THE TREATMENT OF UNDESCENDED TESTES WITH ANTERIOR PITUITARY-LIKE SUBSTANCE1

Abstract

Clinical findings, beginning with those of Cushing and his co-workers (1) and of Aschner (2) about 25 years ago, and the more recent experimental results of Zondek (3), Smith (4), Smith and Engle (5), Evans and Long (6), Moore and co-workers (7), in animals, furnish clear cut evidence of the effect of the anterior lobe of the pituitary on the growth and function of the gonads. While extensive observations on animals were being carried out by various investigators on the effects of the pituitary, Aschheim and Zondek (8) noted the presence in the urine of pregnant women of a substance that stimulated the sex glands. Shortly afterward, the production of genital growth and testicular descent with this material was reported by Schapiro (9) in a large percentage of boys and young men with hypogenitalism and cryptorchidism. Since then several reports have appeared, most of which give high percentages of successful results. To some surgeons familiar with the finding at operation of anatomical factors making descent difficult or impossible, many of these reports appeared enthusiastic. It therefore seemed desirable to make a critical study of the problem by a group of observers, one of whom should be a surgeon of wide and extensive experience in this field (10, 11, 12). Embryological considerations. The testis appears about the 5th week as the genital ridge or mass. There are differences of opinion concerning some of the details of its development. The consensus among embryologists is that the cells of the distal portion of the mass proliferate, while those of the proximal end atrophy; at the same time the fetus grows so that the testis appears to aescend to the level of the inguinal ring, which is being prepared for it.