Choriogonadotropin（hCG） for cryptorchidism（undescended testes） 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

Cryptorchidism（undescended testes） one or both of the testicles do not move down into the scrotum may be unilateral or bilateral.

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

Complications Infertility Inguinal hernia Tumor of testicular Cosmetic problems and psychological Injury of the undescended testis and torsion or twisting of the testis

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 ）

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

Diagnosis physical examination prenatal ultrasound laparoscopy blood test - determine the level of gonadotropin

Treatment Hormonal therapy： human chlorionic gonadotropin hormone (hCG) Gonadorelin（LH-RH） Buserelin Surgery：orchidopexy between 1 and 2 years of age

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

Chlorionic gonadotropin - 2 FDA Labeled Indication Cryptorchidism Hypogonadotropic hypogonadism, In male patients Ovulation induction

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.

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.

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

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

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)

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

FDA Labeled Indication Conclusion Cryptorchidism FDA Labeled Indication adult pediatric Chlorionic gonadotropin yes yes (over 4 y of age) Gonadorelin no Buserelin

FDA Labeled Indication Conclusion Cryptorchidism FDA Labeled Indication Adult Pediatric Efficacy Effective Recommendation Class IIa Strength of Evidence Category B

References  MedlinePlus Medical Encyclopedia MayoClinic.com MICROMEDEX