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Rohayem J, Alexander EC, Heger S, Nordenström A, Howard SR. Mini-Puberty, Physiological and Disordered: Consequences, and Potential for Therapeutic Replacement. Endocr Rev 2024; 45:460-492. [PMID: 38436980 PMCID: PMC11244267 DOI: 10.1210/endrev/bnae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Indexed: 03/05/2024]
Abstract
There are 3 physiological waves of central hypothalamic-pituitary-gonadal (HPG) axis activity over the lifetime. The first occurs during fetal life, the second-termed "mini-puberty"-in the first months after birth, and the third at puberty. After adolescence, the axis remains active all through adulthood. Congenital hypogonadotropic hypogonadism (CHH) is a rare genetic disorder characterized by a deficiency in hypothalamic gonadotropin-releasing hormone (GnRH) secretion or action. In cases of severe CHH, all 3 waves of GnRH pulsatility are absent. The absence of fetal HPG axis activation manifests in around 50% of male newborns with micropenis and/or undescended testes (cryptorchidism). In these boys, the lack of the mini-puberty phase accentuates testicular immaturity. This is characterized by a low number of Sertoli cells, which are important for future reproductive capacity. Thus, absent mini-puberty will have detrimental effects on later fertility in these males. The diagnosis of CHH is often missed in infants, and even if recognized, there is no consensus on optimal therapeutic management. Here we review physiological mini-puberty and consequences of central HPG axis disorders; provide a diagnostic approach to allow for early identification of these conditions; and review current treatment options for replacement of mini-puberty in male infants with CHH. There is evidence from small case series that replacement with gonadotropins to mimic "mini-puberty" in males could have beneficial outcomes not only regarding testis descent, but also normalization of testis and penile sizes. Moreover, such therapeutic replacement regimens in disordered mini-puberty could address both reproductive and nonreproductive implications.
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Affiliation(s)
- Julia Rohayem
- Department of Pediatric Endocrinology and Diabetology, Children's Hospital of Eastern Switzerland, 9006 St. Gallen, Switzerland
- University of Muenster, 48149 Muenster, Germany
| | - Emma C Alexander
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
| | - Sabine Heger
- Department of Pediatric Endocrinology, Children's Hospital Auf der Bult, 30173 Hannover, Germany
| | - Anna Nordenström
- Pediatric Endocrinology, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Paediatric Endocrinology, Royal London Children's Hospital, Barts Health NHS Trust, London E1 1FR, UK
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Hu S, Zhao Z, Wan Z, Bu W, Chen S, Yang S, Chen X, Lu Y. Assessment of testicular volume in neonates in the tropical province of China. BMC Pediatr 2023; 23:438. [PMID: 37660011 PMCID: PMC10474672 DOI: 10.1186/s12887-023-04274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND Testicular volume in neonates is a potential indicator of testicular development during the fetal period, particularly the masculinization programming window. Reliable measurements of testicular volume provide an opportunity for early detection of testicular abnormalities. This study aimed to assess the testicular volume in neonates and evaluate its relationship with gestational week and birth weight in Hainan Province, China. METHODS Data on 458 neonates who underwent ultrasonography examinations at our institution from 2018 to 2022 were collected. The neonates were categorized by gestational week, birth weight, and presence of cryptorchidism. We evaluated the testicular volume among different groups and its relationship to gestational week and birth weight. RESULTS There was no significant difference between the right and left testicular volume in neonates without cryptorchidism. However, a significant difference was observed between normal birth weight and low birth weight neonates in terms of testicular volume. Similarly, there was a significant difference between premature and full-term neonates in testicular volume. Bilateral testicular volume showed positive and significant correlations with gestational week and birth weight. Additionally, a significant difference was noted in testicular volume between the affected side in neonates with cryptorchidism and the same side in normal birth weight full-term neonates. CONCLUSIONS We established the normal range of testicular volume for neonates in Hainan Province and demonstrated that testicular volume is positively correlated with both birth weight and gestational week. Cryptorchidism also affects testicular volume during the neonatal period, likely due to reduced androgenic exposure in utero, particularly during the masculinization programming window. The findings of this study have significant implications for assessing testis development during fetal development.
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Affiliation(s)
- Shaohua Hu
- Department of Urology, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China
| | - Zhenli Zhao
- Department of Urology, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China.
| | - Zhisheng Wan
- Department of Urology, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China
| | - Weizhen Bu
- Department of Urology, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China
| | - Songqiang Chen
- Department of Urology, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China
| | - Shuai Yang
- Department of Ultrasound, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China
| | - Xiaowen Chen
- Department of Pediatric, Hainan Women and Children's Medical Center, Changbin Road, Xiuying District, Haikou, 570206, China
| | - Yiqun Lu
- Department of Urology, Children's Hospital of Fudan University, No 399, Wanyuan Road, Minhang District, Shanghai, 201102, China
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Ersoy B, Ovalı GY, Canda E, Onur E, Özyurt BC, Tansuğ N. The relationship between ultrasonographically measured testicular volumes and cord blood inhibin B concentrations in healthy term male neonates. Reprod Biol 2023; 23:100786. [PMID: 37429065 DOI: 10.1016/j.repbio.2023.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
Serum inhibin B (INHB) concentrations are associated with testicular volumes (TV) in all periods of childhood. The aim of the study was to investigate the relationship between TV measured by ultrasonography (US) and cord blood inhibin B and total testosterone (TT) concentrations, stratified by mode of delivery. In total 90 male infants were included. Testes of healthy, term newborns were evaluated by US on the third day after delivery. TV were calculated using two formulae: The ellipsoid formula [length (mm) × width (mm2) × π/6] and Lambert formula [length (mm) x width (mm) x height (mm) x 0.71]. Cord blood was taken for the determination of total testosterone (TT) and INHB. TT and INHB concentrations were evaluated according to TV percentiles (<10th, 10th-90th, >90th). There was a strong positive correlation between mean TV calculated with both formulae by percentile group (r = 0.777, r = 0.804, r = 0.846; p < 0.001). Cord blood INHB, but not TT were significantly lower in newborns with TV < 10th percentile compared to those with TV between 10 and 90th percentile and > 90th percentile (p < 0.05). There was a positive correlation between left and right TV calculated by either formula, and cord blood INHB (r = 0.212, 0.313, 0.320, 0.246,p < 0.05), not TT. There was no significant difference between hormones and TV when grouped by mode of delivery (p > 0.05). The Lambert and ellipsoid formulas are equally reliable in calculating neonatal testicular by ultrasound. INHB concentration is high in cord blood and positively correlated with neonatal TV. Cord blood INHB concentration may be an indicator for early detection of testicular structure and function disorders in neonates.
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Affiliation(s)
- Betül Ersoy
- Celal Bayar University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Manisa, Turkey.
| | - Gülgün Yılmaz Ovalı
- Celal Bayar University, Faculty of Medicine, Department of Radiology, Manisa, Turkey
| | - Ebru Canda
- Ege University, Faculty of Medicine, Department of Pediatrics, İzmi̇r, Turkey
| | - Ece Onur
- Celal Bayar University, Faculty of Medicine, Department of Clinical Biochemistry, Manisa, Turkey
| | - Beyhan Cengiz Özyurt
- Celal Bayar University, Faculty of Medicine, Department of Public Health, Mani̇sa, Turkey
| | - Nermin Tansuğ
- İstinye University, School of Medicine, Department of Pediatrics, Division of Neonatalogy, İstanbul, Turkey
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Anyanwu LJC, Sowande OA, Asaleye CM, Saleh MK, Mohammad AM, Onuwaje M, Olajide TA, Talabi AO, Elusiyan JBE, Adejuyigbe O. Testicular volume: correlation of ultrasonography, orchidometer and caliper measurements in children. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-0016-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Testicular size assessment is an important and initial technique for the evaluation of gonadal function. Our study aims to determine the correlation between paediatric testicular volumes measured with the orchidometer, high-resolution ultrasonography (US) and intra-operative measurements using calipers.
Results
This is a prospective observational study of 127 boys presenting to our institution with non-emergent scrotal conditions between January 2007 and October 2008. Volume estimates of both testes were measured using the Prader orchidometer. The patient was then sent to a radiologist who measured the testicular volumes using US, being blinded to the orchidometer estimates. At surgery, the testicular dimensions on the side of the pathology were obtained with a vernier caliper. The testicular volumes by US and caliper were calculated using the formula 0.71 × Length × Width × Height. The relationship between the measured volumes was determined using Pearson’s correlation statistic and Student’s t test. The level of significance for all analysis was set at p < 0.05. Their ages ranged from 18 days to 13 years (median 3 years). There was significant correlation between testicular volumes (for both sides, i.e. right and left) measured with the orchidometer and US (r = 0.544; 0.537, p < 0.001), significant correlation between testicular volumes measured with the orchidometer and caliper (r = 0.537; 0.638, p < 0.001) and also significant correlation between volumes measured by US and caliper (r = 0.382; 0.829, p < 0.01).
Conclusion
Prader orchidometer testicular volume estimates correlate significantly with US estimates in children. In resource-constrained settings, it could be used for an accurate and quick testicular volume assessment.
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Jaiswal VK, Khadilkar V, Khadilkar A, Lohiya N. Stretched Penile Length and Testicular Size from Birth to 18 Years in Boys from Western Maharashtra. Indian J Endocrinol Metab 2019; 23:3-8. [PMID: 31016145 PMCID: PMC6446671 DOI: 10.4103/ijem.ijem_242_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genital stage and testicular volume examination and assessment are essential for assessment of growth puberty in boys. There is paucity of Indian data for penile and testicular parameters particularly in pubertal years. AIM The aim of this study is to present normative data for penile length, testicular volume, and testicular length from birth to 18 years in boys from western Maharashtra and to correlate these parameters with sexual maturity staging (SMR) (Tanner staging). MATERIALS AND METHODS A cross-sectional observational study was undertaken in apparently healthy boys from 0 to 18 years of age from western Maharashtra from October 2016 to October 2017. Age, anthropometric parameters, stretched penile length (SPL), testicular volume, and testicular length were measured. Pubertal stage was categorized using Tanner staging. Data were entered in Microsoft excel 2013 and using SPSS version 16. LMS method was used to construct age-specific Z-scores for SPL, testicular volume, and testicular length. RESULTS A total of 843 boys were enrolled in the study. Mean SPL was 4.1 ± 0.4, 5.4 ± 0.8, and 10.2 ± 1.7 cm at 1, 10, and 18 years of age, respectively, and showed a gradual rise from birth to 18 years. Mean testicular volume was 1.8 ± 0.5, 3.3 ± 1.2, and 24.1 ± 3.5 ml, whereas testicular length was 1.3 ± 0.4, 2.1 ± 0.5, and 4.4 ± 0.7 cm respectively, at 1, 10, and 18 years, respectively. The magnitude of increase for SPL and testicular volume was greater around 9-10 years. The increase in SPL and testicular size was hand in hand with SMR for genital development as well as for axillary and pubic hair stages. CONCLUSION Normative data on SPL, testicular volume, and testicular length from western Maharashtra are presented. These data may be useful in disorders of puberty and genitalia in boys.
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Affiliation(s)
- Vijay K. Jaiswal
- Department of Pediatric Endocrinology, Bharati Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Nikhil Lohiya
- Department of Growth and Pediatric Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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Ogundoyin OO, Atalabi OM. Comparison between testicular volumes as measured with prader orchidometer and ultrasonography in Healthy Nigerian Newborns. Afr J Paediatr Surg 2018; 15:93-96. [PMID: 31290471 PMCID: PMC6615003 DOI: 10.4103/ajps.ajps_32_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We compared the testicular volume (TV) measured with Prader orchidometer (PO) to the volume measured with ultrasonography in male neonates and their relationships with some selected neonatal characteristics. SUBJECTS AND METHODS A cross-sectional study of all term male neonates who had clinical examination of their external genitalia performed and TV was measured using PO and ultrasonography. Information about the gestational age, birth weight, and birth length was also recorded to determine their relationships with TV measured. RESULTS The mean TV measured with PO was 1.06 (standard deviation [SD] ± 0.24) ml for both sides. With ultrasonography, the mean left TV was 0.273 (SD ± 0.081) ml and the mean right TV was 0.272 (SD ± 0.079) ml. There were significant correlations between TV using both methods with the birth weight and length. CONCLUSION TV measured with the two methods was comparable and correlates well with their birth weight and birth length.
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