|Year : 2015 | Volume
| Issue : 1 | Page : 42-44
Acquired cryptorchidism with spastic cerebral palsy
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
|Date of Web Publication||21-Apr-2015|
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano
Source of Support: None, Conflict of Interest: None
Cryptorchidism may have significant impact on the psycho-social wellbeing of a child that if not detected could result in low self-esteem and poor scholastic achievement. It may be congenital or acquired; in acquired cryptorchidism the testes would have descended into the scrotum and then subsequently ascended into the inguinal canal or abdomen. Although congenital cryptorchidism is commonly associated with prematurity and diseases such as prune-belly syndrome, Smith-Lemli-Opitz syndrome, Laurence-Moon-Biedl syndromes; acquired cryptorchidism (unlike retractile testes) is rare. Therefore, the case of an 11-year-old boy with acquired cryptorchidism associated with spastic cerebral palsy, which was omitted, is reported. This affected his relationship with his peers and also resulted in poor school attendance.
Keywords: Acquired cryptorchidism, cerebral palsy, low self-esteem, spastic
|How to cite this article:|
Aliyu I. Acquired cryptorchidism with spastic cerebral palsy. Indian J Cereb Palsy 2015;1:42-4
| Introduction|| |
Undescended testis is failure of the testes to descend into its normal location in the scrotal sac.  It may be congenital or acquired, and it occurs worldwide; about 3% of full-term male newborns and 30% of premature males have congenital cryptorchidism. Other predisposing factors include low birth weight, intrauterine growth restriction, and maternal estrogen exposure in the first trimester, multiple gestations. Genetic factors are also implicated because about 7% of siblings of boys with undescended testes may have cryptorchidism and spontaneous descent after the 1 st year of life is uncommon.  The incidence of cryptorchidism is not completely known in Nigeria though a study in Zaria, Nigeria reported an incidence of 0.5% over a 10-year period.  Undescended testis is often associated with congenital malformations such as: Prune-belly syndrome, Smith-Lemli-Opitz syndrome, Laurence-Moon-Biedl syndromes,  however the true incidence of acquired cryptorchidism is unknown and its association with spastic cerebral palsy, though not surprising is often overlooked; which explains the observed scarcity of literature documenting this association. Therefore, the case of an 11-year-old Nigerian boy is reported.
| Case report|| |
An 11-year-old was seen with the complaint of refusal of school attendance; there wasn't any report of bullying, visual or auditory defects. He was delivered at term and had a febrile illness in the neonatal period; afterward, he had delayed motor milestones and physical challenges with ambulation but with good cognitive function. He was diagnosed with spastic cerebral palsy at the age of 12 month; his performance at school had been average. Parents were not aware of the reason for his refusal to attend school but on further interaction with the child he revealed of his absent testes and fears that he might be ridiculed by peers. The parents were not conscious of the defect and do not know the exact age of its absence, but they were sure they were present up to the age of 8-year. On examination; both testes were not palpable, but the scrotum was well formed and rugated - tanner stage 1 [Figure 1] with appropriate penile length for age; and there was spasticity of the left upper and lower limb with power of 4/5; other systemic examinations were not remarkable. The abdominal ultrasound revealed the testes at the region of the inguinal ring. He was followed-up for a period of 1-year, but the testes did not descend spontaneously; child now awaits orchidopexy.
| Discussion|| |
Routine checking for the testis is often overlooked while evaluating children with cerebral palsy. Early diagnosis and management of undescended testis is necessary to preserve fertility; though the role of treatment in preventing development of testicular malignancy has remained controversial;  absent testes or its treatment can pose a psychologic challenge in a child resulting in low self-esteem;  this was observed in the index case who had hard time associating with peers and maintaining regular school attendance for fear of been ridiculed and this significantly affected his relationship with peers.
The mechanism of congenital cryptorchidism is not completely understood, however mechanical and hormonal factors have been implicated.  However, acquired cryptorchidism have been reported in about 50% of cases of spastic cerebral palsy, which was attributed to spasticity of the cremaster muscle;  this may pull the testes upward into the inguinal canal. Though several hypotheses attempts at explaining such ascending testis,: It is believed that as the child grows, tethering of an initially lax gubernaculum pulls the testis up into the inguinal canal, similarly failure of elongation of the spermatic cord in proportion to body growth may also pull the testis upward. Cryptorchidism in this case was detected at the age of 10-year and the exact timing of its occurrence could not be ascertained because the parents and the physician were more concerned with the physical challenges; therefore clinicians should be vigilant and routinely examine the gonads in male patients with spastic cerebral palsy. Physical and mentally challenged children are venerable to physical and emotional neglect/abuses;  therefore this aspect of care should be actively sort for during evaluation and management.
Therapy for congenital cryptorchidism should begin between the ages of 6 months and 2-year;  however in acquired cases, there is no established guideline on best modality and timing of treatment.  Treatment maybe hormonal or surgical and the success of any treatment modality depends on the timing and location of the testicle. 
| Conclusion|| |
Acquired cryptorchidism may occur in patients with spastic cerebral palsy; therefore it should be actively sorted for, because challenges in the management of the neurologic and movement disabilities associated with cerebral palsy maybe overwhelming hence resulting in omission of an acquired cryptorchidism; and early intervention may improve quality-of-life.
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