Sertoli Cell Only Syndrome

Kim, Cheung Soo; Lee, Hee Yong

Abstract

A total of 178 patients with Sertoli cell only syndrome proved by histologic examination was investigated for the past 7 years at the infertility Clinic of Seoul National University Hospital. The size of testes ranged from 5 to 25ml with the mean of 13ml(An average normal size of Korean males: l9ml) However, testes size of greater than l5ml were found in 53.3% of the patients. Plasma FSH Levels ranged from 0.31 to 58.501U/L with a mean of 20.451U/L(Normal level of Korean males: l2.10IU/L). Plasma LH levels ranged from 1.56 to 59.75IU/L with a mean of l2.87 IU/L( Normal level of Korean males: 9.21U/L). Plasma testosterone levels ranged from 0.9 to 11.0ng/ml with a mean of 5.5ng/ml Accordingly, increased FSH levels were found in 49.4% and increased LH levels, in 25.4% of the patients. And decreased levels of testosterone levels were found in 8.9% of the patients. Stimulation tests of LH and FSH by an administration of 100ug bolus of LHRH were attempted on 3 patients. The basal FSH values were elevated over 24.l8IU/L in the 3 patients. The FSH values were increased l.8-fold 90 minutes after stimulation tests. The basal value of LH was elevated in a patient. The LH values were increased 9.l-fold 30 minutes following the stimulation tests. Leydig cell hyperplasia and peritubular fibrosis were found in 2 patients who had shown the exaggerated responses to LHRH stimulation tests. The patients with more abundant microfilament in cytoplasm and increased intercellular digitation of Sertoli cells proved by an electron microscopic examination, had the higher levels of basal FSH and LH. Therefore, the regulatory mechanism of secretion of both FSH and LH appears to be abnormal in the patients with Sertoli cell only syndrome. The karyotype evaluation revealed 46XY in 20 patients, 46XY 15S- in l patient and 46XYt(7, 14) in 1 patient of the 22 patients. Sertoli cell only syndrome seems to be heterogenous or a single process which may be in evolution at different developmental stages. Germ cell aplasia was found in 21 patients with cryptorchidism by histological examination. We could infer the more abnormal regulation of secretion of both gonadotropins (FSH and LH) in patients of cryptorchidism with germ cell aplasia than patients of Sertoli cell only syndrome without cryptorchidism.