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Vol. 21. Núm. 6.
Páginas 500-514 (Noviembre - Diciembre 2007)
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Vol. 21. Núm. 6.
Páginas 500-514 (Noviembre - Diciembre 2007)
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Exposición a disruptores endocrinos y alteraciones del tracto urogenital masculino (criptorquidia e hipospadias)
Exposure to endocrine disruptors and male urogenital tract malformations [cryptorchidism and hypospadias]
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Mariana F. Fernández
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marieta@ugr.es

Correspondencia: Mariana F. Fernández Cabrera. Laboratorio de Investigaciones Médicas. Hospital Universitario San Cecilio. Avda. Dr. Oloriz, s/n. 18012 Granada. España.
, Begoña Olmos, Nicolás Olea
Laboratorio de Investigaciones Médicas, Hospital Universitario San Cecilio, Universidad de Granada, Granada, España
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Antecedentes

Se ha sugerido que la exposición maternoinfantil a compuestos hormonalmente activos (disruptores endocrinos) tiene en la etapa intrauterina una de sus fases más comprometidas.

Objetivo

Revisar los estudios epidemiológicos, nacionales e internacionales, publicados entre 1990 y el primer trimestre de 2006, que tuvieran como hipótesis la asociación entre la exposición humana a disruptores endocrinos y el riesgo de criptorquidia e hipospadias.

Métodos

Se han buscado artículos en MEDLINE/PubMed mediante las palabras clave: disruptores endocrinos, xenoestrógenos, pesticidas organoclorados y criptorquidia e hipospadias. La selección de los 16 trabajos incluidos se hizo atendiendo al diseño y la población de estudio, las medidas de exposición empleadas, los criterios de exclusión e inclusión establecidos y el análisis estadístico utilizado.

Resultados y conclusiones

Aunque los estudios aquí revisados no son concluyentes para confirmar la asociación entre disruptores endocrinos y riesgo de malformación del tracto genitourinario, tampoco demuestran la falta de tal asociación. Por este motivo parece razonable sugerir que este aspecto de la patología hormonal debería investigarse más en profundidad, resolviendo, al menos, el diagnóstico adecuado de los individuos y la estimación de la exposición a múltiples compuestos químicos, contaminantes ambientales, que actúan conjuntamente a través de mecanismos similares a las hormonas endógenas.

Palabras clave:
Disruptores endocrinos
Estrógenos ambientales
Criptorquidia
Hipospadias
Factores de riesgo
Exposición ocupacional
Pesticidas
Revisión sistemática
Abstract
Background

It has been proposed that the intrauterine period of child-mother exposure to hormonally active compounds (endocrine disruptors) is of critical importance.

Objective

We reviewed all Spanish and English-language epidemiological studies published between 1990 and the first trimester of 2006 that studied the possible association between human exposure to chemical compounds and the risk of cryptorchidism and/or hypospadias.

Methods

The MEDLINE (PubMed) database was searched using the following key words: endocrine disruptors, organochlorine pesticides, xenoestrogens, cryptorchidism and hypospadias. Selection of the 16 studies included was based on the following criteria: study design and population, the measures of exposure used, inclusion and exclusion criteria, and the statistical analysis used.

Results and conclusions

Although the studies reviewed do not conclusively confirm the association between exposure to endocrine disruptors and the risk of male genital malformation, this association cannot be ruled out. Further in-depth investigation of this association is required. Issues that remain to be resolved are the diagnostic classification to be used and appropriate measurement of exposure to multiple chemical compounds and environmental contaminants that act conjointly through mechanisms similar to endogenous hormones.

Key words:
Endocrine disruptors
Environmental estrogens
Cryptorchidism
Hypospadias
Risk factors
Occupational exposure
Pesticides
Systematic rewiew
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Bibliografía
[1.]
S. Krimsky.
Hormonal chaos. The scientific and social origins of the environmental endocrine hypothesis.
Johns Hopkins University Press, (2000),
[2.]
N. Olea, M.F. Fernández, P. Aranque, F. Olea-Serrano.
Perspectivas en disrupción endocrina.
Gac Sanit, 16 (2002), pp. 250-256
[3.]
M. Porta, F. Ballester, N. Ribas-Fitó, E. Puigdomènech, J. Selva, S. Llop.
Concentraciones de compuestos tóxicos persistentes en la población general española. Criterios para un diagnóstico de la situación actual.
Gac Sanit, 20 (2006), pp. 233-238
[4.]
N. Olea, P. Pazos, J. Expósito.
Inadvertent exposure to xenoestrogens.
Eur J Cancer Prev, 7 (1998), pp. 17-23
[5.]
M. Porta, M. Kogevinas, E. Zumeta, J. Sunyer, N. Ribas-Fitó.
Concentraciones de compuestos tóxicos persistentes en la población española: el rompecabezas sin piezas y la protección de la salud pública.
Gac Sanit, 16 (2002), pp. 257-266
[6.]
N.E. Skakkebaek, E. Rajpert-De Meyts, K.M. Main.
Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects.
Hum Reprod, 5 (2001), pp. 972-978
[7.]
I.M. Adami, E. Burkhardt, M. Möhner.
Testicular cancer in nine northern European countries.
Int J Cancer, 59 (1994), pp. 333-338
[8.]
E. Carlsen, A. Giwercman, N. Keiding, N.E. Skakkebaek.
Evidence for decreasing quality of semen during past 50 years.
BMJ, 305 (1992), pp. 609-613
[9.]
L.J. Paulozzi.
International trends in rates of hypospadias and cryptorchidism.
Environ Health Perspect, 107 (1999), pp. 297-302
[10.]
S. Nef, L.F. Parada.
Cryptorchidism in mice mutant for Ins13.
Nat Genet, 22 (2000), pp. 295-299
[11.]
E. Rajpert-de Meyts, J. Toppari, N.E. Skakkebaek.
Testicular tumors with endocrine manifestations.
Endocrinology, 4th ed,
[12.]
K. Bay, C. Asklund, N.E. Skakkebaek, A.M. Andersson.
Testicular dysgenesis syndrome: possible role of endocrine disrupters.
Best Pract Res Clin Endocrinol Metab, 20 (2006), pp. 77-90
[13.]
A.G. Andersen, T.K. Jensen, E. Carlsen.
High frequency of suboptimal semen quality in an unselected population of young men.
Hum Reprod, 15 (2000), pp. 366-372
[14.]
N. Jorgensen, C. Asklund, E. Carlsen, N.E. Skakkebaek.
Coordinated European investigations of semen quality: results from studies of Scandinavian young men is a matter of concern.
Int J Androl, 29 (2006), pp. 54-61
[15.]
P. Jouannet, C. Wang, F. Eustache, T. Kold-Jensen, J. Auger.
Semen quality and male reproductive health: the controversy about human sperm concentration decline.
APMIS, 109 (2001), pp. 333-344
[16.]
J.P. Bonde, L. Storgaad.
How work-place conditions, environmental toxicants and lifestyle affect male reproductive function.
Int J Androl, 25 (2002), pp. 262-268
[17.]
A.M. García, T. Flecher, F.G. Benavides, E. Orts.
Parental agricultural work and selected congenital malformations.
Am J Epidemiol, 149 (1999), pp. 64-74
[18.]
I.S. Weidner, H. Moller, T.K. Jensen, N. Skakkebaek.
Cryptorchidism and hypospadias in sons of gardeners and farmers.
Environ Health Perspect, 106 (1998), pp. 793-796
[19.]
R.M. Sharpe, N.E. Skakkebaek.
Are oestrogens involved in falling sperm counts and disorders of the male reproductive tract?.
Lancet, 341 (1993), pp. 1392-1395
[20.]
S.H. Swan.
Intrauterine exposure to diethylstilbestrol: long-term effects in humans.
APMIS, 108 (2000), pp. 793-804
[21.]
A.M. Soto, C. Sonnenschein, K.L. Chung, M.F. Fernández, N. Olea, F. Olea-Serrano.
The E-screen assay as a tool to identify estrogens: an update on estrogenic environmental pollutants.
Environ Health Perspect, 103 (1995), pp. 113-122
[22.]
M. Sala, N. Ribas-Fito, E. Cardo, M.E. De Muga, E. Marco, C. Mazón, et al.
Levels of hexachlorobenzene and other organochlorine compounds in cord blood: exposure across placenta.
Chemosphere, 43 (2001), pp. 895-901
[23.]
S.M. Waliszewski, A.A. Aguirre, R.M. Infanzon, C.S. Silva, J. Siliceo.
Organochlorine pesticide levels in maternal adipose tissue, maternal blood serum, umbilical blood serum, and milk from inhabitants of Veracruz, México.
Environ Contamination Toxicol, 40 (2001), pp. 432-438
[24.]
M. Falcón, J. Oliva, E. Osuna, A. Barba, A. Luna.
HCH and DDT residues in human placentas in Murcia (Spain).
Toxicol, 195 (2004), pp. 203-208
[25.]
B. Botella, J. Crespo, A. Rivas, I. Cerrillo, F. Olea-Serrano, N. Olea.
Exposure of women to organochlorine pesticides in Southern Spain.
Environ Res, 96 (2004), pp. 34-40
[26.]
I. Cerrillo, F. Olea-Serrano, J. Ibarluzea, J. Expósito, P. Torné, J. Laguna, et al.
Environmental and lifestyle factors for organochlorine exposure among women living in southern Spain.
Chemosphere, 62 (2006), pp. 1917-1924
[27.]
G. Toft, L. Hagmar, A. Giwercman, J.P. Bonde.
Epidemiological evidence on reproductive effects of persistent organochlorines in humans.
Reprod Toxicol, 19 (2004), pp. 5-26
[28.]
C.A. Harris, M.W. Woolridge, A.W.H. Hay.
Factors affecting the transfer of organochlorine pesticides residues to breastmilk.
Chemosphere, 43 (2001), pp. 243-256
[29.]
A. Polder, J.O. Odland, A. Tkachev, S. Foreid, T.N. Savinova, J.U. Skaare.
Geographic variation of chlorinated pesticides, toxaphenes and PCBs in human milk from sub-arctic and arctic locations in Russia.
Sci Total Environ, 306 (2003), pp. 179-195
[30.]
A.O. Barakat.
Assessment of persistent toxic substances in the environment of Egypt.
Environ Int, 30 (2004), pp. 309-322
[31.]
Environment and health strategy (SCALE) [citado 20 May 2007]. Disponible en: http://www.euractiv.com/en/environment/environment-health-strategy-scale/article-117480
[32.]
M. Restrepo, N. Muñoz, N. Day, J.E. Parra, C. Hernández, M. Blettner, et al.
Birth defects among children born to a population occupationally exposed to pesticides in Colombia.
Scand J Work Environ Health, 16 (1990), pp. 239-246
[33.]
J. García-Rodríguez, M. García-Martín, M. Nogueras-Ocaña, J. De Dios Luna-del-Castillo, M. Espigares García, N. Olea, et al.
Exposure to pesticides and cryptorchidism: geographical evidence of a possible association.
Environ Health Perspect, 104 (1996), pp. 1090-1095
[34.]
P. Kristensen, L.M. Irgens, A. Andersen, A.S. Bye, L. Sundheim.
Birth defects among offspring of Norwegian farmers.
Epidemiology, 8 (1997), pp. 537-544
[35.]
H. Dolk, M. Vrijheid, B. Armstrong, L. Abramsky, F. Bianchi, E. Garne, et al.
Risk of congenital anomalies near hazardous-waste landfill sites in Europe: the EUROHAZCON study.
Lancet, 352 (1998), pp. 423-427
[36.]
A.M. García, F.G. Benavides, T. Fletcher, E. Orts.
Paternal exposure to pesticides and congenital malformations.
Scand J Work Environ Health, 24 (1998), pp. 473-480
[37.]
A. Irgens, K. Kruger, A.H. Skorve, L.M. Irgens.
Birth defects and paternal occupational exposure. Hypotheses tested in a record linkage based dataset.
Acta Obstet Gynecol Scand, 79 (2000), pp. 465-470
[38.]
S. Hosie, S. Loff, K. Witt, K. Niessen, K.L. Waag.
Is there a correlation between organochlorine compounds and undescended testes?.
Eur J Pediatr Surg, 10 (2000), pp. 304-309
[39.]
M.T. Rueda-Domingo, E. López-Navarrete, M. Nogueras-Ocaña, P. Lardelli-Claret.
Factores de riesgo de criptorquidia.
Gac Sanit, 15 (2001), pp. 398-405
[40.]
M.P. Longnecker, M.A. Klebanoff, J.B. Brock, H. Zhou, K.A. Gray, L.L. Needham, et al.
Maternal serum level of 1,1-dichloro-2,2-bis (p-chlorophenyl) ethylene and risk of cryptorchidism, hypospadias, and polythelia among male offspring.
Am J Epidemiol, 155 (2002), pp. 313-322
[41.]
M. Aho, A.M. Koivisto, T.L. Tammela, A.P. Auviren.
Analysis of Finish hypospadias in 1970-1996.
Environ Res, 92 (2003), pp. 118-123
[42.]
M. Vrijheid, B. Armstrong, H. Dolk, M. Van Tongeren, B. Botting.
Risk of hypospadias in relation to maternal occupational exposure to potential endocrine disrupting chemicals.
Occup Environ Med, 60 (2003), pp. 543-550
[43.]
F.H. Pierik, A. Burdorf, J.A. Deddens, R.E. Juttmann, R.F.A. Weber.
Maternal and paternal risk factors for cryptorchidism and hypospadias: a case-control study in newborn boys.
Environ Health Perspect, 112 (2004), pp. 1570-1576
[44.]
M. Van Tongeren, M.J. Nieuwenhuijsen, K. Gardiner, B. Armstrong, M. Vrijheid, H. Dolk, et al.
A job-exposure matrix for potential endocrine-disrupting chemicals developed for a study into the association between maternal occupation and hypospadias.
Ann Occup Hyg, 46 (2002), pp. 465-477
[45.]
R. Bhatia, R. Shiau, M. Petreas, J.M. Weintraub, L. Farhang, B. Eskenazi.
Organochlorine pesticides and male genital anomalies in the child health and development studies.
Environ Health Perspect, 113 (2005), pp. 220-224
[46.]
N. Kurahashi, S. Kasai, T. Shibata, H. Kakizaki, K. Nonomura, F. Sata, et al.
Parental and neonatal risk factors for cryptorchidism.
Med Sci Monit, 11 (2005), pp. 274-283
[47.]
S.H. Swan, K.M. Main, F. Liu, S.L. Stewart, R.L. Kruse, A.M. Calafat, et al.
Decrease in anogenital distance among male infants with prenatal phthalate exposure.
Environ Health Perspect, 113 (2005), pp. 1056-1061
[48.]
A.C. Vidaeff, L.E. Sever.
In utero exposure to environmental estrogens and male reproductive health: a systematic review of biological and epidemiological evidence.
Reprod Toxicol, 20 (2005), pp. 5-20
[49.]
H. Dolk, M. Vrijheid.
The impact of environmental pollution on congenital anomalies.
Br Med Bull, 68 (2003), pp. 25-45
[50.]
M.F. Fernández, A.M. Rivas, M.F. Olea-Serrano, I. Cerrillo, J. Molina-Molina, P. Araque, et al.
Assessment of total efective xenoestrogen burden in adipose tissue and identification of chemicals responsible for the combined effect.
Anal Bioanal Chem, 379 (2004), pp. 163-170
[51.]
M. Delgado Rodríguez, S. Palma Pérez.
Aportaciones de la revisión sistemática y del metaanálisis a la salud pública.
Rev Esp Salud Publica, 80 (2006), pp. 483-489
[52.]
K. North, J. Golding.
A maternal vegetarian diet in pregnancy is associated with hypospadias. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.
BJU Int, 85 (2000), pp. 107-113
[53.]
A.M. Soto, J.M. Calabro, N.V. Prechtl, A.Y. Yau, E.F. Orlando, A. Daxenberger, et al.
Androgenic and estrogenic activity in water bodies receiving cattle feedlot effluent in Eastern Nebraska, USA.
Environ Health Perspect, 112 (2004), pp. 346-352
[54.]
N. Olea, F. Olea-Serrano, P. Lardelli-Claret, A. Rivas, A. Barba-Navarro.
Inadvertent exposure to xenoestrogens in children.
Toxicol Ind Health, 15 (1999), pp. 151-158
[55.]
L. Weltje, F.S. Vom Saal, J. Oehlmann.
Reproductive stimulation by low doses of xenoestrogens contrasts with the view of hormesis as an adaptive response.
Hum Exp Toxicol, 24 (2005), pp. 431-437
[56.]
M. Jensen, H. Leffers, J.H. Petersen, A. Nyboe Andersen, N. Jorgensen, E. Carlsen, et al.
Frequent polymorphism of the mitochondrial DNA polymerase gamma gene (POLG) in patients with normal spermiograms and unexplained subfertility.
Hum Reprod, 19 (2004), pp. 65-70
[57.]
D.M. De Kretser.
Differences in the prevalence of cryptorchidism.
Lancet, 363 (2003), pp. 1250-1251
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