The pituitary-Leydig cell axis before and after orchiectomy in patients with stage I testicular cancer

Introduction: This study investigates the pituitary-Leydig cell axis in patients with stage I testicular germ cell cancer (TGCC) followed with surveillance only, in order to evaluate the risk of Leydig cell dysfunction one year after orchiectomy. Patients and methods: A retrospective evaluation of reproductive hormones in patients with unilateral stage I TGCC (N = 72) without relapse diagnosed between 1990 and 2008. A group of healthy males (N = 706) served as controls. Results: Before orchiectomy there were no significant differences in luteinizing hormone (LH) and testosterone (T) levels between human chorionic gonadotropin (hCG)-negative patients and controls, although 33% of the patients were outside the 97.5 percentile when using bivariate LH/T evaluation. At 1-year follow-up there was a significant increase in LH (Delta LH = 2.04 IU/L, p < 0.001), and 57% of the patients had an LH/T relation outside the 97.5 percentile. Conclusion: Patients with stage I TGCC are at increased risk of having an LH/T relation outside the normal range one year after orchiectomy, suggesting insufficient Leydig-cell function. Whether a proportion of these patients will develop manifest hypogonadism and benefit from androgen therapy is yet to be clarified. (C)2011 Elsevier Ltd. All rights reserved.