Macroorchidism and testicular fibrosis associated with autoimmune thyroiditis.

A 16-year-old male with long-standing atrophic chronic lymphocytic thyroiditis was evaluated for macroorchidism. A testicular biopsy prior to treatment revealed peritubular and interstitial fibrosis, reduced spermatogenesis and sparse Leydig cells with nonprominent smooth endoplasmic reticulum. Biological/immunological LH and FSH ratios were reduced, I-LH and FSH response to GnRH was blunted, and levels of testosterone and androstenedione were low. Twenty-two months after thyroid treatment, the testicular size was unchanged, and the degree of fibrosis showed minimal regression. Spermatogenesis with normal morphology was present, Leydig cells with Reinke crystals were present, and surface area and diameter of the seminiferous tubules had increased only slightly. There was a normal I-LH and FSH response to GnRH, and normal levels of testosterone and androstenedione. This study, along with previous reports, suggests that the etiology of the hypothyroid state may influence the development of testicular fibrosis.

Torsion of the spermatic cord in adults.

Intravaginal torsion of the spermatic cord is seen typically in the peripubertal period. At our hospital 33 patients with intravaginal torsion were seen between 1970 and 1986, and 13 (39%) were more than 20 years old. Because of delay in seeking treatment or error in initial diagnosis proper treatment often was late in these 13 adults. This delay in treatment allowed for a testicular salvage rate of only 38%. Increased awareness by physicians that torsion often occurs in adults plus an accurate history and evaluation may allow for a higher testicular salvage rate in this age group.