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The diagnosis of small penis

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Updated: Tuesday, Apr 13,2010, 3:03:12 PM
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The diagnosis is essentially a small penis, including the future availability of normal secondary sexual characteristics and fertility of the judge. Although urologists and endocrinologists is the aspiration of early diagnosis and early treatment, but if not the specific chromosomal abnormalities or clinical syndrome, prior to school age and very difficult to make conclusions. The present study was more complete in patients with an initial height growth and bone age greater than 14-year-old still does not appear secondary sex characteristics, and relevant examination and treatment.

Should first learn more about the family, whether hypospadias, cryptorchidism, small testes and other genital abnormalities of the history, the history of any next of kin marriage, with or without mental abnormality, with or without the sense of smell, hearing, and vision abnormalities. To pay attention to any abnormal physical examination and Zhi Zhi face deformities, measuring testicular size, location and length of the penis. Of suspected hypothalamus, pituitary dysplasia or lesions should do head CT, magnetic resonance imaging examination. All patients should undergo karyotype analysis. The small penis of known genes and unknown gene screening study has been carried out in developed countries, based on clinical manifestations and various checks to determine the circumstances under which the corresponding gene screening is currently carrying out further work to be.

All suspected hypopituitarism should check adrenocorticotropic hormone, thyroid-stimulating hormone, growth hormone levels. Hypothalamus - pituitary - gonadal axis function in the diagnostic testing is essential for small penis, testosterone should be OK, DHT, LH, FSH test and HCG stimulation test conducted, GnRH stimulation test and diagnostic treatment of androgen.

1, HCG stimulation test

Pillar cells from the testis, interstitial cells and spermatogonia cells. Pillar cells against vaccine-type control hormones, mesenchymal cells secrete testosterone. HCG stimulation test for the detection of Leydig cell androgen secretion. HCG HCG stimulation test in the amount, frequency, interval and blood testing various different time points. Multiple injections are commonly used methods: HCG 1 500U, intramuscular injection every other day 1, a total of 3 times. Before injection and 3, sacrificing the early morning the next day after the second injection of blood samples, measurement of testosterone, DHT. Testes were normal blood testosterone levels increase up to 2 times; no response or reaction of the lower and more as primary testicular failure or no testicles; secondary testicular dysfunction in patients with hypothalamic or pituitary response depends on the extent of damage; Physical delayed puberty who often has a normal reaction; reaction retarded by several excited HCG can increase blood testosterone, may exclude testicular dysfunction itself.

2, GnRH stimulation test

The test used to detect the hypothalamus, pituitary endocrine function, before school age and meaningful. Stimuli can Gn-RH or GnRHa (GnRH analogues). When bone age greater than 14-year-old boy, first to 11 Testosterone 40mg / d, oral 7d, further GnRH stimulation test, usually 2.5μg/kg intravenous GnRH, in the injection before and after injection 30,60, 90min each blood test LH, FSH response to peak. When LH <5U / L could be considered gonadotropin deficiency [9]. Now even called line GnRHa stimulation test. Available Buserelin 100mg subcutaneously [10], in stimulating blood before and 4h after stimulation, detection LH, FSH levels. Little value on the diagnosis of FSH, LH <8U / L can diagnose gonadotropin deficiency. The test sensitivity of 100%, specificity 96%, easy. Kauschansky other 32 patients over 14 years of age there still no secondary sex characteristics of boys respectively GnRH (0.1mg/m2), GnRHa (triptorelin, 0.1mg/m2) and HCG (1500U, 1 every other day, a total of 3) stimulation test, of which 13 cases were entered puberty after test 1 (A group) and the other 19 cases were followed up for 3 to 4 years without change (B). Comparing the two groups to stimulate GnRH or Gn-RHa difference was found, GnRHa stimulation, A group of LH values (20.4 ± 7.5) mIU / mL (range 10.8 ~ 32.6), B group (2.3 ± 2.0) mIU / mL (range 0.7 to 6.9), the two groups, there is no overlapping LH values, LH cutoff value 8mIU/mL; and after GnRH stimulation, A group of LH values (11.4 ± 4.4) mIU / mL, B group (2.7 ± 1.1) mIU / mL, although the two group was statistically significant, but the data overlapping a larger area, affect the outcome of the judge. It is noteworthy that the study did not use GnRH stimulation of androgen priming (priming) and LH, FSH, testosterone test because the determination, the reagents used to differ, each laboratory should be explored according to their own situation.

3, diagnostic treatment of androgen

The method used to detect whether androgen resistance. Intramuscular injection of testosterone propionate 25mg, 1 every 3 weeks or daily oral administration of Yasuo 40mg, a total of 4 months. If the penis can be increased, except for androgen resistance may be. Effective are penis after treatment than before treatment should be increased at least 2.5cm. The life of hypothalamus - pituitary - gonadal axis function was found within 6 months after birth, the diagnosis of gonadotropin deficiency in another boy time window. As a continuation of fetal GnRH pulse launched the boy after birth FSH, LH, testosterone secretion increased 6 months after the fall. Early diagnosis for the early treatment possible.

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