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門診處方用藥討論

Choriogonadotropin （ hCG ） for cryptorchidism （ undescended testes ）

報告日期： 2008.09.23

報告者：洪惠敏

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Cryptorchidism （ undescended testes ）

• one or both of the testicles do not move down into the scrotum

• may be unilateral or bilateral.

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Signs and Symptoms • Usually no symptoms is present 

• not be present in the scrotom

• may still be in the abdominal cavity or partway down the inguinal canal

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Complications

• Infertility

• Inguinal hernia

• Tumor of testicular

• Cosmetic problems and psychological

• Injury of the undescended testis and torsion or twisting of the testis

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Causes

• The cause of undescended testicle is unknown.

• Hormonal abnormalities （ deficiency or insensitivity to androgens ）

• Torsion of the testes

• genetic defects （ development or function of the gubernaculum ）

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Risk Factors

• Having a father or brother who had the condition increases the risk.

• Low birth weight (less than 2500 g)

• Maternal exposure to estrogen during the first trimester

• Multiple birth (e.g., twin, triplet)

• Premature birth (before 37 weeks gestation)

• Small size for gestational age

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Diagnosis

• physical examination

• prenatal ultrasound

• laparoscopy

• blood test - determine the level of gonadotropin

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Treatment

• Hormonal therapy ： • human chlorionic gonadotropin hormone

(hCG)

• Gonadorelin （ LH-RH ） • Buserelin

• Surgery ： orchidopexy

• between 1 and 2 years of age

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Chlorionic gonadotropin - 1

• Mechanism of Action • Luteinizing hormone which is produced in the

pituitary gland • In ovaries ： it works with FSH to produce a

mature ovum and it stimulates the corpus luteum to produce progesterone

• In the testicles ： it stimulates the production of androgen , and may stimulate testicular descent

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Chlorionic gonadotropin - 2

• FDA Labeled Indication

• Cryptorchidism

• Hypogonadotropic hypogonadism, In male patients

• Ovulation induction

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Chlorionic gonadotropin - 3• Pediatric Dosage ：• 4000 IU 3 times QW for 3 wks; 5000 IU Q2D for 4

doses; 15 injections of 500 to 1000 IU over 6 wks; or 500 IU 3 times QW for 4 to 6 wks , if ineffective, 1 month later using 1000 IU/dose. Therapy is usually started between 4 and 9 yrs of age.

• alternative regimen ： 1000 to 2000 IU/m3 3 times QW for 3 wks

• The International Health Foundation recommends chorionic gonadotropin based on age. At age 3 to 12 months 250 IU, 1 to 6 yrs 500 IU, and over 6 yrs 1000 IU, all doses given 2 times QW for 5 wks.

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Chlorionic gonadotropin - 4

• Adult Dosage

• 4000 IU 3 times QW for 3 wks

• 5000 IU Q2D for 4 doses

• 15 injections of 500 to 1000 IU over a period of 6 wks

• 500 IU 3 times QW for 4 to 6 wks

• if ineffective, 1 month later using 1000 IU/dose.

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Chlorionic gonadotropin - 5• Side Effects• Aching, bloating stomach, heaviness, pelvic

discomfort, abdominal pain, nausea, pelvic pain, severe, rapid weight gain, vomiting

• Precautions• discontinue if signs of precocious puberty occur• fluid retention• history of epilepsy, migraine, asthma, cardiac

disease or renal disease

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Gonadorelin - 1• Mechanism of Action

• Bind to specific receptors on gonadotrophic cells of the anterior pituitary

• stimulate synthesis and secretion of gonadotropins

• Adverse Effects

• abdominal discomfort, flushing, headache, lightheadedness

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Gonadorelin - 2

• Pediatric Dosage ：• 2 to 12 yrs ： 1.2 mg/day intranasal for 4 wks

• 400 mcg intranasal TID for 28 days

• aged from 3.5 to 12.5 yrs, 10 to 100 mcg/day SC for 3 to 7 wks, 4 of 5 cases descent testes (Keogh et al, 1983)

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Buserelin

• Mechanism of Action• synthetic GnRH agonist, binding to specific

GnRH receptors of the anterior pituitary, stimulates release of pituitary gonadotropins

• Dose• Pediatric Dose : 20 mcg intranasal QD for 20

days• Adverse Effects• Nausea, abdominal pain, flushing, headache

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Conclusion

Cryptorchidism

FDA Labeled Indication

adult pediatric

Chlorionic gonadotropinyes yes (over 4 y of

age)Gonadorelin no noBuserelin no no

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Conclusion

Cryptorchidism

FDA Labeled Indication

Adult Pediatric

Efficacy Effective Effective

Recommendation Class IIa Class IIa

Strength of Evidence Category B Category B

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References 

• MedlinePlus Medical Encyclopedia

• MayoClinic.com

• MICROMEDEX