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Key Features

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  • Affects 2–4% of full-term male newborns and up to 30% of premature infants

  • After 6 months of age, spontaneous descent occurs only very rarely

  • Can occur in an isolated fashion or associated with other findings

  • Abnormalities in the hypothalamic-pituitary-gonadal axis and androgen biosynthesis or receptor defects predispose to cryptorchidism

  • Fertility is impaired by approximately 33% after unilateral cryptorchidism and by 66% after bilateral disease

  • Risk of cancer in adults with history of cryptorchidism in childhood is reported to be 5–10 times greater than normal

  • However, histologic changes clearly occur as early as age 6 months in children with undescended testes

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Clinical Findings

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  • During examination, the cremasteric reflex may cause the testis to retract into the inguinal canal or abdomen (pseudocryptorchidism)

  • To prevent retraction, the fingers are placed across the abdominal ring and the upper portion of the inguinal canal

  • Examination in the squatting position or in a warm bath is helpful

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Diagnosis

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  • In infants between 2 and 6 months of age, measurement of luteinizing hormone, follicle-stimulating hormone, inhibin B, and testosterone can help determine whether testes are present

  • After this time, an HCG stimulation test can be done to confirm the presence or absence of functional abdominal testes

  • Ultrasonography, CT scanning, and MRI

    • May detect testes in the inguinal region

    • However, these studies are not completely reliable in finding abdominal testes

  • Diagnosis of bilateral cryptorchidism in an apparently normal male newborn should never be made until the possibility that the child is actually a fully virilized female with potentially fatal salt-losing CAH has been considered

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Treatment

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  • No treatment is necessary for retractile testes

  • Surgical orchidopexy should be performed if descent has not occurred by 6–12 months of age

  • Therapy with HCG to induce descent of the testis has a success rate of about 20%, and even less when retractile testes are excluded

  • HCG doses range from 250 to 1000 international units and are given twice weekly for 5 weeks

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