Analysis of disorders of pituitary-gonadal regulation in patients with testicular neoplasms.
Authors:   the Department of Urology and Operative Nephrology with the course of Oncourology of Peoples Friendship University of Russia, R.F. Kholbobozoda ,   Moscow, Russia, A.A. Kostin ,   department of urology and operative nephrology with course of oncourology, Medical Institute of Peoples' Friendship University of Russia (RUDN University); Moscow, Russia, N.V. Vorobyev ,   Surgery of P.A.Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre, Moscow, Russian Federation, urologist, associate professor of the department of oncology, radiotherapy and plastic surgery I.M.Sechenov First Moscow State Medical University; Moscow, Russia, A.O. Tolkachev ,   oncourology P.A.Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre; Moscow, Russia, A.A. Krasheninnikov ,   the department of oncourology P.A.Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre; Moscow, Russia, N.G. Kulchenko ,   the Department of Human Anatomy of the Medical Institute at Peoples Friendship University of Russia (RUDN University); Moscow, Russia, D.M. Monakov ,   department of oncourology of National Medical Research Center of surgery named after A.V. Vishnevsky; assistant of the department of urology and operative nephrology with the course of oncourology Peoples Friendship University of Russia; Moscow, Russia
Published: May 2024

Introduction. The hypothalamic-pituitary-gonadal axis (HPG) is the most important part of the hormonal system that controls testicular function in men. It is known that testicular neoplasms (TN) can disrupt the regulation of HPG due to the occurrence of hormonal imbalance. However, changes in HPG in patients with TN have been little studied, especially before the start of treatment. Aim: to assess the degree of hormonal disorders affecting HPG in men with TN before treatment. Material and methods. The study included 49 patients with newly diagnosed TN. The concentration of total testosterone (T), free testosterone (cT), estradiol (E2), luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone binding globulin (SHBG) and prolactin (PRL), as well as tumor markers (β-HCG, AFP) were measured in all men; the body mass index (BMI), tumor size, bad habits and surgical history (treatment of cryp- torchidism, varicocele) were evaluated. Clinically significant T deficiency (DT) was defined as the level of total T <8 nmol/l or the level of T in the range of 8-12.1 nmol/l, taking into account free T <243 pmol/L. Results. There were statistically significant differences in hormone levels between patients with normal 30 (61,2%) and high 19 (38,8%) values of cancer markers (p<0,05). A high concentration of β-hCG was associated with a decrease in the level of FSH and LH below normal values (p<0,001) and an increase in the level of total T (p=0.019), cT (p=0,01) and E2 (p=0,003) compared with patients without hypertension. an increase in this cancer marker. Laboratory signs of DT were found in 15 (30,6%) patients, mostly with normal β-hCG values (p=0,025). However, a causal relationship was not established due to a small sample in this subgroup. The probability of developing DT in men with a history of cryptorchidism (22,4%) was 6,56 times higher (95% CI: 1,532 – 28,120; p=0,021). Correlation analysis revealed the relationship between LH (p=-0,351; p=0,014), FSH (p=-0,3; p=0,041), E2 (p=0,323; p=0,03) and tumor size. When analyzing hormone levels depending on age, smoking and BMI, no statistically significant differences were obtained (p>0,05). Conclusion. Abnormalities in HPG were detected in 30% of patients with TN before treatment. One third of the men had laboratory signs of DT. Further studies involving more patients are required to develop practical recommendations.