High Prevalence of Reduced Fecundity in Men with Congenital Adrenal Hyperplasia

  • Nicole Reisch
    Endocrinology and Metabolism (N.R., L.F., M.B., F.B., M.Re.), University Hospital München, D-80336 München, Germany
  • Linda Flade
    Endocrinology and Metabolism (N.R., L.F., M.B., F.B., M.Re.), University Hospital München, D-80336 München, Germany
  • Michael Scherr
    Medizinische Klinik-Innenstadt, Department of Radiology (M.S.), University Hospital München, D-80336 München, Germany
  • Marietta Rottenkolber
    Institute of Medical Information Technology, Biometry and Epidemiology (M.Ro.), Ludwig-Maximilians-Universität, München D-81377, Germany
  • Francesco Pedrosa Gil
    Psychosomatic Ambulance and Outpatient Clinic (F.P.G.), University Hospital München, D-80336 München, Germany
  • Martin Bidlingmaier
    Endocrinology and Metabolism (N.R., L.F., M.B., F.B., M.Re.), University Hospital München, D-80336 München, Germany
  • Hans Wolff
    Outpatient Clinic of Andrology, Department of Dermatology (H.W.), University Hospital München, D-80336 München, Germany
  • Hans-Peter Schwarz
    Department of Endocrinology, von Haunersches Kinderspital (H.-P.S.), University Hospital München, D-80336 München, Germany
  • Marcus Quinkler
    Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin, Berlin 13353, Germany
  • Felix Beuschlein
    Endocrinology and Metabolism (N.R., L.F., M.B., F.B., M.Re.), University Hospital München, D-80336 München, Germany
  • Martin Reincke
    Endocrinology and Metabolism (N.R., L.F., M.B., F.B., M.Re.), University Hospital München, D-80336 München, Germany

抄録

<jats:title>Abstract</jats:title><jats:p>Context: Testicular adrenal rest tumors (TARTs) are regarded to contribute to the high prevalence of subfertility in males with congenital adrenal hyperplasia (CAH).</jats:p><jats:p>Objectives: Our objectives were to evaluate reduced fecundity and its possible causes in well-controlled adult males with CAH, and to investigate diagnostic tools for improved treatment monitoring with respect to fertility outcomes.</jats:p><jats:p>Design: In a cross-sectional study at the Department of Endocrinology at the University Hospital München, Germany, 22 adult male CAH patients (15 salt wasting and seven simple virilizing, age 19–48 yr) were clinically assessed according to their hormonal control. We performed testicular ultrasound (22 of 22), magnetic resonance imaging (18 of 22), and a semen analysis (19 of 22) in the participants.</jats:p><jats:p>Results: All patients had a pathological semen analysis. TART prevalence was 10 of 22 (eight salt wasting, two simple virilizing). Poor therapy control was present in five patients, and all five had TARTs. Of the other 17 well-controlled patients with normal or suppressed adrenal androgens and 17-hydroxyprogesterone levels, five presented with TARTs. There was a significant correlation between sperm concentration and functional testicular volume (r = 0.70; P = 0.002), TART volume (r = −0.70; P = 0.036), as well as inhibin B levels (r = 0.75; P &lt; 0.0001), respectively. In several men, hormonal control parameters suggested hypogonadism, with glucocorticoid overtreatment as a relevant factor for poor semen quality.</jats:p><jats:p>Conclusions: Poor semen parameters are common in male CAH patients. TARTs, most likely reflecting undertreatment, as well as inhibin B are important indicators of fecundity. On the other hand, long-term glucocorticoid overtreatment also seems to contribute to low semen quality.</jats:p>

収録刊行物

被引用文献 (1)*注記

もっと見る

詳細情報 詳細情報について

問題の指摘

ページトップへ