DETERMINATION OF THE RELATIONSHIP BETWEEN TESTICULAR VOLUMES AND PHYSICAL GROWTH PARAMETERS IN SICKLE CELL ANAEMIA CHILDREN AGED 1-18

Abstract

Sickle cell anaemia (SCA) is characterized by repeated intravascular sickling and reversal of
sickling of haemoglobin SS red blood cells and this affects all body organs. It has been documented
that these events, when localized to the testes, lead to primary testicular failure and hypogonadism
with attendant delays in physical development of the affected children. The objective of the study
was to determine the relationship between the testicular volumes and physical growth parameters
of Nigerian children with sickle cell anaemia and compare them with age-matched normal
children.
METHOD
The study was a cross sectional study involving 95 male children with SCA and 95 age matched
controls between one and 18 years, recruited consecutively into the study. The period of sample
collection was between June 2014 and October 2015. The study participants were recruited via the
Children Out-Patient Clinics and Sickle Cell Clinic of the University of Uyo Teaching Hospital,
Uyo, Akwa Ibom State. After obtaining informed consent/assent, the participants responded to an
interviewer administered questionnaire. The weight, length/height of the participants were
measured in triplicates and the average taken for each parameter per child. The body mass index
of each child was calculated and the testicular volumes were also measured using both Prader
orchidometry and testicular ultrasonography. Pubertal onset using Prader orchidometry was
considered to occur from testicular volumes of 4mls and above. Using testicular ultrasonography,
each testis was measured thrice and an average taken. Pubic hair development for each participant
was assessed by visual inspection as described by Marshall and Tanner. Steady state packed cell
volume was estimated for the subjects while haemoglobin electrophoresis was done for the
controls.
RESULTS
The median ultrasound testicular volumes of the subjects were higher than those of controls within
the prepubertal period with a statistically significant difference of < 0.001. At early puberty, the
testicular volumes of the controls became higher than those of the subjects and this remained so
till late puberty. The subjects had comparable values with the controls at prepubertal ages for
weight, length or height and the Body Mass Index. However the values for the controls became
greater at puberty. Subjects and controls had similar sexual maturity by pubic hair staging, with
94.74% of subjects and 82.11% of controls having a stage 1 rating. There was significant positive
linear correlations of age, weight, length/height and pubic hair rating of both subjects and controls
to testicular volume (p < 0.001). There was a significant positive correlation between the BMI and
testicular volume for the controls (P < 0.001) which was not the case in the subjects (p = 0.45).
There was a significant negative correlation between steady state PCV and the testicular volume
for the subjects (p = 0.02) but no significant correlation was found for the controls (p = 0.43).
Frequency of testicular pain (p = 0.04), pubic hair rating of the subjects (p = 0.03) and the weight
of the subjects (p = 0.02) were significant predictors of testicular volume changes among subjects.
CONCLUSION
Testicular volumes and physical growth parameters (weight and height) of sickle cell anaemia
children exhibited a positive linear relationship. The testicular volumes of subjects with sickle cell
anaemia were higher than those of controls within the prepubertal age group with the controls
having higher volumes at the pubertal ages. Frequency of testicular pain episodes, pubic hair rating
and weight were the independent predictors of testicular volume changes in the subjects.
Prevention of frequent vaso-occlusive crisis with efforts aimed at maintaining adequate weight in
these subset of children may help prevent sexual complications in adulthood.

DETERMINATION OF THE RELATIONSHIP BETWEEN TESTICULAR VOLUMES AND PHYSICAL GROWTH PARAMETERS IN SICKLE CELL ANAEMIA CHILDREN AGED 1-18