Functional assessment of testicular Sertoli cell function in chemotherapy—treated prepubertal and pubertal male survivors of childhood cancer.

ROMINA P. GRINSPON; MARJORIE MORALES BAZURTO; MAR¨ªA G. BALLERINI; MARIA G. ROPELATO; BERGADA IGNACIO; RODOLFO A. REY

Praga, República Checa

Congreso; 49th Annual Meeting of the European Society for Paediatric Endocrinology; 2010

European Society for Paediatric Endocrinology

Functional assessment of testicular Sertoli cell function in chemotherapy-treated prepubertal and pubertal male survivors of childhood cancer Romina Grinspon, Marjorie Morales Bazurto, María Gabriela Ballerini, María Gabriela Ropelato, Ignacio Bergadá, Rodolfo Rey Centro de Investigaciones Endocrinológicas (CEDIE-CONICET), División de Endocrinología, Hospital de Niños R. Gutiérrez, Buenos Aires, Argentina. It is well established that male germ cells are highly sensitive to chemotherapy, whereas quiescent Leydig cell precursors in the prepubertal boy seem to be less affected. Sertoli cell function has rarely been studied in prepubertal boys having received chemotherapy, mainly by determining serum FSH, an indirect marker of Sertoli cell function. The aim of this study was to assess function of the pituitary-testicular axis, with particular emphasis on Sertoli cell function, in boys and adolescents with extragonadal tumors having received chemotherapy exclusively. We performed a retrospective analysis including 51 patients treated before age 10 yr and 38 treated between 10 and 18 yr. Serum LH, FSH, testosterone and AMH (as a direct marker of Sertoli cell function) were used as endpoints. In 35 of the 51 patients treated <10 yr, serum hormone levels analysed before puberty (age 9.42± 2.34yr; 2.73 ± 2.64 yr post-chemotherapy) showed normal AMH, with mild (+2 to +3 SDS) elevation of FSH in 8.57% and LH in 20%.  In 30 of the 51 cases treated <10 yr, hormone levels analysed at pubertal age (14.81 ± 2.23 yr; 8.59 ± 3.63 yr post-chemotherapy) showed low AMH in 26.92%, low testosterone in 26.66% and mildly elevated FSH in 16.66% and LH in 13.3%. In 38 cases, chemotherapy was administered during puberty; analysis at age 16.02 ± 2.472 yr (2.11 ± 1.91 yr post-chemotherapy) showed low AMH in 18.18%, low testosterone in 11.1% and moderately (+3 to +4 DSD) elevated LH in 5.26%, and elevated FSH in 26.31% (mild in 7.9%, moderate in 15.8% and severe [> +4 SDS] in 5.2%). We conclude that Sertoli and Leydig cells have low sensitivity to chemotherapy in prepubertal and pubertal males. The elevation of FSH at puberty in a subset of patients is probably due to germ cell loss.