Hypogonadism

Hypogonadism( gonadal insufficiency, hypogenitalism) is an endocrine disease caused by a decrease in the level of androgens in the body and characterized by underdevelopment of the external and internal genital organs, as well as indistinctly expressed secondary sexual characteristics. Hypogonadism distinguishes between primary and secondary

. Causes of

. Primary hypogonadism occurs due to direct damage to the gonad, which can be caused by a genetic factor, after a traumatic or infectious inflammatory process, during embryogenesis, as a consequence of hormonal inactive tumors of the gonads or castration.

The development of secondary hypogonadism is due to weak stimulation of the gonads by the gonadotropic hormones of the pituitary gland( due to their inadequate synthesis) due to the destruction of the adenohypophysis by an infectious inflammatory process, a tumor or its traumatic lesion. Secondary form of hypogonadism can occur with pituitary nanism, adiposogenital dystrophy, acromegaly , etc.

In women, the most common cause of decreased synthesis of gonadotropic hormones is the developed necrosis of the pituitary gland, after massive blood loss during childbirth. In some cases, patients may have a congenital disorder of the production of gonadotropic hormones( or hypothalamic neurohormones) or these hormones can be produced as inactive forms of

Symptoms of

Clinical manifestations depend on the degree of androgenic insufficiency and age of the patient. Distinctive and post-pubertal forms of this disease are distinguished. If the defeat of the testicles occurred before puberty, underdevelopment of the shoulder and thorax, lengthening of the limbs, disproportionate growth, a typical eunuchoid syndrome develops. Also, there is a slight development of skeletal muscle and a female-type distribution of subcutaneous fat. The skin is pale, possibly having gynecomastia. Secondary sexual signs are developed rather poorly: there is no hairiness on the body and face, underdevelopment of the larynx, on the pubic hairiness on the female type, high voice. Genital organs are underdeveloped: the testicles are hypoplastic, the penis is small;The scrotum is formed, but depigmented, without folding;Prostate gland is underdeveloped( may not be palpated).

In secondary hypogonadism, in addition to the symptoms of androgen deficiency, obesity is often observed, as well as symptoms of hypofunction of other endocrine glands( adrenal cortex, thyroid gland).Potency and sexual desire are completely absent.

In case the testicular lesions occurred after puberty( the formation of bone-muscular tissue and sexual development has already ended), the symptomatology of hypogonadism is less pronounced. Body and face hair loss decreases, the skin becomes thinner and loses elasticity, female type obesity develops, testicles decrease, sexual functions are disrupted, vegetative-vascular disorders develop, develops infertility

Diagnosis of

Diagnosis of hypogonadism is established based on signs that indicate underdevelopment of internal andExternal genitalia, the absence or indistinct secondary sex characteristics, the results of radiologic and cytogenetic studies. Primary hypogonadism must be differentiated with secondary hypogonadism, based on serum levels of gonadotropic hormones

Treatment of

Treatment of primary hypogonadism consists in the use of substitution therapy for sex hormones. Treatment of secondary hypogonadism is carried out with preparations of gonadotropic hormones( sometimes combining them with sex hormones), and the preparations themselves and their dosage are selected strictly individually. Due to adequate systematic treatment, secondary sexual characteristics develop, men may experience partial restoration of potency( spermatogenesis is sometimes restored), menstrual periods appear in women.

Surgical treatment of hypogonadism includes ovarian or testicle transplantation, phalloplasty( plastic correction of the underdeveloped penis), re-entry of the testicle with cryptorchidism. It is possible to perform implantation of a synthetic testicle( if an unresolved testicle is absent in the abdominal cavity).

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