Testicular tumors secondary

Decreased concentrations of 17-KSs usually are found in men with primary hypogonadism (Klinefelter s syndrome and castration), in secondary hypogonadism (panhypopituitarism), and in women with pituitary hypoadrenahsm (Addison s disease). Increased concentrations are found in patients with testicular tumors (interstitial cell tumor and chorioepithelioma), adrenal hyperplasia, and adrenal carcinoma, and in some women with hirsutism. 

Compared with primary tumors, secondary testicular tumors are typically found in an older age group (older than 50 years of age). However, one third of the cases occur before age 40. Prostate carcinoma (50%) dominates the list of primary sources, in large part because of the prior practice of bilateral orchiectomy as part of the hormone deprivation therapy for PCa. Other primary sources, in descending order, include kidney, melanoma, and lung primaries. 

CRYPTORCHIDISM Cryptorchidism, the failure of one or both testes to descend into the scrotum, affects up to 3% of fuU-term male infants, becoming less prevalent with advancing postnatal age. Cryptorchid testes have defective spermatogenesis and are at increased risk for developing germ cell tumors. Hence, the current approach is to reposition the testes as early as possible, typically at 1 year of age but definitely before 2 years of age. The local actions of androgens stimulate descent of the testes thus, hCG can be used to induce testicular descent if the cryptorchidism is not secondary to anatomical blockage. Therapy usually consists of injections of hCG (3000 lU/m body surface area) intramuscularly every other day for 6 doses. 

AU alkylating agents are toxic to hematologic cells. Thus, myelosuppression is a predictable side effect. Antimetabolites may cause secondary tumors, even years after therapy. Important side effects are shown in Table 8.1 and Figure 8.3. Note which drugs are used to treat CNS tumors, not because they are better agents, but because they cross the blood brain barrier. Similarly, drugs that penetrate the blood-testis barrier are used to treat testicular cancer. 

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