8 to 95 years of age, and of primitive and secondary testicular dyschrinia. In one part of this casuistry, normal and primitive hypogonadics, we have estimated the response to the intravenous administration of Gn-RH. Among the results which have been obtained, it appears that physiologic hypogonadism of the elderly is a primary phenomenum, not hypophyso-dependent. In the hypophysiary stimulus test, the response of gonadotropins in those old men moves away from the response of hypogonadics considered, by a behaviour much more similar to that of normal adults, even if delayed and prolonged. In all the cases, normal and pathologic, the response of testosterone is variable, perhaps owing to the relation with the various factor which have been noted.

Studies on pituitary-gonadal endocrine function in XYY men

Serum luteinizing and follicle-stimulating hormones and testosterone levels were studied in 11 patients with 47-XYY chromosomes and a comparison was made to normal men and patients with other testicular diseases, including Klinefelter's syndrome. Serum follicle-stimulating hormone levels in patients with XYY chromosomes were elevated significantly in comparison to those in normal men but lower than those in men with Sertoli cell only syndrome and Klinefelter's syndromes. Serum luteinizing hormone levels were somewhat elevated and serum testosterone levels were somewhat low in comparison to normal men, although the difference was not significant. Results of the short-term human chorionic gonadotropin stimulation test suggested almost normal Leydig cell reserve capacity in patients with XYY chromosomes.

Pituitary-gonadal feedback in testicular disorders

Stimulation response of the pituitary to LHRH and testicular biopsy were investigated in 17 infertile men in comparison to 10 healthy controls. A significant elevation of basal FSH and LHRH-stimulated FSH serum levels was observed in Sertoli cell only syndrome and spermatogenetic arrest, while LH and testosterone remained normal. The LHRH test seems to be of value for differentiation of pretesticular, testicular and posttesticular infertility.

The HCG stimulation test in men with testicular disorders

The rise in plasma testosterone levels following stimulation with human chorionic gonadotrophin (3000 i.u./day for 4 days) has been used as a test of interstitial cell function in normal men and men with testicular disorders. The large majority of patients with testicular disorders resulting in infertility, showed a subnormal testosterone response to stimulation. The most marked impairment was noted in those patients with the biopsy appearance of germinal cell arrest and Sertoli cell only syndrome.

Myotonia dystrophica: Studies on gonadal function using luteinizing hormone-releasing hormone (LRH)

Eight men and four women with myotonia dystrophica were investigated. The gonadotropin responses to 100 mug luteinizing hormone-releasing hormone (LRH) were studied, and serum testosterone assayed. In the men with testicular atrophy a high basal follicle stimulating hormone was found with an exaggerated response to LRH. Although the mean basal luteinizing hormone was not significantly elevated, there was an excessive response to LRH, which was possibly conditioned by the lower mean testoerone levels in this group. This study provides biochemical indices of both the primary nature of the testicular damage and the disproportionately greater involvement of the seminiferous tubules. The pituitary-gonadal axis was normal in the women.

Plasma LH and FSH response to LRH in boys with compensatory testicular hypertrophy

The plasma LH, FSH and testosterone response to LRH was studied in 12 boys with compensatory testicular hypertrophy (CTH) and normal puberty and in a matched control group with normal testicular development. It was found, that the boys with CTH had normal basal plasma testosterone and LH concentrations; at the same time the basal plasma FSH level were significantly higher than in the control group. The response of plasma LH and FSH to LRH was markedly greater in the CTH group than it was in the control group. It is concluded, that the contralateral testicular hypertrophy which enables a normal pubertal process is the result of increased secretion of gonadotropins, mainly FSH.

[Radioimmunoanalysis of plasma testosterone]

A simple radioimmunoassay procedure for the determination of testosterone concentration in plasma is described. Small amounts of plasma, 0,5 ml for males and 1 ml for females, are extracted with diethyl ether. Recoveries for the extraction are obtained by the addition of labelled tesosterone. The radioimmunoassay is performed directly on the extracts without further purification. Separation of the free from the antibodie bound testosterone is achieved with dextran coated charocoal. Under the used conditions, the calibration curve covers a range between 0,5 and 1,5 ng per sample. Reproducibility is acceptable with a coefficient of variation of 7%. The normal values are slightly higher than those obtained with methods using some purification step of the extract before the assay but due to its simplicity the described method is a suitable one for clinical purposes.