Anorchia

• Alternative Names

  Vanishing testes - anorchia; Empty scrotum - anorchia; Scrotum - empty (anorchia)

• Causes, incidence, and risk factors

  In the first several weeks after the egg is fertilized, the embryo develops early sex organs. In the male, if the early testes fail to develop before 8 weeks into the pregnancy, the baby will have female genitals.

  If the testes are lost between 8 and 10 weeks, the baby will be born with ambiguous genitalia. This means the child will have parts of both male and female genitals.

  However, if the testes are lost after the time when the male genitals differentiate (between 12 and 14 weeks), the baby will have normal male genitals (penis and scrotum), but no testes. This is known as congenital anorchia, or the "vanishing testes syndrome."

  The cause is unknown, but in some cases there are genetic factors.

• Symptoms
  • Normal outside genitals before puberty
  • Failure to start puberty at the correct time and lack of secondary sex characteristics (penis and pubic hair growth, deepening of the voice, and increase in muscle mass)
• Signs and tests

  Signs include:

  • Empty scrotum
  • Lack of secondary sex characteristics

  Tests include:

  • Anti-Mullerian hormone levels
  • Bone density
  • FSH and LH levels
  • Surgery to look for male reproductive tissue
  • Testosterone levels (low)
  • Ultrasound or MRI
  • X,Y karyotype
• Treatment

  Treatment includes:

  • Artificial (prosthetic) testicle implants
  • Male hormones (androgens)
  • Psychological support
• Expectations (prognosis)

  The outlook is good with treatment.

• Complications

  Complications include:

  • Face, neck, or back abnormalities (occasionally)
  • Infertility
  • Psychological problems due to gender
• Calling your health care provider

  Call your health care provider if your male child appears to have extremely small or absent testicles or does not appear to be entering puberty during his early teens.

• References

  Rapaport R. Hypofunction of the testes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 584.

  Sigman M, Jarrow JP. Male infertility. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.

Review Date: 9/7/2008

Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Louis S. Liou, MD, PhD, Assistant Professor of Urology, Department of Surgery, Boston University School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.