Hypogonadism
Hypogonadism: Excerpt from Professional Guide to Diseases (Eighth Edition)
Hypogonadism is a condition resulting from decreased androgen production in males, which may impair spermatogenesis (causing infertility) and inhibit the development of normal secondary sex characteristics. (See Production of sperm.) The clinical effects of androgen deficiency depend on the patient’s age at onset.
Causes and incidence
Primary hypogonadism results directly from interstitial (Leydig’s cell) cellular or seminiferous tubular damage due to faulty development or mechanical damage. This causes increased secretion of gonadotropins by the pituitary in an attempt to increase the testicular functional state and is therefore termed hypergonadotropic hypogonadism. This form of hypogonadism includes Klinefelter syndrome, Reifenstein’s syndrome, Turner syndrome, Sertoli-cell-only syndrome, anorchism, orchitis, and sequelae of irradiation.
Secondary hypogonadism is due to faulty interaction within the hypothalamic-pituitary axis, resulting in failure to secrete normal levels of gonadotropins, and is therefore termed hypogonadotropic hypogonadism. This form of hypogonadism includes hypopituitarism, isolated follicle-stimulating hormone deficiency, isolated luteinizing hormone deficiency, Kallmann’s syndrome, and Prader-Willi syndrome. Depending on the patient’s age at onset, hypogonadism may cause eunuchism (complete gonadal failure) or eunuchoidism (partial failure).
Medications, such as exogenous testosterone or anabolic steroids, can also cause of hypogonadism, resulting in infertility.
Hypogonadism is rare, and it has no racial predilection.
Signs and symptoms
Although symptoms vary, depending on the specific cause of hypogonadism, some characteristic findings may include delayed closure of epiphyses and immature bone age; delayed puberty; infantile penis and small, soft testes; below-average muscle development and strength; fine, sparse facial hair; scant or absent axillary, pubic, and body hair; and a high-pitched, effeminate voice. In an adult, hypogonadism diminishes sex drive and potency and causes regression of secondary sex characteristics.
Diagnosis
Accurate diagnosis necessitates a detailed patient history, physical examination, and hormonal studies. Serum and urinary gonadotropin levels increase in primary (hypergonadotropic) hypogonadism but decrease in secondary (hypogonadotropic) hypogonadism. Other relevant hormonal studies include assessment of neuroendocrine functions, such as thyrotropin, corticotropin, growth hormone, and vasopressin levels. Chromosomal analysis may determine the specific causative syndrome. Testicular biopsy and semen analysis determine sperm production, identify impaired spermatogenesis, and assess low levels of testosterone.
Treatment
Treatment depends on the underlying cause and may consist of hormonal replacement, especially with testosterone, methyltestosterone, estrogen, progesterone, or human chorionic gonadotropin (hCG) for primary hypogonadism, and with hCG for secondary hypogonadism. Fertility can’t be restored after permanent testicular damage. However, eunuchism that results from hypothalamic-pituitary lesions can be corrected when administration of gonadotropins stimulates normal testicular function.
Special considerations
Because the patient with hypogonadism tends to have multiple associated physical problems, the care plan should be tailored to meet his specific needs.
❑ When caring for an adolescent boy with hypogonadism, make every possible effort to promote his self-confidence. If he feels sensitive about his underdeveloped body, provide access to a private bathroom. Explain hypogonadism to his parents. Encourage them to express their concerns about their son’s delayed development. Reassure them and the patient that effective treatment is available.
❑ Make sure the parents and the patient understand hormonal replacement therapy fully, including expected adverse effects, such as acne and water retention.
❑ Encourage counseling as appropriate.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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