Cryptorchidism and Steroid Hormones

Two important functions of testis are production of spermatozoa and synthesis of steroids. These functions depend on anatomical, hormonal and constitutional homeostasis and begin during the first stage of gestation. Cryptorchidism can be defined as an abnormal localization of one or both testes. It’s the failure of one or both testes descent into the scrotal sac. The third trimester in humans is crucial for the testis descent. When the testis is not found in normal location it may be palpable or nonpalpable. The palpable testis may be cryptorchid, ectopic or retractile. Non-palpable testis may be cryptorchid, atrophic or absent. Cryptorchidism occurs when the testis fails to descend into its normal postnatal location and may be found in the abdomen, in the inguinal canal or just reaching the external ring (prescrotal) (Nguyen 1999). Before sex determination, both female and male embryonic gonads are located in the same high intra-abdominal position. During mammalian development, the cranial suspensory ligament (CLS) and the caudal ligament (or gubernaculum) is responsible for a sexual dimorphic position of the testis and ovary. In males, regression of the CLS, along with the outgrowth of the gubernaculum and its migration to the scrotum, results in the extraabdominal position of the testis (Agoulnik 2005). Androgens induce regression of the cranio-suspensory ligament to release the testis to descent. The inguinoscrotal descent of the normal testicle takes place between 26 and 35 weeks of gestation. In preterm males with cryptorchidism the testes may descent postnatally (Berkowitz 1993, Cortez 2008). Cryptorchidism is one of the most common urogenital disorders in boys. Cryptorchidism can occur as an isolated disorder or may be associated with other congenital anomalies. The intraabdominal temperature is dangerous for germ cells and cryptorchidism may be a risk factor for male infertility and for testicular malignancy in adulthood. The decrement in intratesticular temperature in adult males is 24oC lower compared with body temperature (Thonneau 1998). This temperature difference is necessary to maintain spermatogenesis. The lower temperature in the scrotum is essential for normal spermatogenesis. Dangerous effects of increased temperature on spermatogenesis are well documented. For undescended testis abnormal spermatogenesis may be related with degenerative changes connected with high temperature (Mieussed 1993). This condition affects both morphology and function of the Sertoli and Leydig cells of the testis (Farrer 1985) The association of cryptorchidism with testicular cancer is also well