Hormone profiles and contralateral testicular histology in Down's syndrome with unilateral testicular tumor

Serum Gonadotropin Levels in Patients with Germ-Cell Tumors of the Testis: Interrelations, Possible Cross-Reactions and Interpretation of Beta-Hcg Level

The concentration of FSH, LH, LTH, testosterone and beta-hCG was estimated in 177 serum samples from 86 patients with malignant germ-cell tumors of the testis. The objectives of the investigation were the following: the detection of interrelations of hypophyseal gonadotropins at different beta-hCG levels; the determination of the significance of borderline values of beta-hCG; the analysis of the effect of elevated concentrations of beta-hCG on pituitary gonadotropins: the detection of possible cross-reactions during gonadotropin determinations. The RIA method was used to estimate levels of three gonadotropins. The results revealed that there was no cross-reaction between FSH and beta-hCG at RIA assays. When the serum level of beta-hCG of tumor origin exceeded 100 U/l a subtotal inhibition of FSH secretion was observed. Pathologically increased values of beta-hCG were found not only in serum with subnormal FSH levels, but also when FSH levels were excessively elevated (exceeding 50 U/l). In the latter case the elevated beta-hCG levels could possibly be the consequence of the secretion of beta subunits by the hypophysis or a cross-reaction with LH, and not of a tumor. With values of beta-hCG over 100 U/l cross-reaction with LH occurs, so the true LH levels cannot be assessed. For an adequate interpretation of elevated values of beta-hCG in the serum (i.e. whether they are tumor-derived or not), it is necessary to have values of FSH from the same serum sample.

Challenges in treating patients with Down's syndrome and testicular cancer with chemotherapy and radiotherapy: The Royal Marsden experience

AIMS

With a life expectancy similar to the general population, greater numbers of patients with Down's syndrome are being diagnosed with testicular cancer. Learning difficulties and medical co-morbidity are common in this patient population and may lead to non-standard oncological treatment. We aimed to identify and discuss management challenges in the treatment of these patients with chemotherapy and radiotherapy and report their clinical outcome.

MATERIALS AND METHODS

The Royal Marsden Hospital urology database was searched from 1982 to 2005 to identify all cases of patients with Down's syndrome and histologically confirmed testicular cancer who were referred for consideration of chemotherapy or radiotherapy.

RESULTS

Nine patients were identified, of whom eight received chemotherapy or radiotherapy. Two patients had bilateral tumours and four had crypto-orchidism. At the time of diagnosis, the patients were 21-50 years of age. Of the 11 tumours identified, nine were seminomas and two were malignant teratoma undifferentiated. Five patients presented with stage I disease, of whom three received carboplatin and one received para-aortic radiotherapy as adjuvant treatment. Three patients presented with stage II disease, of whom two were treated with carboplatin and one received combination chemotherapy followed by radiotherapy. One patient with stage IV disease was treated with carboplatin. Five of nine patients relapsed within 30 months, of whom three were successfully salvaged with radiotherapy and one with combination chemotherapy.

CONCLUSION

After standard and non-standard therapy for seminoma, the relapse rate for patients in our cohort was high. Since relapsed disease is much more difficult to manage with combination chemotherapy on account of respiratory, cardiac and renal co-morbidity, adequate initial treatment is advised. Consideration of psycho-social issues and the multiple treatment strategies available is vital in delivering optimal care to patients with Down's syndrome and testicular cancer.

Beta-adrenergic hyperresponsiveness in compensated hypothyroidism associated with Down syndrome

Although compensated hypothyroidism (CH) is the most common thyroid impairment in Down syndrome (DS), its pathogenesis remains elusive. Because primary gonadal failure is another DS-associated endocrinopathy, we hypothesized that an impaired signal-transduction pathway shared by several organs may provide a unifying explanation for both endocrinopathies. We assessed two possible transduction-pathway components associated with CH in DS: the G-protein adenylate-cyclase (AC) system and beta-adrenergic responsiveness, previously reported to be enhanced in DS fibroblasts. Twenty-one DS patients and 14 control subjects were studied. Peripheral mononuclear cells (PMCs) were incubated with G-protein modulators [prostaglandin E1 (PGE1) and cholera toxin (CTx)], an AC stimulator (forskolin), and a beta-adrenergic agonist (isoproterenol), and cAMP levels were determined. All participants had normal plasma thyroid hormone levels, but 11 of the DS patients had elevated TSH levels (hTSH), whereas in the 10 others, they were normal (nTSH). cAMP levels in response to forskolin, PGE1, and CTx were similar in all groups, whereas isoproterenol-stimulated cAMP levels were significantly higher in the hTSH group than in the nTSH group and control subjects (45 +/- 30 versus 22 +/- 9 and 21 +/- 9 pmol . 10(6) cells(-1) . 10 min(-1), respectively; p = 0.02). Four patients in the DS hTSH subgroup had impaired sexual development. We found hyperresponsiveness of PMCs to a beta-adrenergic agonist in a subgroup of DS patients with CH. If this observation is applicable to the thyroid gland, then it may reflect a mechanism in which negative effects on cell growth or responsiveness to TSH lead to CH.

Bone mass, gonadal function and biochemical assessment in young men with trisomy 21

OBJECTIVE

The objective of the study was to find out whether biochemical and hormonal profile of sexual function and mineral metabolism are related to low bone mass in young men with Down syndrome.

STUDY DESIGN

Eleven young men with trisomy 21 (mean age 26.45 years) and 12 healthy university students of similar age, participated in the study. The bone mineral density (BMD) of the lumbar vertebrae was measured in posteroanterior (PA) projection. Sexual development was assessed by clinical examination. The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone and parathormone (PTH) were measured accordingly by radioimmunoassay. Serum calcium (Ca) and phosphate (P) as well as fasting urinary Ca and hydroxyproline (OHP) were also measured.

RESULTS

BMD in DS patients was significantly lower (P<0.001) compared to their control counterparts. No significant differences were observed in mean concentrations of FSH, testosterone and DHEA-S, while LH and 17-OH progesterone levels were significantly higher in DS compared to control group (P<0.01 and <0.05, respectively). Serum Ca and P and urine Ca/Creat ratio did not differ between groups. OHP/Creat ratio was significantly higher in DS patients. PTH levels were extremely low (1pmol/l) in two patients.

CONCLUSIONS

The findings of this study show decreased bone mass in subjects with DS. Factors, possibly related to low bone mass, are some degree of hypogonadim, hypotonia, low muscular strength and immobility. The findings suggest further research on the biochemistry and endocrinology of bone metabolism in patients with trisomy 21.

Gonadal function in young women with Down syndrome

OBJECTIVE

Investigations suggest an increased incidence of gonadal dysfunction in patients with Down syndrome. New features, Alzheimer disease and osteoporosis emerge in these individuals. Therefore, hormonal investigation in persons with Down syndrome is pursued.

METHODS

Thirteen females with trisomy 21 (23.65 +/- 3.23 years old) participated in the study. Ultrasound studies were performed to explore the internal genitals. Blood samples were taken for the determination of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), dehydroepiandrosterone sulfate (DHEA-S), testosterone (T) and 17-hydroxyprogesterone (17-OHP).

RESULTS

The patients were at stage V of sexual development. Ultrasonography demonstrated normal uterine and ovarian size and endometrial thickness as well. The ovaries of all patients contained follicles of normal distribution and various sizes. The mean concentrations of FSH, DHEA-S and E2 were normal. The level of PRL was significantly higher than that of the controls, but within the normal lab range. The levels of LH, T and 17-OHP were significantly elevated, compared to those of the control group (P < 0.05, P < 0.01, P < 0.001, respectively).

CONCLUSIONS

Our data produce new information on the gonadal function of Down syndrome women. Specific studies on pituitary-gonadal and pituitary-adrenal axis function are needed.

Aspects of the neoplasms observed in patients with constitutional autosomal trisomy

A review of the literature reveals numerous clinical case reports, systematic histologic analyses, epidemiologic studies, and large series of tumors showing that subjects with trisomy 8, 9, 13, 18, and 21 have an excess of hematologic and various solid tumors compared to the general population. These tumors more frequently affect particular organs for a given type of trisomy. A large proportion of tumors are observed during fetal and neonatal life, are incompletely developed, and subsequently regress. In older children or even adults, tumors are less frequent, are often found on the same organs as earlier in life, are more aggressive, and do not involute. The mechanism responsible for the development of these neoplasms could be similar to that which generates the malformations in these children and may result from cooperation of the chromosomal abnormality with physiologic growth phenomena, which are particularly active early in life. Trisomic subjects must be carefully followed in order to detect tumors as early as possible and to allow treatment under optimal conditions.