Hypogonadism overview
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Overview
Hypogonadism is a medical term for a defect of the reproductive system which results in lack of function of the gonads (ovaries or testes).
Historical Perspective
Hypogonadim was first reported by Dr. Maestre de San Juan in a case of small testes and loss of smelling sense in patient. Dr. Kallmann after that, in 1944, identified this syndrome and it was named based on his name. Dr. de Morsier reported various cases of hypogonadism with abscent olfactory bulbs in the 1950s.
Classification
Hypogonadism may be classified according to the etiological site into three subtypes primary, secondary or combined. It can also be classified according to the age into two adult and child. Based on the causes, it can be classified into acquired or congenital.[1]
Pathophysiology
Hypogonadism pathophysiology depends mainly on the effect of different factors and diseases on the pituitary-hypothalamic-gonadal pathway. Testosterone is secreted in response to stimulation signals from the brain to the hypothalamus which secrets the gonadotropin releasing hormones (GnRH). GnRH is responsible for secretion of FSH and LH. In males, LH stimulates the leydig cells in the testes which produce testosterone by converting the cholesterol to testosterone. In females, FSH and LH stimulates secretion of estrogen which helps in follicles maturation. Estrogen also helps in the process of ovulation. Deficiency of GnRH leads to decrease of testosterone levels and eventually causing hypogonadism. Genetic mutations have a big role as well in development of hypogonadism. There are more than 25 gene mutations participate in the pathogenesis of hypogonadism. These genes like genes responsible for Kallmann syndrome as ANOS 1, SOX10, SEMA3A, IL17RD and FEZF1. Other genes include KISS, GNRNH and PROK.
Causes
Differentiating Hypopituitarism from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
According to the endocrine society, screening for hypogonadism is not recommended as it costs too much. Hypogonadism screening may be done in order to diagnose the disease early and provide the appropriate treatment. Screening may be done for men patients who present with erectile dysfunction, infertility, HIV patients and young patients with osteoporosis.
Natural History, Complications, and Prognosis
Diagnosis
History and Symptoms
The most common symptoms of hypogonadims in males include delayed puberty and loss of sexual characters as voice deepening and hair growth. Common symptoms include also erectile dysfunction, small testes, loss of libido and sweating. Common symptoms in females include no breast enlargement and no pubic hair. Less common symptoms include headache, visual impairment, galactorrhea and anorexia nervosa.
Physical Examination
Laboratory Findings
X ray
CT scan
MRI scan
Ultrasound
Other Diagnostic Studies
Other imaging findings
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ Rey RA, Grinspon RP, Gottlieb S, Pasqualini T, Knoblovits P, Aszpis S; et al. (2013). "Male hypogonadism: an extended classification based on a developmental, endocrine physiology-based approach". Andrology. 1 (1): 3–16. doi:10.1111/j.2047-2927.2012.00008.x. PMID 23258624.