Abstract
The prevalence of idiopathic oligozoospermia has been esteemed as high as 75%. An Italian survey has reported bilateral testicular hypotrophy in 14% of final-year high school students. The search for determinants of testicular growth in childhood is important for the primary prevention of spermatogenic failure. Therefore, this retrospective study aimed to evaluate the testicular growth and pubertal onset in deficient children treated recombinant human growth hormone (rhGH). To accomplish this, the clinical charts of 93 patients with GH deficiency (GHD) were carefully reviewed. Their mean age at the time of diagnosis was 11.2 ± 2.4 years. rhGH was administered for 44.0 ± 22.4 months, and the onset of puberty was recorded after a mean of 25.8 ± 22.4 months from the first rhGH administration. As expected, serum insulin-like growth factor 1 (IGF1) levels increased significantly after treatment. Before rhGH therapy, the Tanner stage was I in 59 out of 70 boys (84.3%), II in 8/70 (11.4%), III in 3/70 (4.3%). No one was on stage IV or V. The mean Tanner stage was 1.19 ± 0.51. At the last visit, the Tanner stage was I in 8/72 boys (11.1%), II in 6/72 (8.3%), III in 6/72 (8.3%), IV in 16/72 (22.2%), and V in 36/72 (50.0%). After a mean of 44.0 ± 22.4 months of rhGH treatment, the mean Tanner stage was 4.05 ± 1.30. Patients treated with rhGH showed a significant testicular volume (TV) growth over time, whereas no growth was observed in age-matched but not yet treated patients, even when the age was compatible with a spontaneous start of puberty. The multivariate regression analysis showed that the duration of treatment and the mean rhGH dose significantly predicted the percentage of TV increase. In contrast, age, serum FSH, and IGF1 levels, and final rhGH dose did not impact TV growth over time. In conclusion, these findings suggest that GH may play a role in testicular growth and pubertal onset, despite the descriptive nature of this study. Further properly designed studies are needed to confirm these findings. This knowledge may be useful to implement the diagnostic-therapeutic algorithm in case of a lack of testicular growth in childhood.
Highlights
Male infertility represents an increasingly emergent issue in Western countries, since it affects ~7% of the male population [1]
The Tanner stage was expectably higher at the end of the study (4.1 ± 1.3) compared to baseline (1.2 ± 0.5), and the onset of puberty was recorded after 25.8 ± 22.4 months from the first recombinant human growth hormone (rhGH) administration
The other variables were shown not to influence testicular volume (TV) growth over time (Table 2). This retrospective study was undertaken to evaluate whether treatment with rhGH can influence testicular growth and the onset of puberty in a cohort of patients with growth hormone (GH) deficiency (GHD), the vast majority of whom were pre-pubertal
Summary
Male infertility represents an increasingly emergent issue in Western countries, since it affects ~7% of the male population [1]. GH deficiency (GHD) represent a useful clinical model which provides information on the in-vivo consequences of the lack of IGF1 and recombinant human GH (rhGH) replacement therapy on testicular growth and pubertal onset in a predefined window of life. This retrospective study aimed to evaluate the role of GH treatment on testicular growth and pubertal onset in a cohort of GHD children. The variables included in the model were: the length of treatment (number of months during which patients received rhGH therapy), mean IGF1, mean FSH serum levels, calculated from the beginning of puberty to the time when the full testicular development was reached, mean rhGH dosage, final rhGH dosage, age at the end of treatment. The results were considered statistically significant when the p-value was lower than 0.05
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