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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Assessment of testicular function in boys and adolescents
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<blockquote data-quote="madman" data-source="post: 267398" data-attributes="member: 13851"><p><strong>Abstract</strong></p><p><strong></strong></p><p><strong>Objective:</strong> <em>The hypothalamic‐pituitary‐testicular axis is characterized by the existence of major functional changes from its establishment in fetal life until the end of puberty. The assessment of serum testosterone and gonadotrophins and semen analysis, typically used in the adult male, is not applicable during most of infancy and childhood. On the other hand, the disorders of the gonadal axis have different clinical consequences depending on the developmental stage at which the dysfunction is established. This review addresses the approaches to evaluate the hypothalamic-pituitary-testicular axis in the newborn, during childhood, and at pubertal age.</em></p><p></p><p><strong>Design: </strong><em>We focused on the hormonal laboratory and genetic studies as well as on the clinical signs and imaging studies that guide the aetiological diagnosis and the functional status of the gonads.</em></p><p></p><p><strong>Results:</strong> <em>Serum gonadotrophin and testosterone determination are useful in the first 3–6 months after birth and at pubertal age, whereas AMH and inhibin B are useful biomarkers of testis function from birth until the end of puberty. Clinical and imaging signs are helpful in appraising testicular hormone actions during fetal and postnatal life.</em></p><p></p><p><strong>Conclusions: </strong><em>The interpretation of results derived from the assessment of hypothalamic-pituitary-testicular in pediatric patients requires a comprehensive knowledge of the developmental physiology of the axis to understand its pathophysiology and reach an accurate diagnosis of its disorders.</em></p><p></p><p></p><p></p><p></p><p><strong>1 | INTRODUCTION</strong></p><p><strong></strong></p><p><strong>1.1 | Scope of the review</strong></p><p></p><p><em><strong>The hypothalamic‐pituitary‐testicular axis shows significant functional changes from fetal life to adulthood.</strong> While its assessment in the adult most frequently relies on the determination of serum testosterone and gonadotrophins and on semen analysis, this diagnostic strategy is inappropriate in most pediatric patients, especially during infancy and childhood 1 Furthermore, the impact of disorders of testicular function has different clinical consequences according to the stage of development at which the dysfunction is established.2 <strong>In this review, we will address the different diagnostic approaches to evaluate testicular function, including the hormonal laboratory and genetic studies as well as the clinical and imaging signs to be sought for as the expected consequences of gonadal dysfunction at different stages of postnatal life.</strong></em></p><p></p><p></p><p><strong>1.2 | Physiology of the prenatal and postnatal male gonadal axis</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>2 | ASSESSMENT OF TESTICULAR FUNCTION IN PREPUBERTY AND PUBERTAL AGE</strong></p><p><strong></strong></p><p><strong>2.1 | Patients with DSD</strong></p><p><strong></strong></p><p><strong><em>2.1.2 | Genetic studies</em></strong></p><p><em><strong>2.1.3 | Hormonal laboratory</strong></em></p><p></p><p></p><p></p><p></p><p><strong>2.2 | Newborns/infants with micropenis and/or cryptorchidism</strong></p><p><strong></strong></p><p><strong><em>2.2.1 | Physical examination and imaging</em></strong></p><p><em><strong>2.2.2 | Hormonal laboratory</strong></em></p><p><strong><em>2.2.3 | Genetic studies</em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>2.3 | Patients born preterm or small for gestational age</strong></p><p><strong></strong></p><p><strong><em>2.3.1 | Physical examination and imaging</em></strong></p><p><em><strong>2.3.2 | Hormonal laboratory</strong></em></p><p></p><p></p><p></p><p></p><p><strong>2.4 | Boys with precocious pubertal maturation</strong></p><p><strong></strong></p><p><strong><em>2.4.1 | Physical examination and imaging</em></strong></p><p><em><strong>2.4.2 | Hormonal laboratory</strong></em></p><p><strong><em>2.4.3 | Genetic studies</em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>2.5 | Adolescents with delayed or arrested puberty</strong></p><p><strong></strong></p><p><strong><em>2.5.1 | Physical examination and imaging</em></strong></p><p><em><strong>2.5.2 | Hormonal laboratory</strong></em></p><p><em><strong>2.5.3 | Genetic studies</strong></em></p><p></p><p></p><p></p><p></p><p><strong>2.6 | Boys and adolescents with miscellaneous conditions affecting testicular function</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>3 | CONCLUDING REMARKS</strong></p><p><strong></strong></p><p><strong><em>The assessment of the gonadal function in boys and adolescents differs significantly from the usually done in the adult male. <u>The accurate knowledge of the developmental physiology of the axis is essential for the understanding of its pathophysiology and the diagnosis of the diverse conditions affecting it</u>. While serum gonadotrophins and testosterone may be informative in the first 3–6 months after birth and at pubertal age, <u>serum AMH and inhibin B are the most useful biomarkers during childhood</u>. <u>Both reflect Sertoli cell activity, the most relevant cell population in the prepubertal testis</u>. At the age of puberty, the decline in serum AMH reflects a normal (or precocious) elevation of intratesticular androgen concentration, while the increase in serum inhibin is indicative of spermatogenic development in the seminiferous tubules.</em></strong></p></blockquote><p></p>
[QUOTE="madman, post: 267398, member: 13851"] [B]Abstract Objective:[/B] [I]The hypothalamic‐pituitary‐testicular axis is characterized by the existence of major functional changes from its establishment in fetal life until the end of puberty. The assessment of serum testosterone and gonadotrophins and semen analysis, typically used in the adult male, is not applicable during most of infancy and childhood. On the other hand, the disorders of the gonadal axis have different clinical consequences depending on the developmental stage at which the dysfunction is established. This review addresses the approaches to evaluate the hypothalamic-pituitary-testicular axis in the newborn, during childhood, and at pubertal age.[/I] [B]Design: [/B][I]We focused on the hormonal laboratory and genetic studies as well as on the clinical signs and imaging studies that guide the aetiological diagnosis and the functional status of the gonads.[/I] [B]Results:[/B] [I]Serum gonadotrophin and testosterone determination are useful in the first 3–6 months after birth and at pubertal age, whereas AMH and inhibin B are useful biomarkers of testis function from birth until the end of puberty. Clinical and imaging signs are helpful in appraising testicular hormone actions during fetal and postnatal life.[/I] [B]Conclusions: [/B][I]The interpretation of results derived from the assessment of hypothalamic-pituitary-testicular in pediatric patients requires a comprehensive knowledge of the developmental physiology of the axis to understand its pathophysiology and reach an accurate diagnosis of its disorders.[/I] [B]1 | INTRODUCTION 1.1 | Scope of the review[/B] [I][B]The hypothalamic‐pituitary‐testicular axis shows significant functional changes from fetal life to adulthood.[/B] While its assessment in the adult most frequently relies on the determination of serum testosterone and gonadotrophins and on semen analysis, this diagnostic strategy is inappropriate in most pediatric patients, especially during infancy and childhood 1 Furthermore, the impact of disorders of testicular function has different clinical consequences according to the stage of development at which the dysfunction is established.2 [B]In this review, we will address the different diagnostic approaches to evaluate testicular function, including the hormonal laboratory and genetic studies as well as the clinical and imaging signs to be sought for as the expected consequences of gonadal dysfunction at different stages of postnatal life.[/B][/I] [B]1.2 | Physiology of the prenatal and postnatal male gonadal axis 2 | ASSESSMENT OF TESTICULAR FUNCTION IN PREPUBERTY AND PUBERTAL AGE 2.1 | Patients with DSD [I]2.1.2 | Genetic studies[/I][/B] [I][B]2.1.3 | Hormonal laboratory[/B][/I] [B]2.2 | Newborns/infants with micropenis and/or cryptorchidism [I]2.2.1 | Physical examination and imaging[/I][/B] [I][B]2.2.2 | Hormonal laboratory[/B][/I] [B][I]2.2.3 | Genetic studies[/I] 2.3 | Patients born preterm or small for gestational age [I]2.3.1 | Physical examination and imaging[/I][/B] [I][B]2.3.2 | Hormonal laboratory[/B][/I] [B]2.4 | Boys with precocious pubertal maturation [I]2.4.1 | Physical examination and imaging[/I][/B] [I][B]2.4.2 | Hormonal laboratory[/B][/I] [B][I]2.4.3 | Genetic studies[/I] 2.5 | Adolescents with delayed or arrested puberty [I]2.5.1 | Physical examination and imaging[/I][/B] [I][B]2.5.2 | Hormonal laboratory 2.5.3 | Genetic studies[/B][/I] [B]2.6 | Boys and adolescents with miscellaneous conditions affecting testicular function 3 | CONCLUDING REMARKS [I]The assessment of the gonadal function in boys and adolescents differs significantly from the usually done in the adult male. [U]The accurate knowledge of the developmental physiology of the axis is essential for the understanding of its pathophysiology and the diagnosis of the diverse conditions affecting it[/U]. While serum gonadotrophins and testosterone may be informative in the first 3–6 months after birth and at pubertal age, [U]serum AMH and inhibin B are the most useful biomarkers during childhood[/U]. [U]Both reflect Sertoli cell activity, the most relevant cell population in the prepubertal testis[/U]. At the age of puberty, the decline in serum AMH reflects a normal (or precocious) elevation of intratesticular androgen concentration, while the increase in serum inhibin is indicative of spermatogenic development in the seminiferous tubules.[/I][/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone and Men's Health Articles
Assessment of testicular function in boys and adolescents
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