What is the role of lab testing in the workup of cryptorchidism?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

For unilateral undescended testis without hypospadias, no laboratory studies are needed. Bilateral nonpalpable testes associated with either hypospadias or ambiguous genitalia may represent a life-threatening situation. Consultation with a pediatric endocrinologist and/or geneticist is recommended.

For unilateral or bilateral undescended testes with hypospadias or bilateral nonpalpable testes, tests include the following:

  • Testing to rule out intersexuality (mandatory)
  • 17-hydroxylase progesterone
  • Testosterone
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Further laboratory studies, depending on initial results

To determine anorchia in cases of bilateral nonpalpable gonads, perform the following:

  • LH testing
  • FSH testing
  • Testosterone level testing before and after stimulation with human chorionic gonadotropin (hCG)

Elevated basal gonadotropin levels and a negative testosterone response to hCG stimulation suggests congenital bilateral anorchism. Numerous protocols exist for hCG stimulation tests, but the most practical is a single injection of hCG (100 IU/kg or 2940 IU/body surface area) followed by a testosterone evaluation 72-96 hours postinjection.


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