Hypogonadism differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Hypogonadism must be differentiated from [[diseases]] that cause [[delayed puberty]] or [[infertility]]. These diseases include [[Congenital disease|congenital diseases]] as [[Klinefelter syndrome]], [[Kallmann syndrome]] and [[cryptorchidism]]. The diseases include | Hypogonadism must be differentiated from [[diseases]] that cause [[delayed puberty]] or [[infertility]]. These diseases include [[Congenital disease|congenital diseases]] as [[Klinefelter syndrome]], [[Kallmann syndrome]] and [[cryptorchidism]]. The diseases also include [[testicular torsion]] and [[orchitis]] in males, [[polycystic ovary syndrome]], [[pelvic inflammatory disease]], and [[endometriosis]] in females. | ||
==Differentiating Hypogonadism from other Diseases== | ==Differentiating Hypogonadism from other Diseases== | ||
Hypogonadism must be differentiated from [[diseases]] that cause [[delayed puberty]] or [[infertility]]. These diseases include [[Congenital disease|congenital diseases]] as [[Klinefelter syndrome]], [[Kallmann syndrome]] and [[cryptorchidism]]. The diseases include | Hypogonadism must be differentiated from [[diseases]] that cause [[delayed puberty]] or [[infertility]]. These diseases include [[Congenital disease|congenital diseases]] as [[Klinefelter syndrome]], [[Kallmann syndrome]] and [[cryptorchidism]]. The diseases also include [[testicular torsion]] and [[orchitis]] in males, [[polycystic ovary syndrome]], [[pelvic inflammatory disease]], and [[endometriosis]] in females. | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="2" |Diseases | ! colspan="2" |Diseases | ||
| Line 16: | Line 16: | ||
| rowspan="3" |Congenital diseases | | rowspan="3" |Congenital diseases | ||
|[[Klinefelter syndrome]] | |[[Klinefelter syndrome]] | ||
|Clinical features of Klinefelter syndrome are as the following:<ref name="fertstert2004">{{Citation|last = Denschlag|first = Dominik, MD|last2 = Clemens|first2 = Tempfer, MD|last3 = Kunze|first3 = Myriam, MD|last4 = Wolff|first4 = Gerhard, MD|last5 = Keck|first5 = Christoph, MD|title = Assisted reproductive techniques in patients with Klinefelter syndrome: A critical review|journal = Fertility and Sterility|volume = 82|issue = 4|pages = 775–779|date = October 2004|year = 2004|doi = 10.1016/j.fertnstert.2003.09.085}}</ref> | |Clinical features of [[Klinefelter syndrome]] are as the following:<ref name="fertstert2004">{{Citation|last = Denschlag|first = Dominik, MD|last2 = Clemens|first2 = Tempfer, MD|last3 = Kunze|first3 = Myriam, MD|last4 = Wolff|first4 = Gerhard, MD|last5 = Keck|first5 = Christoph, MD|title = Assisted reproductive techniques in patients with Klinefelter syndrome: A critical review|journal = Fertility and Sterility|volume = 82|issue = 4|pages = 775–779|date = October 2004|year = 2004|doi = 10.1016/j.fertnstert.2003.09.085}}</ref> | ||
* Language learning impairment. | * Language learning impairment. | ||
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* [[Urine culture]] | * [[Urine culture]] | ||
* [[PCR]] to detect the presence of ''[[Neisseria gonorrheae]]'' and ''[[Chlamydia trachomatis]]'' | * [[PCR]] to detect the presence of ''[[Neisseria gonorrheae]]'' and ''[[Chlamydia trachomatis]]'' | ||
* Scrotal ultrasound is the diagnostic imaging of choice in cases of | * Scrotal [[ultrasound]] is the diagnostic [[imaging]] of choice in cases of acute scrotum. | ||
| | | | ||
* [[Bed rest]] and limitation of [[physical activity]] | * [[Bed rest]] and limitation of [[physical activity]] | ||
| Line 112: | Line 112: | ||
|[[Pelvic inflammatory disease]] | |[[Pelvic inflammatory disease]] | ||
|Patients usually present with the following:<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref> | |Patients usually present with the following:<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref> | ||
* Bilateral abdominal pain | * Bilateral [[abdominal pain]] | ||
* Abnormal uterine bleeding | * [[Abnormal uterine bleeding]] | ||
* [[Urinary frequency]] | * [[Urinary frequency]] | ||
* Abnormal [[vaginal discharge]] | * Abnormal [[vaginal discharge]] | ||
* Fever | * [[Fever]] | ||
* Decreased bowel sounds | * Decreased [[bowel sounds]] | ||
| | | | ||
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for PID. | * [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for [[PID]]. | ||
* [[Transvaginal ultrasound|Transvaginal utrasonography]] | * [[Transvaginal ultrasound|Transvaginal utrasonography]] | ||
| | | | ||
* Broad spectrum antibiotics | * Broad spectrum [[antibiotics]] | ||
* Hospitalization | * [[Hospitalization]] | ||
|- | |- | ||
|[[Endometriosis]] | |[[Endometriosis]] | ||
| Line 132: | Line 132: | ||
* Intermenstrual spotting | * Intermenstrual spotting | ||
* Prolonged [[menstrual bleeding]] and increased amount of [[bleeding]] ([[menorrhagia]]) | * Prolonged [[menstrual bleeding]] and increased amount of [[bleeding]] ([[menorrhagia]]) | ||
* Acute abdomen | * [[Acute abdomen]] | ||
| | | | ||
* Features of [[iron deficiency anemia]] may be present such as: | * Features of [[iron deficiency anemia]] may be present such as: | ||
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* [[Aromatase inhibitor|Aromatase inhibitors]] | * [[Aromatase inhibitor|Aromatase inhibitors]] | ||
Surgery: | Surgery: | ||
* Conservative removal of the endometrial tissues by laser or | * Conservative removal of the [[endometrial]] tissues by laser or electrocautry | ||
* Definitive surgery[[hysterectomy]] with [[Salpingo-oophorectomy|bilateral salpingo-oophorectomy]]. | * Definitive surgery[[hysterectomy]] with [[Salpingo-oophorectomy|bilateral salpingo-oophorectomy]]. | ||
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Revision as of 15:05, 5 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
Hypogonadism must be differentiated from diseases that cause delayed puberty or infertility. These diseases include congenital diseases as Klinefelter syndrome, Kallmann syndrome and cryptorchidism. The diseases also include testicular torsion and orchitis in males, polycystic ovary syndrome, pelvic inflammatory disease, and endometriosis in females.
Differentiating Hypogonadism from other Diseases
Hypogonadism must be differentiated from diseases that cause delayed puberty or infertility. These diseases include congenital diseases as Klinefelter syndrome, Kallmann syndrome and cryptorchidism. The diseases also include testicular torsion and orchitis in males, polycystic ovary syndrome, pelvic inflammatory disease, and endometriosis in females.
| Diseases | Clinical findings | Diagnosis | Manangement | |
|---|---|---|---|---|
| Congenital diseases | Klinefelter syndrome | Clinical features of Klinefelter syndrome are as the following:[1]
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| Kallmann syndrome | Clinical features of Kallmann syndrome include:
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| Cryptorchidism | Clinical features of cryptorchidism include:[2]
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| Male diseases | Testicular torsion | Patients of testicular torsion usually present with following:[3] |
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Management is mainly surgical through detorsion and fixation of the affected testes. |
| Orchitis | Clincial features of orchitis include the following:[4][5]
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| Female diseases | Polycystic ovarian syndrome (PCOS) | Possible clinical findings in cases of PCOS:[6] |
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| Pelvic inflammatory disease | Patients usually present with the following:[8][9]
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| Endometriosis | Clinical features of endometriosis include the following:[10]
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Medical therapy:
Surgery:
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References
- ↑ Denschlag, Dominik, MD; Clemens, Tempfer, MD; Kunze, Myriam, MD; Wolff, Gerhard, MD; Keck, Christoph, MD (October 2004), "Assisted reproductive techniques in patients with Klinefelter syndrome: A critical review", Fertility and Sterility, 82 (4): 775–779, doi:10.1016/j.fertnstert.2003.09.085
- ↑ Virtanen HE, Bjerknes R, Cortes D, Jørgensen N, Rajpert-De Meyts E, Thorsson AV; et al. (2007). "Cryptorchidism: classification, prevalence and long-term consequences". Acta Paediatr. 96 (5): 611–6. doi:10.1111/j.1651-2227.2007.00241.x. PMID 17462053.
- ↑ Schmitz D, Safranek S (2009). "Clinical inquiries. How useful is a physical exam in diagnosing testicular torsion?". J Fam Pract. 58 (8): 433–4. PMID 19679025.
- ↑ Trojian TH, Lishnak TS, Heiman D (2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
- ↑ Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
- ↑ Christine Cortet-Rudelli, Didier Dewailly (2006). "Diagnosis of Hyperandrogenism in Female Adolescents". Hyperandrogenism in Adolescent Girls. Armenian Health Network, Health.am. Unknown parameter
|month=ignored (help) - ↑ Legro RS, Barnhart HX, Schlaff WD (2007). "Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome". N Engl J Med. 356 (6): 551–566. PMID 17287476.
- ↑ Brunham RC, Gottlieb SL, Paavonen J (2015). "Pelvic inflammatory disease". N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.
- ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
- ↑ Murphy AA (2002). "Clinical aspects of endometriosis". Ann N Y Acad Sci. 955: 1–10, discussion 34-6, 396–406. PMID 11949938.