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Measurement of Mullerian Inhibiting Substance Facilitates Management of Boys with Microphallus and Cryptorchidism

Pediatric Endocrine Unit (M.M.) and Pediatric Surgical Research Laboratory (D.T.M., P.K.D.), Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts 02114; and Pediatric Endocrine Division, Duke University Medical Center (M.M.L.), Durham, North Carolina 27710

Address all correspondence and requests for reprints to: Mary M. Lee, M.D., Pediatric Endocrine Division, Box 3080, Bell Building, Duke University Medical Center, Durham, North Carolina 27710. E-mail: . lee00140{at}mc.duke.edu

Abstract

Mullerian inhibiting substance (MIS) is a gonadal hormone expressed in a sexually dimorphic pattern. In males, serum MIS reflects Sertoli cell function and provides an estimate of seminiferous tubular integrity. We examined the role of MIS determination in the evaluation of boys with microphallus (n = 62) and/or cryptorchidism (n = 156). MIS was normal in 69.2% of boys with isolated microphallus compared with 38.1% of boys with microphallus and coexisting cryptorchidism (P < 0.05). In the cryptorchid group, MIS was normal in 46.8%, low in 24.4%, and absent in 28.8%. Normal values for age were associated with testicular tissue, whereas undetectable values were indicative of anorchia, except for two boys with MIS gene mutations (persistent Mullerian duct syndrome). These data demonstrated that a basal MIS measurement is more specific and has a higher positive predictive value than stimulated testosterone values for ascertaining the absence of testes (anorchia). In summary, a normal serum MIS concentration in the prepubertal child is a reliable determinant of testicular tissue, whereas an undetectable value is a highly sensitive initial screening test for anorchia. We conclude that preoperative measurement of MIS facilitates the management of children with cryptorchidism and intersex disorders and offers a measure of Sertoli cell function.

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