Hypogonadotropic hypogonadism in men
Hypogonadotropic( secondary) hypogonadism is characterized by a violation of the hypothalamic-pituitary system. Violations due to:
- loss of function of the hypothalamus, to develop rilizin gonadotropin-releasing hormone( GnRH), is responsible for the stimulation of the pituitary gland to develop a gonadotropin-releasing hormone.
- By the loss of gonadotropic function of the pituitary gland, responsible for the production of gonadotropic hormones. Under gonadotropic hormones take luteinizing hormone( LH) and follicle-stimulating hormone( FSH).They are responsible for stimulating the testicles to produce sex hormones and sperm.
One of the true signs of hypogonadotropic hypogonadism is a reduced level of LH and FSH.Violation of the production of gonadotropic hormones inevitably leads to a decrease in the level of testosterone and the violation of spermatogenesis. Depending on the degree of defeat, they distinguish congenital and acquired hypogonadism.
congenital etiology hypogonadotropic hypogonadism
| Pathology | Hormone | characteristic clinical signs |
|---|---|---|
| isolated( idiopathic) hypogonadism - hypogonadism shape in which only the genital system is affected. Most often, the cause of the disease is the toxemia of a mother's pregnancy. Based on the results of gonadoliberin( GnRH) tests, the exact cause of the pathology is established, consisting in loss of functions of the hypothalamus, tk. Cells of the pituitary gland correspond to the synthesis of LH and FSH for the sample | LH is strongly lowered, FSH can be lowered slightly or within normal limits, testosterone is low. Sample chorionic gonadotropin( hCG) is positive: three days after injection of hCG in a dose of 1500-2000 U / m², an increase in testosterone levels to 30-50% | underdevelopment genital syndrome, absence of secondary sexual characteristics, gynecomastia, deposition of fat on the female type insulated |
| LH deficiency - pituitary pathology in which impaired production of luteinizing hormone LH | low FSH - in the normal, testosterone lowered | Similarly idiopathic hypogonadism |
| InsulatedDeficiency of FSH - pathology of the pituitary gland in which the development of the follicle-stimulating hormone | is normal, FSH is low, testosterone is within or below the norm. | Normal sexual development is observed, the main complaint is infertility and decreased erectile function |
| . Callman syndrome is a combination of hypogonadism with olfactory impairment(anosmia).Inadequate production of gonadotropic hormones is due to inadequate secretion of GnRH.The incidence of the disease is 1: 100 000 | LG, FSH, testosterone - low. Repeated administration of GnRH increases levels of gonadotropic hormones | lack of smell( anosmia) along with clinical symptoms of androgen shortage are major features of the disease. Along with this, many patients may manifest a hearing loss, blindness, cryptorchidism, various somatic pathology( cleft lip, cleft palate, six-fingered, facial asymmetry, short tongue frenulum, etc.) |
| Prader-Willi - a hereditary disease, a characteristic feature of whichis a combination of hypogonadism, obesity, short stature and low mental capacity | LH, FSH, testosterone - low | hypogonadism, obesity, increased appetite, slow growth, decreased mental capacity, forrudnennaya speech gipotonus |
| Lawrence syndrome - Moon - Bardet - Biedl - a hereditary disease, typical signs of which is a combination of pigmentary retinal degeneration with hypogonadism, obesity and mental retardation. Incidence rate of 1: 160 000. The level of LH and FSH secretion is lowered due to violation of GnRH | LH, FSH, testosterone - low | retinitis pigmentosa often leading to blindness, obesity, impaired mental capacity, increasing the number of fingers or toes, underdevelopedGenitals. In half the cases, not all the signs of |
Etiology of acquired hypogonadotropic hypogonadism
- Consequences of injuries, operations( hypophysectomy);
- Encephalitis;
- Tumor processes;
- Systemic diseases( cardiovascular, renal, endocrine, connective tissue diseases);
- Vascular insufficiency of the brain.
Diagnosis and treatment
Diagnosis is carried out with a primary examination of the patient. The severity of androgen deficiency is determined by the presence of secondary sexual characteristics in men, the degree of development of the genital organs, and so on. Indication of the severity of secondary symptoms is ambiguous indicates a pre-burglary and post-puertate form of hypogonadism. A laboratory blood test includes the determination of testosterone, LH, FSH, GnRH, estradiol levels.
If the chorionic gonadotropin( HG) test is successful, then therapy with HCG injections, leading to stimulation of the secretion of its own testosterone and spermatogenesis, should be a desirable treatment, while therapy with exogenous testosterone preparations does not restore the patient's spermatogenesis. With congenital forms of secondary hypogonadism, therapy is life-long.
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