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| | {{Hypogonadism}} |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| == Overview ==
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| '''Hypogonadism''' is a medical term for a defect of the [[reproductive system]] which results in lack of function of the [[gonad]]s ([[ovary|ovaries]] or [[testis|testes]]). The gonads have two functions: to produce [[hormone]]s ([[testosterone]], [[estradiol]], [[antimullerian hormone]], [[progesterone]], [[inhibin|inhibin B]]), [[activin]] and to produce [[gamete]]s ([[Ovum|egg]]s or [[Spermatozoon|sperm]]). Deficiency of sex hormones can result in defective primary or secondary sexual development, or withdrawal effects (e.g., premature [[menopause]]) in adults. Defective egg or sperm development results in [[infertility]].
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| The term hypogonadism is usually applied to permanent rather than transient or reversible defects, and usually implies deficiency of reproductive hormones, with or without [[fertility]] defects. The term is less commonly used for infertility without hormone deficiency.
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| == Differential Diagnosis ==
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| === Primary Testicular Failure ===
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| * [[Anorchidism]]
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| * [[Chemotherapy]]
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| * [[Cryptorchidism]]
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| * [[FSH]] beta subunit mutation (follicle stimulating hormone)
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| * [[FSH]] receptor mutation
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| * [[Klinefelter Syndrome]]
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| * [[LH]] (luteinizing hormone) beta subunit mutation
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| * [[LH]] receptor mutation
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| * [[LH]] resistance
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| * [[Radiation therapy]]
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| * [[Sertoli-cell]]-only syndrome
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| * Testicular biosynthetic defects
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| === Primary Ovarian Failure ===
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| * Autoimmune oophoritis
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| * Chemotherapy
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| * Familial and sporadic XX gonadal dysgenesis and its variants
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| * Familial and sporadic XY gonadal dysgenesis and its variants
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| * [[FSH]] beta subunit mutation (follicle stimulating hormone)
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| * [[FSH]] receptor mutation
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| * Galactosemia
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| * Glycoprotein syndrome type 1
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| * LH (luteinizing hormone) beta subunit mutation
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| * LH/[[Ddx:Human Chorionic Gonadotropin|human chorionic gonadotropin]] resistance
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| * LH receptor mutation
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| * [[Noonan Syndrome]]
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| * Premature [[menopause]]
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| * [[Polycystic ovarian disease]]
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| * [[Radiation therapy]]
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| * Resistant ovary
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| * [[Turner Syndrome]]
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| === Secondary Hypogonadism ===
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| * [[Astrocytoma]]
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| * [[Bardet-Biedl Syndrome]]
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| * Congenital adrenal hypoplasia
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| * Congenital hypogonadotropic hypogonadism
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| * Craniofacial anomalies
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| * [[Craniopharyngioma]]
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| * Exercise-induced amenorrhea
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| * Functional gonadotropin deficiency
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| * [[Gaucher Disease]]
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| * Germinoma
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| * Head trauma
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| * [[Ddx:Prolactin|Hyperprolactinemia]]
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| * Hypothalamic glioma
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| * Isolated FSH deficiency
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| * Isolated LH deficiency
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| * [[Kallmann Syndrome]]
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| * Langerhans histiocytosis
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| * [[Laurence-Moon Syndrome]]
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| * Marijuana use
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| * Optic glioma
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| * Other germ cell tumors
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| * Pituitary tumor
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| * Postinfectious lesions of the central nervous system (CNS)
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| * [[Prader-Willi Syndrome]]
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| * Radiation therapy
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| * Vascular abnormalities of the CNS
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| ==Classification==
| | {{CMG}}; {{AE}} {{AEL}} |
| There are many possible types of hypogonadism and several ways to categorize them.
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| ===by Congenital vs. acquired===
| | {{SK}}Gonadal failure, Testosterone deficiency, Idiopathic hypogonadotropic hypogonadism |
| * An example of [[congenital]] hypogonadism (present at birth) is [[Turner syndrome]].
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| * An example of [[acquired]] hypogonadism (develops in childhood or adult life) is [[castration]].
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| ===by Hormones vs. fertility=== | | ==[[Hypogonadism overview|Overview]]== |
| Hypogonadism can involve just [[hormone]] production or just [[fertility]], but most commonly involves both.
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| * Examples of hypogonadism that affect hormone production more than fertility are [[hypopituitarism]] and [[Kallmann syndrome]]; in both cases fertility is reduced until hormones are replaced but can be achieved solely with hormone replacement.
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| * Examples of hypogonadism that affect fertility more than hormone production are [[Klinefelter syndrome]] and [[Kartagener syndrome]].
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| ===by Affected system=== | | ==[[Hypogonadism historical perspective|Historical Perspective]]== |
| Hypogonadism is also categorized by endocrinologists by the level of the reproductive system which is defective. | | ==[[Hypogonadism classification|Classification]]== |
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| *Hypogonadism resulting from defects of the [[gonads]] is traditionally referred to as '''primary hypogonadism'''. Examples include [[Klinefelter syndrome]] and [[Turner syndrome]].
| | ==[[Hypogonadism pathophysiology|Pathophysiology]]== |
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| *Hypogonadism resulting from [[hypothalamic]] or [[pituitary]] defects are termed '''secondary hypogonadism''' or '''central hypogonadism''' (referring to the [[central nervous system]]).
| | ==[[Hypogonadism causes|Causes]]== |
| **Examples of [[hypothalamus|Hypothalamic]] defects include [[Kallmann syndrome]]
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| **Examples of [[pituitary gland|Pituitary]] defects include [[hypopituitarism]]
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| *An example of a hypogonadism resulting from hormone response is [[androgen insensitivity syndrome]]
| | ==[[Hypogonadism differential diagnosis|Differentiating Hypogonadism from other Diseases]]== |
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| ==Steroid use== | | ==[[Hypogonadism epidemiology and demographics|Epidemiology and Demographics]]== |
| Hypogonadism may be induced by chronic use of [[anabolic steroid|anabolic/androgenic steroids]] (AAS). The negative-feedback system of the [[hypothalamic-pituitary-gonadal axis]] (HPTA) shuts down pituitary production of gonadotropins after extended exposure to AAS. This has been documented both in patients receiving AAS for legitimate medical reasons such as [[AIDS]] or [[cancer]] as well as athletes using AAS illicitly.
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| Hypogonadism may persist for some time after steroid use is discontinued. | | ==[[Hypogonadism risk factors|Risk Factors]]== |
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| ==Symptoms== | | ==[[Hypogonadism natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Low Testosterone (Low T) symptoms include loss of energy, fatigue, loss of libido, muscle mass decline, decreased positive mood factors and an increased negative mood factors.
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| ==Diagnosis== | | ==Diagnosis== |
| Low Testosterone can be identified through a simple blood test performed by a physician. Normal testosterone levels range from 298 - 1098 ng/dl. Physicians measure [[gonadotropin]]s ([[luteinizing hormone|LH]] and [[follicle stimulating hormone|FSH]]) to distinguish primary from secondary hypogonadism. In primary hypogonadism the LH and/or FSH are usually elevated, while in secondary hypogonadism both are normal or low.
| | [[Hypogonadism history and symptoms|History and Symptoms]] | [[Hypogonadism physical examination|Physical Examination]] | [[Hypogonadism laboratory findings|Laboratory Findings]] | [[Hypogonadism CT|CT]] | [[Hypogonadism MRI|MRI]] | [[Hypogonadism echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Hypogonadism other imaging findings|Other Imaging Findings]] | [[Hypogonadism other diagnostic studies|Other Diagnostic Studies]] |
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| Hypogonadism is often discovered during evaluation of [[delayed puberty]], but ordinary delay which eventually results in normal [[puberty|pubertal]] development and reproductive function is termed.
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| ==Treatment== | | ==Treatment== |
| Hypogonadism is most often treated by replacement of the appropriate hormones. For men this is [[testosterone]]. Commonly used testosterone formulations include transdermal testosterone, injectable testosterone, and buccal testosterone. Oral testosterone is no longer used in the U.S. because it is broken down in the liver and rendered inactive. | | [[Hypogonadism medical therapy|Medical Therapy]] | [[Hypogonadism surgery|Surgery]] | [[Hypogonadism primary prevention|Primary Prevention]] | [[Hypogonadism secondary prevention|Secondary Prevention]] | [[Hypogonadism cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Hypogonadism future or investigational therapies|Future or Investigational Therpies]] |
| Another feasible alternative is [[hCG]].
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| For women [[estradiol]] and [[progesterone]] are replaced. Some types of fertility defects can be treated; some cannot.
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | [[Hypogonadism case study one|Case #1]] |
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| ==External links== | | ==External links== |
| * [http://www.nlm.nih.gov/medlineplus/ency/article/001195.htm NIH] | | * [http://www.nlm.nih.gov/medlineplus/ency/article/001195.htm NIH] |
| * [http://www.mesomorphosis.com/articles/scally/anabolic-steroid-induced-hypogonadism.htm Anabolic Steroid Induced Hypogonadism]
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| {{Endocrine pathology}} | | {{Endocrine pathology}} |
| {{SIB}}
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| [[de:Hypogonadismus]]
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| [[es:Hipogonadismo]] | | [[es:Hipogonadismo]] |
| [[fr:Hypogonadisme]] | | [[fr:Hypogonadisme]] |
| [[pt:Hipogonadismo]] | | [[pt:Hipogonadismo]] |
| [[fi:Hypogonadismi]]
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| [[zh:性腺功能低下症]] | | [[zh:性腺功能低下症]] |
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| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Signs and symptoms]]
| | [[Category:Disease]] |
| [[Category:Disease state]] | |
| [[Category:Urologic Surgery]] | | [[Category:Urologic Surgery]] |
| [[Category:Gynecology]] | | [[Category:Gynecology]] |