1 門診處方用藥討論 choriogonadotropin ( hcg ) for cryptorchidism ( undescended testes...
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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
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Cryptorchidism ( undescended testes )
• one or both of the testicles do not move down into the scrotum
• may be unilateral or bilateral.
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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
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Complications
• Infertility
• Inguinal hernia
• Tumor of testicular
• Cosmetic problems and psychological
• Injury of the undescended testis and torsion or twisting of the testis
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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 )
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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
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Diagnosis
• physical examination
• prenatal ultrasound
• laparoscopy
• blood test - determine the level of gonadotropin
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Treatment
• Hormonal therapy : • human chlorionic gonadotropin hormone
(hCG)
• Gonadorelin ( LH-RH ) • Buserelin
• Surgery : orchidopexy
• between 1 and 2 years of age
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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
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Chlorionic gonadotropin - 2
• FDA Labeled Indication
• Cryptorchidism
• Hypogonadotropic hypogonadism, In male patients
• Ovulation induction
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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.
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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.
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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
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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
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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)
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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
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Conclusion
Cryptorchidism
FDA Labeled Indication
adult pediatric
Chlorionic gonadotropinyes yes (over 4 y of
age)Gonadorelin no noBuserelin no no
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Conclusion
Cryptorchidism
FDA Labeled Indication
Adult Pediatric
Efficacy Effective Effective
Recommendation Class IIa Class IIa
Strength of Evidence Category B Category B
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References
• MedlinePlus Medical Encyclopedia
• MayoClinic.com
• MICROMEDEX