Hypogonadotropic hypogonadism: symptoms, treatment

As a rule, hypogonadotropic hypogonadism is associated with underdevelopment of sexual organs and secondary sexual characteristics. Fat and protein metabolism in pathology is also violated, which causes obesity, cachexia, disorders in the bone system and malfunctioning of the heart.

To what doctors to address?

It should be noted that the male and female hypogonadotropic hypogonadism is different.

Diagnosis and treatment of the disease is carried out jointly by endocrinologists, gynecologists and gynecologists-endocrinologists, if the patient is a woman, and andrologists, if the patient is a man.

The basis of treatment is hormonal therapy. If necessary, surgical intervention is indicated, plastic surgery.

How is the disease classified?

Hypogonadism can be primary and secondary. The primary form was provoked by a violation of the functionality of the testicular tissue due to a defect in the testicles. Violations at the chromosomal level can provoke aplasia or hypoplasia of the testicular tissue, manifested in the absence of a secret of androgens or the inadequacy of their production for the full formation of genital organs and secondary sexual characteristics.

Hypogonadotropic hypogonadism in boys is expressed in mental infantilism.

The secondary form is caused by a disorder in the structure of the pituitary gland, a decrease in its gonadotropic function, or damage to the centers of the hypothalamus, which affect the pituitary gland and regulate its activity. The disease is expressed in mental disorders.

Both primary and secondary forms can be congenital or acquired. Pathology can promote infertility in men in 40-60% of cases.

Causes of the disease in men

A low amount of androgens can be caused by a decrease in the amount of hormones produced or the pathological condition of the testes themselves, a violation of the hypothalamus and pituitary function.

The etiology of the primary manifestation of the disease can be described as:

• Congenital maldevelopment of the sexual glands, which occurs with defects of a genetic nature,
• Aplasia of testicles.

Predisposing factors include:

• Violation of the descent of the testicles;
• Exposure to toxic substances;
• Chemotherapy;
• Exposure to organic solvents, nitrofurans, pesticides, alcohol, tetracycline, hormone-based drugs in increased dosage, etc .;
• Diseases of infectious nature (parotitis, measles, orchitis, vesiculitis);
• Presence of radiation sickness;
• Acquired pathology of testicles;
• Twisting of the spermatic cord;
• Vomeron testes;
• Atrophic process after surgery;
• Excision of a hernia;
• Surgical operation in the scrotum area.

At primary hypogonadism the drop in the level of androgens in the blood is observed. The compensatory reaction of the adrenal glands develops, the production of gonadotropins increases.

To the secondary form disturbances of a hypothalamus and a pituitary body (processes of inflammatory character, neoplasms, infringement in work of vessels, a pathology of an intrauterine development of a fruit lead).

To promote the development of secondary hypogonadism can:

• Adenoma of the pituitary gland, which produces growth hormone;
• Adrenocorticotropic hormone (Cushing's disease);
• Prolactinoma;
• Dysfunction of the pituitary or hypothalamus after surgery;
• The aging process, which provokes a decrease in testosterone in the blood.

In the secondary form, there is a decrease in gonadotropins, resulting in a decrease in the production of androgens with testicles.

One of the forms of the disease affecting men is a decrease in sperm production with a normal testosterone index. Very rarely there is a decrease in the level of testosterone at normal sperm level.

Symptomatic of the disease in men

Hypogonadotropic hypogonadism in men has its clinical manifestations. They are due to the age of the patient, as well as the level of androgen deficiency.

If the testicles of the boy are struck before puberty, then typical eunuchoidism is formed. The skeleton becomes disproportionately large. This is due to the retardation of ossification in the growth zone. The brachial region and thorax also lag behind in development, the limbs become long, the skeletal musculature is poorly developed.

There may be obesity in the female type, gynecomastia, hypogenitalism, which is manifested in the small size of the penis, the absence of folds in the scrotum, testicular hypoplasia, underdevelopment of the prostate gland, the absence of hair in the pubic area, hypoplasia of the larynx, high voice timbre.

When a secondary manifestation of the disease is often noted, the patient's weight is large, the adrenal cortex has a high function, and the thyroid gland is broken.

If the function of the testicles is reduced after the pubertal period, then the symptomatology of such a pathology as hypogonadotropic hypogonadism is traced less.

The following phenomena are noted:

• Decreased testes;
• Small hairiness of the face and body;
• Loss of skin elasticity and thinning;
• Decreased sexual function;
• Vegetative disorders.

Reducing the size of the testicles is always associated with a lower production of sperm. This causes infertility, there is regression of secondary sexual characteristics, muscle weakness, asthenia.

Diagnosis of hypogonadism in men

Diagnosis is carried out through anthropometry, examination and palpation of the genitals, assessment of clinical symptoms of puberty.

X-ray examination will help evaluate the bone age. Densitometry is used to determine bone saturation with minerals. With the x-ray of the Turkish saddle, its size and the presence of neoplasms are determined.

Estimation of bone age allows to determine, by the terms of ossification of the wrist and wrist joint, when the sexual maturation began. This should take into account the possibility of earlier (for patients born in the south) and later (for patients born in the north) ossification, as well as the fact that the violation of osteogenesis can be caused by other factors.

A study in the semen laboratory allows one to talk about such states as azo or oligospermia.

The content of such hormones is indicated:

• Sexual gonadotropins;
• Total and free testosterone ;
• Luteinizing hormone;
• Gonadoliberin;
• Antimuller's hormone;
• Prolactin;
• Estradiol.

In the primary form of the disease, the gonadotropin index in the blood is elevated, and in the secondary form, it is lowered. Sometimes their level is in the redistribution of the norm.

Determination of estradiol in the serum is necessary for clinically expressed feminization and secondary manifestation of the disease, in the presence of tumors in the testes producing estrogen, or tumors in the adrenal gland.

The indicator of the content of ketosteroids in urine can be normal or decreased. If a diagnosis of Klinefelter's syndrome is suspected, chromosome analysis is indicated.

A testicular biopsy is not capable of providing information for proper diagnosis.

Treatment

Treatment of hypogonadotropic hypogonadism is aimed at eliminating the main cause that caused pathology. The purpose of therapy is concluded in preventive measures that promote the normalization of sexual development, the subsequent restoration of testicular testicles and the elimination of infertility. Therapy is carried out under the supervision of a urologist and an endocrinologist.

How is hypogonadotropic hypogonadism eliminated in men? Treatment depends on a number of factors:

• Clinical form of pathology;
• The severity of the disruption of the hypothalamus, the pituitary and the reproductive system;
• Presence of parallel existing pathologies;
• Time of occurrence of the disease;
• Age of the patient.

Treatment of adult patients consists in correcting the level of androgens and eliminating sexual dysfunction. Infertility, which originated in the congenital form of hypogonadism, is not treatable.

In the case of the primary congenital form of an anomaly or acquired disease, with the preservation of endocrine cells in the testicles, stimulant preparations are used. Boys are treated non-hormonal means, and adult patients - drugs on a hormonal basis (androgens and gonadotropins in small doses).

In the absence of reserve function of the testicles, substitution therapy with androgens and testosterone is indicated. Admission of hormones is carried out throughout life.

In the secondary form of the disease in children and adults, it is necessary to use hormone therapy with gonadotropins. If necessary, they are combined with sex hormones.

Also, general restorative treatment and physical education are shown.

The operation in case of a disease consists of an ovary transplantation with cryptorchidism, with the underdevelopment of the penis plastic surgery is used. With cosmetic purpose resort to implantation of a testicle on a synthetic basis (in the absence of an undescended testicle in the abdominal cavity).

Surgical intervention is used when using microsurgical techniques, along with monitoring the state of the immune system, the level of hormones, and also the implanted organ.

In the process of systematically administered therapy, androgen deficiency decreases, the development of secondary sexual characteristics resumes, the potency is partially restored, the manifestations of osteoporosis and the lag of bone age decrease.

How does the disease occur in women

Hypogonadotropic hypogonadism in women is characterized by underdevelopment and increased function of the sexual glands of the ovaries. The primary form is due to congenital underdevelopment of the ovaries or their damage during the neonatal period.

There is a lower production of sex hormones, which provokes an increase in the level of gonadotropins, which stimulate the ovaries.

The analysis shows a high rate of hormones that stimulate follicles and lutein, as well as a low level of estrogen. The lowered estrogen index causes atrophy or underdevelopment of female genital organs, mammary glands, absence of menstruation.

If the function of the ovaries was broken before puberty, then there is no secondary sexual characteristics.

Hypogonadotropic hypogonadism in women in the primary form is observed under the following conditions:

• Congenital disorder at the genetic level;
• Congenital hypoplasia of the ovaries;
• Infectious processes (syphilis, tuberculosis, mumps, irradiation, surgical removal of the ovaries);
• Damage to autoimmune nature;
• Syndrome of testicular feminization ;
• Polycystic ovary.

Secondary hypogonadotropic hypogonadism in women occurs in the pathology of the pituitary and hypothalamus. It is characterized by a low content or complete cessation of gonadotropin production regulating the function of the ovaries. This process is provoked by inflammation in the brain. Such diseases have a damaging effect and are accompanied by a decrease in the level of action of gonadotropins on the ovaries.

How are such diseases connected, as hypogonadotropic hypogonadism in women, and pregnancy? Unfavorable fetal development of the fetus can also affect the occurrence of pathology.

Symptoms of the disease in women

Vivid symptoms of the disease in the childbearing period - a violation of the monthly or lack thereof.

Low level of female hormones leads to underdevelopment of the genital organs, mammary glands, violation of the deposition of fatty tissue and sparse hair.

If the disease is innate, then secondary sexual characteristics do not appear. Women have a narrow pelvis and flat buttocks.

If the disease occurred before puberty, then the sexual signs that appeared, remain preserved, but the monthly stops, the genitals tissue atrophy.

Conducting diagnostics

When hypogonadism, there is a decrease in the level of estrogen and an increase in the level of gonadotropins. By means of ultrasound, the uterus decreases in size, osteoporosis and delay in the formation of the skeleton are diagnosed.

Treatment of pathology in women

How is hypogonadotropic hypogonadism eliminated in women? Treatment involves replacement therapy. Women are prescribed medication, as well as sex hormones (ethinyl estradiol).

In the event of menstruation, oral contraceptives containing estrogens and gestagens, as well as preparations "Triziston", "Trikvilar", are prescribed.

Means "Klimen", "Trisekvens", "Klimonorm" appoint to patients after 40 years.

Treatment with hormonal drugs is contraindicated in the following conditions:

• Oncological tumors in the area of the mammary glands and genital organs;
• Heart and vascular disease;
• Pathology of the kidneys and liver;
• Thrombophlebitis.

Prevention

Such a disease, as hypogonadotropic hypogonadism, has a favorable prognosis. Prevention consists in health education of the population and monitoring of pregnant women, as well as in health protection activities.