Endocrinological Studies in Patients with Metastatic Malignant Testicular Germ Cell Tumours

Abstract

In this study, various serum hormone levels were determined in patients with metastatic testicular germ cell tumours. Raised LH levels, due to a cross reaction with hCG in the radioimmunoassay, were observed in 20 out of 29 patients with active disease and were mainly caused by gonadotrophin production in the tumour tissue. Increased LH levels were frequently observed in the patients with non-seminomatous tumours, but were also found in 4 (out of 6) patients with metastatic seminoma. One should, however, preferably use a specific hCG radioimmunoassay in order to measure tumour hCG as a tumour marker with a high diagnostic accuracy. In patients with active disease despite ongoing combination chemotherapy which included LH suppressing medication, serum testosterone remained above 6 nmol/l in 11 out of 16 patients. These patients remained sexually potent, while testosterone values below 6 nmol/l usually were combined with sexual impotence in patients during combination chemotherapy. These data strongly suggest that the tumour hCG has a biological activity, stimulating the remaining testis to increased testosterone secretion in these patients. The serum E2-17 beta levels were slightly to moderately increased in half of the patients with metastatic disease. Markedly increased serum E2-17 beta levels (> 0.30 nmol/l) and very high prolactin values (> 32 micrograms/l) were observed only in patients with high LH levels (> 9.5 micrograms/l) and a large tumour burden. These observations indicate that E2-17 beta and prolactin determinations are of minor value for early detection of tumour manifestations. Serum FSH cannot serve as a tumour marker in patients with testicular germ cell tumours.

Significance of simultaneous determination of serum human chorionic gonadotropin (hCG) and hCG‐β in testicular tumor patients

“…In patients with testicular tumor, hCG‐β is thought to be a sensitive and specific marker of tumor activity. 1,2 For detection of seminoma patients, hCG‐β was more effective than hCG because in 54 seminoma patients, hCG‐β was positive in 83% (45/54) of the cases and hCG was positive in 50% (27/54). However, in respect to non‐seminomatous testicular tumor, hCG‐β was positive in 74% (55/74) and hCG was positive in 82% (61/74).…”

“…Cross reactivities of Bole ELISA.F‐β‐hCG kit with LH, FSH and hCG were not detected. The χ 2 test was used to assess differences.…”

“…Fraction β of the human chorionic gonadotropin hormone (hCG‐β) is believed to be a more sensitive testicular tumor marker than human chorionic gonadotropin hormone (hCG). 1,2 However, simultaneous examinations of hCG and hCG‐β frequently produce discrepancies, that is when hCG or hCG‐β is normal, the other is elevated. Accordingly, we examined the significance of simultaneous determination of serum hCG and hCG‐β in testicular tumors.…”

Highly Sensitive Detection of Hormone Estradiol E2 Using Surface-Enhanced Raman Scattering Based Immunoassays for the Clinical Diagnosis of Precocious Puberty

“…Thus, sensitive and specific assays for E2 are needed to track pubertal development and to better define the ranges of normal levels across childhood. The E2 concentration in serum is very low (<10 pg/mL) in prepubertal girls. , However, because of the absence of sensitive assays that can accurately quantify E2 at concentrations less than 10 pg/mL, many issues related to the role of E2 in pubertal development and growth remain unanswered. Thus, there is an urgent need to develop a highly sensitive method for the detection of E2 in human serum, especially in prepubertal children.…”

Evaluation of an Isotope Dilution HPLC Tandem Mass Spectrometry Candidate Reference Measurement Procedure for Total 17-β Estradiol in Human Serum

“…Estradiol (E2) measurements are used to monitor antiestrogen therapy (e.g., aromatase inhibitor therapy), assess fertility, monitor sex steroid metabolism disorders, identify E2 secreting tumors, and assess fracture risk . Several research studies and meta-analyses found that elevated E2 levels in postmenopausal women increase the risk for breast cancer with relative risk ratios similar to those observed for cholesterol levels and cardiovascular disease risk. , Additional studies have reported associations between E2 and the risk of endometrial cancer, , cardiovascular disease, and cognitive function …”