1. Choriogonadotropin（hCG） for cryptorchidism（undescended testes）
門診處方用藥討論
Choriogonadotropin（hCG） for cryptorchidism（undescended testes）
報告日期：
報告者：洪惠敏

6. Cryptorchidism（undescended testes）
one or both of the testicles do not move down into the scrotum
may be unilateral or bilateral.

7. 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

8. Complications Infertility Inguinal hernia Tumor of testicular
Cosmetic problems and psychological
Injury of the undescended testis and torsion or twisting of the testis

9. 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 ）

10. 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

11. Diagnosis physical examination prenatal ultrasound laparoscopy
blood test - determine the level of gonadotropin

12. Treatment Hormonal therapy：
human chlorionic gonadotropin hormone (hCG)
Gonadorelin（LH-RH）
Buserelin
Surgery：orchidopexy
between 1 and 2 years of age

13. 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

14. Chlorionic gonadotropin - 2
FDA Labeled Indication
Cryptorchidism
Hypogonadotropic hypogonadism, In male patients
Ovulation induction

15. 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.

16. 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.

17. 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

18. 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

19. 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)

20. 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

21. FDA Labeled Indication
Conclusion
Cryptorchidism
FDA Labeled Indication
adult
pediatric
Chlorionic gonadotropin
yes
yes (over 4 y of age)
Gonadorelin no
Buserelin

22. FDA Labeled Indication
Conclusion
Cryptorchidism
FDA Labeled Indication
Adult
Pediatric
Efficacy
Effective
Recommendation
Class IIa
Strength of Evidence
Category B

23. References 
MedlinePlus Medical Encyclopedia
MayoClinic.com
MICROMEDEX