Endocrinological Studies in Patients with Metastatic Malignant Testicular Germ Cell Tumours

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Abstract
Various serum hormone levels were determined in patients with metastatic testicular germ cell tumors. Raised LH [lutropin] levels, due to a cross reaction with hCG [human chorionic gonadotropin] in the radioimmunoassay, were observed in 20 out of 29 patients with active disease and were mainly caused by gonadotropin production in the tumor tissue. Increased LH levels were frequently observed in the patients with non-seminomatous tumors, but were also found in 4 (out of 6) patients with metastatic seminoma. One should probably use a specific hCG radioimmunoassay to measure tumor hCG as a tumor marker with a high diagnostic accuracy. In patients with active disease despite ongoing combination chemotherapy which included LH suppressing medication [vincristine, adriamycin, cyclophosphamide, actinomycin-D and medroxyprogesterone acetate], 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 tumor hCG has a biological activity, stimulating the remaining testis to increased testosterone secretion in these patients. The serum E2-17.beta. [estradiol] 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 .mu.g/l) were observed only in patients with high LH levels (> 9.5 .mu.g/l) and a large tumor burden. E2-17.beta. and prolactin determinations are evidently of minor value for early detection of tumor manifestations. Serum follitropin cannot serve as a tumor marker in patients with testicular germ cell tumors.

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