肥胖儿童小阴茎的发病机制与临床管理

doi:10.11852/zgetbjzz2025-0689

摘要/Abstract

摘要： 阴茎发育是衡量男性性发育的重要指标,主要受下丘脑-垂体-性腺轴(hypothalamic pituitary gonadal, HPG轴)及雄激素水平的调控。近年来,肥胖与男性生殖系统发育异常的关联越来越受到关注,其中较为突出的问题是小阴茎。肥胖导致小阴茎的机制复杂,目前研究主要聚焦在肥胖与HPG轴功能之间的关联,可能涉及内分泌-代谢-慢性炎症等多因素作用。建立全面临床管理是改善肥胖儿童小阴茎预后的关键,具体包括全面评估、体重管理、药物干预、物理治疗及必要的心理支持等。

关键词: 肥胖, 小阴茎, 下丘脑-垂体-性腺轴, 发病机制, 临床管理

Abstract: Penile development serves as a critical marker of male sexual maturation, primarily regulated by the hypothalamic-pituitary-gonadal (HPG) axis and androgen exposure.Recent evidence highlights a association between childhood obesity and aberrations in male reproductive development, with micropenis emerging as a prominent clinical concern.The pathogenesis of obesity-associated micropenis is multifactorial, involving complex interactions between endocrine dysregulation (notably HPG axis dysfunction), metabolic derangements, and chronic inflammation.Current mechanistic research focuses on elucidating obesity's impact on HPG axis dynamics.Establishing a comprehensive clinical management strategy is essential for optimizing outcomes, including accurate phenotypic characterization, targeted weight management, judicious pharmacological intervention, mechanical approaches, and integrated psychological support.

Key words: obesity, micropenis, hypothalamic-pituitary-gonadal axis, pathogenesis, clinical management

中图分类号:

R179

吴月明, 徐通. 肥胖儿童小阴茎的发病机制与临床管理[J]. 中国儿童保健杂志, 2026, 34(1): 106-111.

WU Yueming, XU Tong. Pathogenesis and clinical management of micropenis in children with obesity[J]. Chinese Journal of Child Health Care, 2026, 34(1): 106-111.

参考文献

[1] 《中国居民营养与慢性病状况报告(2020年)》(2020-12-24)[J].营养学报,2020,42(6):521.
[2] 中国医师协会儿科医师分会内分泌遗传代谢学组,中华医学会儿科学分会内分泌遗传代谢学组,中国医师协会青春期健康与医学专业委员会,等.先天性小阴茎临床管理中国专家共识[J].中华儿科杂志,2023,61(8): 679-684.
Chinese Medical Doctor Association Pediatric Endocrinology, Genetics and Metabolism Professional Committee; Subspecialty Group of Endocrinology, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association; Chinese Medical Doctor Association Adolescent Health and Medical Professional Committee, et al.Expert consensus for the management of congenital micropenis[J].Chin J Pediatr,2023,61(8):679-684.(in Chinese)
[3] Soubra A, Natale C, Brimley S,et al.Revelations on men who seek penile augmentation surgery: A review[J].Sex Med Rev, 2022,10(3):460-467.
[4] Mushannen T, Cortez P, Stanford FC, et al.Obesity and hypogonadism-A narrative review highlighting the need for high-quality data in adolescents[J].Children (Basel), 2019,6(5):63.
[5] Aslan TB, Gurbuz F, Temiz F, et al.Etiological evaluation of patients presenting with isolated micropenis to an academic health care center[J].Indian J Pediatr, 2014,81(8):775-779.
[6] Cannarella R, Crafa A, La Vignera S, et al.Role of the GH-IGF1 axis on the hypothalamus-pituitary-testicular axis function: Lessons from Laron syndrome[J].Endocr Connect, 2021,10(9):1006-1017.
[7] 朱伊祎, 伍学焱.胰岛素样生长因子在下丘脑垂体睾丸轴中的作用[J].中华医学杂志, 2022,102(20): 1555-1558.
Zhu YY, Wu XY.The role of insulin-like growth factors in the hypothalamic-pituitary-testicular axis[J].Natl Med J China, 2022,102(20): 1555-1558.(in Chinese)
[8] Qi X, Zhang M, Sun M, et al.Restoring impaired fertility through diet: Observations of switching from high-fat diet during puberty to normal diet in adulthood among obese male mice[J].Front Endocrinol, 2022, 13:839034.
[9] Mancini M, Pecori Giraldi F, Andreassi A, et al.Obesity is strongly associated with low testosterone and reduced penis growth during development[J].J Clin Endocrinol Metab, 2021,106(11):3151-3159.
[10] 瞿秋萍,童方运,唐芳,等.单纯性肥胖男童阴茎睾丸发育不良监测及治疗分析[J].国际泌尿系统杂志,2023,43(1):121-125.
Qu QP, Tong FY, Tang F, et al.Monitoring and treatment of penile and testicular dysplasia in simple obese boys[J].International Journal of Urology and Nephrology, 2023,43(1):121-125.(in Chinese)
[11] 刘媚,杨蕾蕾,杨芊,等.肥胖损伤下丘脑GnRH神经元功能的研究进展[J].中华内分泌代谢杂志,2024,40(7):625-634.
Liu M, Yang LL, Yang Q, et al.Progress on obesity-induced hypothalamic GnRH neuron dysfunction[J].Chin J Endocrinol Metab, 2024,40(7):625-634.(in Chinese)
[12] 孙欣,杨娜,卞晓洁,等.性激素与男性肥胖相关性的研究进展[J].医学综述,2022,28(12):2441-2447.
Sun X, Yang N, Bian XJ, et al.Research progress of correlation between sex hormones and male obesity[J].Medical Recapitulate, 2022,28(12):2441-2447.(in Chinese)
[13] Khodamoradi K, Khosravizadeh Z, Seetharam D, et al.The role of leptin and low testosterone in obesity[J].Int J Impot Res, 2022,34(7):704-713.
[14] Odle AK, Akhter N, Syed MM, et al.Leptin regulation of gonadotrope gonadotropin-releasing hormone receptors as a metabolic checkpoint and gateway to reproductive competence[J].Front Endocrinol, 2018,8:367.
[15] Grossmann M, Ng Tang Fui M, Cheung AS.Late-onset hypogonadism: Metabolic impact[J].Andrology, 2020,8(6):1519-1529.
[16] DiVall SA, Herrera D, Sklar B, et al.Insulin receptor signaling in the GnRH neuron plays a role in the abnormal GnRH pulsatility of obese female mice[J].PLoS One, 2015,10(3):e0119995.
[17] Rerat S, Amsellem-Jager J, L'hour MC, et al.Lower circulating sertoli and leydig cell hormone levels during puberty in obese boys: A cross-sectional study[J].J Clin Endocrinol Metab, 2022,107(4):e1568-e1576.
[18] Liu Y, Ding Z.Obesity, a serious etiologic factor for male subfertility in modern society[J].Reproduction, 2017,154(4):R123-R131.
[19] Hagman E, Besor O, Hershkop K, et al.Relation of the degree of obesity in childhood to adipose tissue insulin resistance[J].Acta Diabetol, 2019,56(2):219-226.
[20] Wagner IV, Klöting N, Atanassova N, et al.Prepubertal onset of obesity negatively impacts on testicular steroidogenesis in rats[J].Mol Cell Endocrinol, 2016,437:154-162.
[21] 付超,李旭良.正常男性阴茎生长发育调查[J].中华小儿外科杂志, 2010,31(6):432-434.
Fu C, Li XL.Normal penile growth amongst Chinese[J].Chin J Pediatri Surg, 2010,31(6):432-434.(in Chinese)
[22] Wang Y, Gong C, Qin M, et al.Clinical and genetic features of 64 young male paediatric patients with congenital hypogonadotropic hypogonadism[J].Clin Endocrinol (Oxf), 2017,87:757-766.
[23] 陈海涛,黄会,马慧,等.小阴茎患儿外周血淋巴细胞染色体核型分析[J].中华男科学杂志, 2020,26:1006-1009.
Chen HT, Huang H, Ma H, et al.Correlation of micropenis with abnormal chromosomal karyotype in peripheral blood lymphocytes[J].Natl J Androl, 2020,26:1006-1009.(in Chinese)
[24] Al-Beltagi M, Saeed NK, Bediwy AS, et al.Microphallus early management in infancy saves adulthood sensual life: A comprehensive review[J].World J Clin Pediatr, 2024,13(2):89224.
[25] 中华医学会儿科学分会内分泌遗传代谢学组,中华医学会儿科学分会儿童保健学组,中华医学会儿科学分会临床营养学组,等.中国儿童肥胖诊断评估与管理专家共识[J].中华儿科杂志,2022,60(6):507-515.
Subspecialty Group of Endocrinologic, Hereditary and Metabolic Diseases, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Child Health Care, the Society of Pediatrics, Chinese Medical Association; Subspecialty Group of Clinical Nutrition, the Society of Pediarics, Chinese Medical Association, et al.Expert consensus on diagnosis, assessment, and management of obesity in Chinese children[J].Chin J Pediatr, 2022,60(6):507-515.(in Chinese)
[26] 马依娜,濮婉婷,娜菲莎·吐尔地,等.物理干预联合医学营养减重综合治疗肥胖儿童阴茎短小的疗效观察[J].中华男科学杂志,2025,31(4):300-305.
Ma YN, Pu WT, Nafeisa TED, et al.Physical intervention combined with medical nutritional weight loss for the treatment of short penis in obese children[J].Natl J Androl, 2025,31(4):300-305.(in Chinese)
[27] Guthrie RD, Smith DW, Graham CB.Testosterone treatment for micropenis during early childhood[J].J Pediatr, 1973,83:247-252.
[28] Gabrich PN, Vasconcelos JS, Damião R, et al.Penile anthropometry in Brazilian children and adolescents[J].J Pediatr (Rio J), 2007,83:441-446.
[29] Xu D, Lu L, Xi L, Cheng R, et al.Efficacy and safety of percutaneous administration of dihydrotestosterone in children of different genetic backgrounds with micropenis[J].J Pediatr Endocrinol Metab, 2017,30:1285-1291.
[30] 林娟,马华梅,李燕虹,等.来曲唑对青春早中期男童生殖功能与线性生长的近期影响[J].中山大学学报(医学版),2018,39(3):386-392.
Li J, Ma HM, Li YH, et al.Effect of letrozole on the reproductive function and linear growth in the early and mid puberty boys[J].J SUN Yat-sen Univ(Med Sci), 2018,39(3):386-392.(in Chinese)
[31] 刘贵中,牛远杰,白文俊,等.青春期小阴茎的规范性诊疗[J].国际泌尿系统杂志,2020,40(3):525-527.
Liu GZ, Niu YJ, Bai WJ, et al.Normative diagnosis and treatment of puberty micropenis[J].International Journal of Urology and Nephrology, 2020,40(3):525-527.(in Chinese)
[32] Guo S, Zheng J, Li G.Effects of growth hormone on lipid metabolism and sexual development in pubertal obese male rats[J].Open Life Sci, 2022,17(1):1531-1540.
[33] Oh JK, Im YJ, Park K, et al.Effects of combined growth hormone and testosterone treatments in a rat model of micropenis[J].Endocr Connect, 2018,7(11):1150-7.
[34] 濮婉婷,马依娜,娜菲莎·吐尔地,等.探究物理治疗对儿童阴茎发育不良的疗效及发育不良指数的构建[J].中华男科学杂志,2025,31(1):34-38.
Pu WT, Ma YN, Nafeisa TED, et al.Efficacy of a short-penis therapeutic apparatus on penile dysplasia in chidlren and prediction of the dysplasia index[J].Natl J Androl, 2025,31(1):34-38.(in Chinese)
[35] 崔盈,赵金玲,程灶火,等.单纯性肥胖儿童心理行为问题、自我意识及家庭因素研究[J].中华行为医学与脑科学杂志,2018,27(11):988-992.
Cui Y, Zhao JL,Cheng ZH,et al.Behavioral problems,self-awareness and family factors in children with simple obese[J].Chin J Behavl Med Brain Sci, 2018,27(11):988-992.(in Chinese)
[36] 杨红荣,奚益群,吕逸清,等.儿童性发育异常诊疗服务的伦理审查经验探讨[J].中国医学伦理学,2021,34(2):227-231.
Yang HR, Xi YQ, Lü YQ,et al.Discussion on the experience of ethical review in the diagnosis and treatment of children with disorders of sex development[J].Chinese Medical Ethics,2021,34(2):227-231.(in Chinese)