Evaluation Serum AMH Levels After Orchiopexy in Infants with Unilateral Undescended Testis

Öz

In boys, serum anti-Müllerian hormone (AMH) reflects Sertoli cell function, seminiferous tubular integrity and testicular function. Serum AMH value remains stable until one year of age in the postnatal period. In our study, preoperative and postoperative serum AMH values were compared in infants between age of 3-12 months who underwent orchiopexy due to unilateral cryptorchidism. The study population consisted of 77 cryptorchid children under one year of age who had unilateral palpabl testis and underwent orchiopexy. Following the diagnosis of undescended testis, all patients underwent inguinal orchiopexy. Serum AMH levels and testicular size were evaluated before the orchiopexy, and AMH levels and testicular size were compared at the sixth month following orchiopexy. Serum AMH values measured in the postoperative sixth month control period were significantly higher than preoperative serum AMH values. All testicles were examined in the scrotum in the postoperative period. There was no difference in size of testes that underwent orchiopexy before and after surgery. AMH may reflect gonadal function as it is a well-known Sertoli cell marker. Unlike the other gonadal hormones, AMH remains stable in the serum following the period called infantile mini-puberty. Particulary in this period AMH is more advantageous than other serum markers in demonstrating testicular functions. In our study, a significant increase in serum AMH level was observed after orchiopexy. As an indicator of testicular function, especially in the first year of postnatal period, comparing AMH levels before and after orchiopexy may also be useful in determining the effectiveness of treatment.

Anahtar Kelimeler

• Antimullerian hormone
• Orchiopexy
• İnfertility

Tek Taraflı İnmemiş Testisi olan İnfantlarda Orşiopeksi Sonrası Serum AMH Seviyelerinin Değerlendirilmesi

Öz

Serum antimüllerian hormon (AMH) değeri postnatal dönemde 1 yaşa kadar stabil seyreder. Çalışmamızda tek taraflı kriptorşidizm nedeniyle orşiopeksi uygulanan yaşları 3-12 ay olan çocuklarda preoperatif dönemde serum AMH değerleri belirlendi ve postoperatif dönem serum AMH seviyesinde ki değişim incelendi. Çalışma popülasyonu, tek taraflı testisleri palpe edilen ve orşiopeksi uygulanan bir yaş altı 77 kriptorşid çocuktan oluşuyordu. İnmemiş testis tanısı takiben tüm hastalara inguinal orşiopeksi yapıldı. Orşiopeksi öncesi serum AMH seviyeleri ve testis boyutları belirlendi ve orşiopeksi sonrası altıncı ayda AMH seviyeleri ve testis boyutları karşılaştırıldı. Ameliyat sonrası altıncı ay kontrol döneminde ölçülen serum AMH değerleri ameliyat öncesi ölçülen serum AMH değerlerine göre anlamlı yüksek bulundu. Ameliyat sonrası yapılan fizik muayenede bütün testisler skrotumda izlendi. Ameliyat öncesi ve sonrası dönemde orşiopeksi yapılan testis boyutlarında farklılık izlenmedi. AMH, iyi bilinen bir sertoli hücre belirteci olarak gonadal fonksiyonu yansıtabilir. İnfantil mini-puberte olarak adlandırılan dönemi takiben diğer gonadal hormonların aksine serum AMH serumda stabil seyreder. AMH, özellikle bu dönemde testis fonksiyonlarını göstermede diğer serum belirteçlerine göre daha avantajlıdır. Çalışmamızda orşiopeksi sonrası serum AMH seviyesinde anlamlı artış izlendi. Özellikle doğum sonrası ilk yılda testis fonksiyonlarının bir göstergesi olarak orşiopeksi öncesi ve sonrası AMH düzeylerinin karşılaştırılması tedavinin etkinliğini belirlemede de faydalı olabilir.

Anahtar Kelimeler

• Antimüllerian hormon
• Orşiopeksi
• İnfertilite

Kaynakça

1. 1) Thong MK, Lim CT, Fatimah H. Undescended testes: Incidence in 1002 consecutive male infants and outcome at 1 year of age. Pediatr. Surg. Int. 1998, 13: 37-41.
2. 2) John Radcliffe Hospital Cryptorchidism Study Group. Cryptorchidism: A prospective study of 7,500 consecutive male births, 1984-8. Arch. Dis. Child. 1992; 67: 892- 899.
3. 3) Berkowitz G.S., Lapinski R.H. Risk factors for cryptorchidism: a nested case-control study. Paediatr. Perinat. Epidemiol. 1996, 10: 39-51.
4. 4) Virtanen HE, Cortes D, Rajpert-De Meyts E. Development and descent of the testis in relation to cryptorchidism. Acta Paediatr. 2007, 96;622–627.
5. 5) Hutson JM, Hasthorpe S, Heyns CF. Anatomical and functional aspects of testicular descent and cryptorchidism. Endocr. Rev. 1997,18; 259–280
6. 6) Hutson JM, Sasaki Y, Huynh J, Yong E, Ting A. The gubernaculum in testicular descent and cryptorchidism. Turk J Pediatr.2004; 46 (suppl):3–6
7. 7) Hutson JM, Lopez-Marambio FA. The possible role of AMH in shortening the gubernacular cord in testicular descent: a reappraisal of the evidence. J Pediatr Surg. 2017; 52(10):1656– 60.
8. 8) Hutson JM, Balic A, Nation T, Southwell B. Cryptorchidism. Semin Pediatr Surg. 2010; 19(3):215–24.

9. 9) Grinspon RP, Rey RA. Anti-Mullerian hormone and Sertoli cell function in pediatric male hypogonadism. Horm Res Paediatr 2010;73(2):81–92.
10. 10) Tyrvainen E, Turpeinen U, Hamalanen E, Stenman UH. Increased activity of the hypothalamic–pituitary–testicular axis in infancy results in increased androgen action in premature boys. J Clin Endo- crinol Metab 2011;96(1):98–105.
11. 11) Josso, N., Di Clemente, N., TGF-beta family members and gonadal development. Trends In Endocrinol And Metabolism.1999; 10 (6): 216–222.
12. 12) Yamanaka J, Baker ML, Metcalfe SA, Hutson JM. Serum levels of Mullerian inhibiting substance in boys with cryptorchidism. J Pediatr Surg.1991; 26:621–623 13) Lee MM, Donahoe PK, Silverman BL, et al. Measurements of serum Mullerian inhibiting substance in the evaluation of children with non palpable gonads. N Eng J Med.1997;336 :1480-1486
13. 14) Tran D, Picard JY, Vigier B, Berger R, Josso N. Persistence of Mullerian ducts in male rabbits passively immunized against bovine anti- Mullerian hormone during fetal life. Dev Biol. 1986; 116:160–167
14. 15) Hutson JM, Baker M, Terada M, Zhou B, Paxton G. Hormonal control of testicular descent and the cause of cryptorchidism. Reprod Fertil Dev. 1994;6(2):151–6.
15. 16) Lee MM, Donahoe PK, Hasegawa T et al. Müllerian inhibiting substance in humans: normal levels from infancy to adulthood. J. Clin. Endocrinol. Metab. 1996; 81: 571–576.
16. 17) Aksglaede L, Sørensen K, Boas M, et al. Changes in anti-Mullerian hormone (AMH) the life span: a population-based study of 1027 healthy males from birth (cord blood) to the age of 69 years. J Clin Endocrinol Metab 2010;95(12):5357–64.
17. 18) Kuiri-Hanninen T, Seuri R, Tyrvanen E, et al. Increased activity of the hypothalamic– pituitary–testicular axis in infancy results in increased androgen action in premature boys. J Clin Endocrinol Metab 2011;96 (1):98–105.
18. 19) Grinspon RP, Gottlieb S, Bedecarras P, Rey RA. Anti-Müllerian hormone and testicular function in prepubertal boys with cryptorchidism. Front Endocrinol (Lausanne) 2018; 9: artc no:182.
19. 20) Ahmed SF, Keir L, McNeilly J, Galloway P, O'Toole S, Wallace AM. The concordance between serum anti-Mullerian hormone and testosterone concentrations depends on duration of hCG stimulation in boys investigation of gonadal function. Clinical Endocrin. 2010;72: 814–819.21) RP Grinspon, RA Rey. Anti-Mullerian hormone and sertoli cell function in paediatric male hypogonadism. Horm Res Pediatr. 2010; 73: 81–92
20. 22) Guibourdenche J, Lucidarme N, Chevenne D et al. Anti-Müllerian hormone levels in serum from human foetuses and children: pattern and clinical İTerest. Mol and Cell Endoc. 2003; 211: 55–63.
21. 23) Komarowska MD , Milewski R , Charkiewicz R et al. Are anti-Müllerian hormone and its receptor polymorphism associated with the hormonal condition of undescended testes? Adv. in Med. Sci. 2016; 61(2): 288–292
22. 24) Demircan M, Akıncı A, Mutus M. The effects of orchiopexy on serum anti-Müllerian hormone levels in unilateral cryptorchid infants. Ped Surg Int. 2006; 22(3):271–273.
23. 25) Baker ML, Metcalfe SA, Hutson JM.Serum levels of Müllerian inhibiting substance in boys from birth to 18 years, as determined by enzyme immunoassay. J Clin Endocrinol Metab. 1990; 70: 11–15.
24. 26) Lee MM, Donahoe PK, Silverman BL, et al. Measurements of serum Müllerian inhibiting substance in the evaluation of children with non palpable gonads. N. Engl. J. Med. 1997; 336: 1480–1486.
25. 27) Virtanen HE, Bjerknes R, Cortes D, et al. Cryptorchidism: classification, prevalence and long-term consequences. Acta Paediatr. 2007; 96: 611–616.
26. 28) DS Engeler, Hosli PO, John H, et al. Early orchiopexy: prepubertal İTratubular germ cell neoplasia and fertility outcome. Urology. 2000 ; 56 :144–148
27. 29) PA Lee, LA O’Leary, Songer NJ, Coughlin MT, Bellinger MF , LaPorte RE. Paternity after unilateral cryptorchidism: a controlled study. Pediatrics. 1996; 98:676–679
28. 30) Klingmuller D, Haidl G. Inhibin B in men with normal and disturbed spermatogenesis. Hum Reprod 1997;12(11):2376–8.
29. 31) Cortes D, Thorup J, Hogdall E, Norgaard-Pedersen B, Petersen BL, Hogdall C. The relation of germ cells per tubule in testes, serum inhibin B and FSH in cryptorchid boys. Pediatr Surg Int.2007; 23(2):163–9.
30. 32) Verkauskas G, Malcius D, Eidukaite A, et al. Prospective study of histological and endocrine parameters of gonadal function in boys with cryptorchidism. J Pediatr Urol. 2016; 12(4): 238.e1–6.
31. 33) Hadziselimovic F, Herzog B. Importance of early postnatal germ cell maturation for fertility of cryptorchid males. Horm Res.2001;55 (1):6–10.
32. 34)Komarowska MD, Hermanowicz A, Matuszczak E, et al. Anti-Müllerian hormone levels in serum 1 year after unilateral orchiopexy. J Pediatr Endoc and Met. 2012; 25:(11-12) 1073–1076.