ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Clin Med. 2019;8(12):2204. sandrolavignera@unict.it

This cross-sectional study evaluated morpho-volumetric development of the testis, endocrine function and sperm parameters in 102 young adult childhood cancer survivors (CCS). About 1/3 of patients showed low testicular volume (<24 ml); the Hodgkin disease group showed significantly lower total testicular volumes, compared to the rest of the group. CCS who underwent hematopoietic stem cell transplantation (SCT) showed significantly lower total testicular volume, followed by those who received chemotherapy plus radiotherapy. Eighty-seven CCS underwent hormonal evaluation; 3/87 showed low LH levels, 5/87 high LH levels, 8/87 high FSH values. Twenty-eight out of 84 patients (33.3%) had suboptimal testosterone values (<3.5 ng/ml), while 5/84 showed frankly reduced levels (<2.3 ng/ml). AMH levels were measured in 17 CCS and were normal in all of them. Thirty-four patients accepted to undergo sperm analysis; sperm count was reduced in 7/34 patients (20.6%), while azoospermia was found in 6/34 patients (17.7%). All patients with azoospermia had a primary testicular failure (FSH levels >8 UI/l and low testicular volume) and had received radiotherapy or SCT. History of Hodgkin’s disease, SCT, and non-cranial irradiation associated with chemotherapy were risk factors for reduced sperm concentration. Patients treated during puberty showed lower total testicular volume than patients treated before puberty, probably due to a more aggressive treatment in older patients. Sperm concentration was more closely related to testicular volume than to FSH levels, while AMH values were unrelated to testicular function. In this study, only one third of patients accepted to undergo sperm analysis. The same reluctance has been described by other authors. This common attitude among CCS has prompted the search for surrogate markers of spermatogenesis to be used in infertility screening. Inhibin B has proved to be a better marker for spermatogenesis than FSH. Surprisingly, inhibin B was not analysed in this study, while as expected, AMH was not useful in the evaluation of testicular function. Similarly, the cumulative dose of alkylating agents, already identified as a detrimental factor affecting gonadal function in these patients, was not evaluated.

Reference:

1. van Dorp W, van der Geest IM, Laven JS, et al. Gonadal function recovery in very long-term male survivors of childhood cancer. Eur J Cancer. 2013;49:1280–6.