| Objective:Observe changes of secondary sexual characteristics and sexual hormones levels of male children with micropenis after hCG treatment. Letrozole was given for 3 months and 6 months in children whom were found high estrogen level and breast development treated with hCG. Evaluation of effectiveness of letrozole treatment and comparison of advantages over hCG treatment in children with micropenis and gynecomastia were made by observation indexes changes.Research objects and methods:Forty-five male children with "micropenis" who met the standards and received treatments and periodic reviews were enrolled from children who visited pediatric clinics and wards of Shandong Provincial hospital from 2014 January to 2015 January as micropenis group, the average age was (11.87±1.91) years old. Twenty-eight male children who visited the hospital in the same period time for mere health examination were selected as normal control group, whose average age was (12.57±1.32) years old. One course of experimental treatment of hCG were given to these children (drug dose varied from 500 to 2000iu according to the age, intramuscular injection,3 days a time,10 times in total), reexamination of observation indexes were needed the day after the course ended.Oral letrozole of 2.5mg/d was given to children whom were found high estrogen level and breast development after hCG treatment. Analysis and comparison of observation indexes changes and efficacy differences were made after 3 months and 6months administration of letrozole. Evaluate the advantages of letrozole over hCG treatment. SPSS17.0 was applied to statistical analysis, difference was considered to be of statistical significant only when P<0.05.Observation index:Height (Ht), body weight (Wt), body mass index(BMI), secondary sexual characteristics (breast development stage (B), penile length, penile circumference, testicular volume), Tanner stage (T), sex hormone levels (follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (To), estradiol(E2), imaging examination (bone age (BA), scrotal and testicular ultrasound, the hypothalamus-pituitary magnetic resonance).Results:1. The basic data and sex hormone levels of enrolled children1.1 The basic data of enrolled childrenThe normal control group was consist of 28 children, the average age was (12.57±1.32) years old, the average bone age was (11.87±1.92) years old; the total case number of micropenis group was 45 people, the average age was (11.87±1.91) years old, the average bone age was (12.44±1.84) years old, the differences of average age and average bone age were of no statistical value between two groups (P>0.05). The bone age of micropenis group was advanced than actual age.The height of micropenis group were significantly lower than that in normal control group (P<0.05), body weight and BMI were significantly larger than that in normal control group (P<0.05), breast enlargement was significantly found more than in the normal control group (P<0.001), the development of the vulva (penis length, penile circumference, testicular volume), Tanner stage were all behind the normal control group condition (P<0.001).1.2 The sex hormone levels of enrolled childrenThe FSH, LH, LH/FSH, To levels in normal control group were significantly higher than that of micropenis group (P<0.001), while To/E2 value showed no significant difference between two groups (P>0.05).2. hCG experimental treatment2.1 The basic data changes and comparisons after hCG experimental treatmentThe penis length, penile circumference and testicular volume of micropenis group were significantly increased than that of newly diagnosed levels (P<0.001), but were still lagged behind normal control group (P<0.001). Eight children were found breast enlargement (P>0.05), Tanner stage showed no change (P>0.05) and was still lagged behind normal children of the same age (P<0.001).2.2 The sex hormone level changes and comparisons after hCG experimental treatmentThe FSH and LH levels of micropenies group were significantly decreased after hCG stimulation and were obviously lower than the normal control group (P<0.05); the LH/FSH and To levels increased (P<0.001), yet had no significant difference compared with the normal control group (P>0.05); the level of E2 increased apparently (P<0.001) and was significantly higher than the normal control group (P<0.05); To/E2 value showed no statistical difference neither after hCG stimulation nor compared with normal control group.3. Letrozole treatment for 3 months.3.1 The basic data changes and comparisons after letrozole treatment for 3 monthsThe height increased significantly than that of newly diagnosed (P<0.001) and reached the average level of the normal control group (P>0.05); the weight and BMI showed no statistical difference compared with pre-treatment levels (P>0.05) and was still higher than that of normal children (P<0.001).The penis length, penile circumference and testicular volume were significantly increased than that of newly diagnosed (P<0.001); the Tanner stages changed obviously after treatment (P<0.001); breast was significantly smaller after treatment (P<0.05); but all the changes mentioned above were still of statistical significance compared with normal control group (P<0.05).3.2 The sex hormone level changes and comparisons after letrozole treatment for 3 monthsThe FSH, LH and To levels were only significantly higher than those before treatment (P<0.05); LH/FSH value was significantly increased than that of newly diagnosed (P<0.05) E2 level was lower than that after hCG treatment and normal control group (P<0.05); the level of To/E2 was significantly higher than that before treatment and the normal control group (P<0.05).4. Letrozole treatment for 6 months.4.1 The basic data changes and comparisons after letrozole treatment for 6 monthsThe height increased significantly (P<0.05) but no significant difference was found compared with normal control group (P>0.05); the weight and BMI were significantly lower than that before treatment (P<0.05) but were still higher than the normal control group (P<0.05). Compared with condition before letrozole treatment, penis length and circumference, testicular volume, puberty, breast development changed significantly after 6 months administration of letrozole (P<0.05), yet these changes showed no significant difference compared with normal control group(P>0.05).4.2 The sex hormone level changes and comparisons after letrozole treatment for 6 monthsThe level of To and LH were significantly increased (P<0.05), E2 level was significantly decreased (P<0.05); FSH and To/E2 values were only increased significantly compared with condition of newly diagnosed and after hCG treatment (P<0.05); LH/FSH value was significantly elevated than that of newly diagnosed. The FSH, LH, To and To/E2 levels were significantly higher than those of normal children in control group (P<0.05), but no significant difference was found in LH/FSH level (P>0.05).Conclusions:1. Application of hCG treatment can increase the To, E2 level and improve the development of vulva, increase the risk of breast enlargement or development while pituitary can be suppressed by negative feedback and secretion of Gn decreases.2. The application of letrozole treatment can obviously promote gonadal development in adolescent children, increase the penis and testicles volumes and reduce the breast in the same time.3. Long term application of letrozole can maintain children in a high Gn, To, To/E2 and low E2 status, reduce weight and BMI, minish the effect of E2 on bones, thus delaying bone age and improving final height. |
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