FURTHER STUDIES ON THE TREATMENT OF CONGENITAL ADRENAL HYPERPLASIA WITH CORTISONE: V. EFFECTS OF CORTISONE THERAPY ON TESTICULAR DEVELOPMENT*†

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Abstract
Studies are reported on the size and histologic appearance of the testes of 7 boys with virilism due to adrenal hyperplasia, before and after treatment with cortisone. Before treatment the testes were of preadolescent size. The tubules were immature. The germ cells either had not differentiated beyond the stage of spermatogonia or showed some mitoses with development only to the stage of spermatocytes. Spermatids and spermatozoa were not found. No Leydig cells were present. With cortisone therapy, boys who were 6.75 8.75 yrs. of age but had the osseous maturity of 13-14 yrs. showed rapid growth of the testes with active spermatogenesis. Numerous Leydig cells appeared. In boys who had an osseous maturity of less than 11 yrs., no growth or maturation of the testes occurred under cortisone treatment. It is believed that the testicular maturation is not a direct effect of cortisone but is due to the release of pituitary gonadotropins which occurs when the excessive secretion of adrenal androgens and estrogens is suppressed. The ability of the pituitary to secrete gonadotropins is attained when the general level of maturity, as measured by the bone age, is about 11-13 yrs. The hypotheses are substantiated by the fact that when a virilizing adrenal tumor was removed from a 3.75 yr.-old boy with a bone age of 5.5 yrs., no testicular development occurred, whereas, when a similar tumor was removed from a boy of 4.75 yrs. with a bone age of 12 yrs., there was rapid testicular maturation with spermatogenesis.