PENISES MORE NORMALLY
SIZED AND ERECTION
IN 56 DOWN CHILDREN
UNDERGOING DRUG THERAPY
Renato COCCHI, a
neurologist and a medical psychologist
Abstract
Fifty-six Down’s syndrome children
aged 8-96 months at first consultation showed a small-sized penis. Parents
reported lack of erection in 54 of them. Following an individually tailored
drug therapy acting on GABA and related neurochemical circuits lasting on
average 29.20 months, their penises were observed increased in size in 34 Ss
(64.29%).
Parents reported erections in 42 of
them (77.78%) after on average 30.35 months of this drug therapy.
To improve GABAergic function can
favourably act on the hypothalamus-hypophysis-gonadal axis, as it could have
done in these cases.
Key-words: Down's syndrome; penis size;
erection; GABA; drug therapy.
Drug therapy of stress reactions
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An evident small-sized penis is an aspect
that always strikes when visiting a male Down’s syndrome child, being so also
for the scrotum and testicles. One or both testicles can appear as not gone
down into the scrotum.
This is a well-known datum regularly
reported in the literature, whose incidence varies from 98% to 41% (Oster,
1983; Domino and Newman, 1965; Lewinson, Friedman and Stamps 1955; Schiavetti
et al., 1984).
This research has the aim of referring a
phenomenon first seen by the parents of children undergoing drug therapy
prescribed by myself.
After a certain period of drug taking,
several children with small-sized penises and without any erection showed an
increased size of the penis, and sometimes morning erections.
These observations deserved a investigation
and a report, although with all cautions due to careful attention only since a
starting point. It does not refer to all children undergoing drug therapy who
came back for checkup after a suitable time. So, this is a preliminary and
orientation survey.
Subjects,
materials and method
I investigated only male Down children
having these features:- chromosomal diagnosis;- collected and noted in the
clinical card during the first consultation: "a small-sized penis,
with/without erection";
- drug therapy token at least for one year;
- collected and noted at the last checkup
any variation in size of the penis (or, no variation at all);
- collected and noted at the last checkup
any appearance of penis erection, as reported by the parents;
- maximum age of nine years at the last
checkup, to avoid that results due to the pubertal development, can have a
wrong attribution to the drug therapy.
Results
Only 56 children fitted all the above criteria.
Tables 1-3 show epidemiological data, timing of the drug therapy, results and
their distribution.
Table 1: Epidemiological and clinical data
of the sample
|
Average age at first consultation (months) |
46.38 +/- 58.24 |
Range: 8-94 |
|
|
|
|
|
Distribution of chromosomal diagnoses |
|
|
|
Standard trisomy 21 |
52 Ss |
92.86% |
|
Translocations |
2 Ss |
3.57% |
|
Mosaicisms |
2 Ss |
3.57% |
|
|
|
|
|
Small-sized penis observed at first consultation |
56 Ss |
100.00% |
|
Reported lack of erection at first consultation |
54 Ss |
96.43% |
|
Reported erection at first consultation |
2 Ss |
3.57% |
Table 2: Length of drug taking and time
of noted variations
|
Increased penis size |
36 Ss |
64.29% |
|
Average length of drug taking (months) |
29.29 +/- 20.15 |
Range: 12-83 |
|
Av. age when change was obser. (months) |
61.73 +/- 28.56 |
|
|
|
|
|
|
Appearance of erections |
42 Ss |
77.78% |
|
Average length of drug taking (months) |
30.35 +/- 17.60 |
Range: 12-72 |
|
Av. age when erections appeared (months) |
68.11 +/- 24.79 |
|
Table 3: Distribution of both features
after drug therapy.
|
Increased penis size and erections appearance |
34 Ss |
62.96% |
|
Increased penis size without any erection |
2 Ss |
3.70% |
|
Erections without increased penis size |
8 Ss |
14.82% |
|
Not increased penis size without any erection |
10 Ss |
18.52% |
|
Increased penis size in Ss with previous erections |
1 S |
1.79% |
|
Not increased penis size in Ss with previous erections |
1 Ss |
1.79% |
Discussion
Since the increased penis size is a datum
discovered by chance, and since I investigated it in a not systematic way, I
wrote only a descriptive statistics.
Nevertheless, the distribution of the
chromosomal diagnoses of my sample parallels both Italian and International
standards.
In the authors above quoted there is a very
large difference as for the prevalence of the symptom "small-sized
penis." Being it reported within a 41-98% range is a fact that informs us
about not similar criteria used in collecting the data.
Anyhow I need immediately say that we are
dealing with a variable symptom. Oster, 1983, Domino and Newman, 1965,
Levinson, Friedman and Stamps 1955, Schiavetti et al., 1984, did not find it in
2-59% of their investigated Downs.
As for any other variable symptom of the
Down’s syndrome, it is fully independent from the chromosomal diagnosis. So we
may imply that this symptom is close to all the other variable symptoms, and
not directly depends on the presence of an extrachromosome 21. Moreover, it
seems modified by drug therapies acting against stress reactions, as this
research can suggest.
On the other hand, Schiavetti et al., 1984
wrote that the small penis size spontaneously disappears in pubertal age,
perhaps a statement that needs confirmation.
Cautiously, present research dropped out the
children of more than nine years at the last checkup, to have major security to
misunderstand the symptoms of incoming puberty.
Of course, this last usually has also
secondary sexual features never observed in these 56 cases. What is more, the
increased size of the penis following drug therapy was always within the range
of a prepubertal variance.
Quite different as for the erection, the
appearance of which in 77.78% of children where parents never have previously
observed, stands for a noticeable result.
Both penis size and erection, already
independent from each other in not-treated Downs, remain not linked even after
drug therapy. The appearance of the first does not imply the same for the
second.
A separate and very speculative speech is
that I am going to write to give a possible explanation about what happened.
As I wrote in past in several papers, the drug
therapy I usually prescribe to Down children acts mainly on GABA and modulates
stress reactions (Cocchi 1987a; Cocchi 1987b; Cocchi 1990; Cocchi, 1994;
Cocchi, 1998)).
In Downs there is an internal metabolic
stress following the acceleration of all the metabolisms the genes of which are
located on the chromosome 21. A third functioning gene implies 150% increasing
of the related metabolism, differently as for the metabolisms the control genes
of which are on the remaining 20 chromosomes.
We read that the GABA has a precise action
on the hypothalamus-hypophysis-gonadal axis, which is to say on the mechanisms
of sexual development and reproduction (Larsson, 1979; Fernandez-guasti,
Larsson and Beyer, 1985; Qureshi et al, 1988; Knobil and Neill, 1988).
In a previous research on sensitiveness to
the environmental temperature in Downs I suggested a B-GABAergic inbalance of
the hypothalamus (Cocchi, 1989)
As for myself, I don’t think I can go
further, without entering a very specialized field, with the risk of less and
less justifiable suggestions.
Although I referred these cases in a quite
anecdotal way, 45 positive results out of 56 ought to lead thinking.
References
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sindrome di Down: Inquadramento teorico. In: Cocchi R., Belacchi C., Cercolani
P. (a cura di): Risultati di 8 anni di terapia farmacologica nella sindrome di
Down. GISSTIMMAI, Pesaro 1987a: 19-41
Cocchi R.: Reduction of susceptibility to
upper respiratory tract infections in Down sindrome children following treatment
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ambientale nei soggetti Down: Una indagine su 432 casi. Riv. It. Disturbo
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Elsevier, Amsterdam 1990.
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Fernandez-Guasti A., Larsson K., Beyer C::
Comparison of the effects of different isomers of bicuculline infused in the
preoptic area on male rat sexual behavior Experientia 1985, 41: 1414-1416.
Knobil E., Neill J.D. (eds): The physiology
of reproduction. Ravem, New York, 1988.
Lewinson A: Friedman A., Stamps F.:
Variability of mongolism. Pediatrics 1955, 14: 43-54.
Larsson K.: features of neuroendocrine
control of masculine sexual behavior. In: Bayer C. 8ed): Endocrine control of
sexual behavior. Raven, New York 1979: 77-163.
Oster J.: Mongolism. Danish Science Press,
Copenhagen 1953.
Qureshi G.A., Bednar I., Forsberg G.,
Soedersten P.: GABA inhibits sexual behavior in female rats. Neuroscience 1988,
27: 169-174.
Schiavetti P., Barbano G.C., Forni G.L., Acutis
M.S., Rasore-Quartino A.: Il fenotipo della sindrome di Down. Studio di 300
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First printed in Italian on Riv. Ital.Disturbo. Intellet. 1990, 3:
145-148
English version on Internet: 31.03.2001, with two references added (*)
Author's address: Dr. Renato COCCHI, via
Rabbeno, 3
42100 Reggio Emilia (Italy).
renatococchi@libero.it
Down's syndrome
Drug therapy of stress reactions
Mental retardation
Symptoms
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