Hypogonadism: Difference between revisions
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=== Clinic === | === Clinic === | ||
* | * Diminished functional activity of the gonads which results in diminished production of sex hormones. | ||
* Low androgen | ** Hypoandrogenism (Low androgen e.g., testosterone) | ||
** Hypoestrogenism (Low estrogen e.g., estradiol) | |||
* Hypogonadism | * Hypogonadism commonly referred to Low testosterone and other hormones including progesterone, [[DHEA-S|DHEA]], anti-Müllerian hormone, activin and inhibin. | ||
* Spermatogenesis and Ovulation may be impaired which causes | * Spermatogenesis and Ovulation may be impaired which causes [[Infertility remedies|infertility]]. | ||
* Hypogonadism can involve just hormone production or just fertility, but most commonly involves both. | |||
*# [[Hypopituitarism]] and Kallmann syndrome: Hypogonadism that affect hormone production more than fertility | |||
*# Klinefelter syndrome and Kartagener syndrome: Hypogonadism that affect fertility more than hormone production | |||
=== Types === | |||
* | |||
==== (1) Primary hypogonadism ==== | |||
* LH and/or FSH are usually elevated, since the main problem is in Testicles / Ovaries (Hyper-gonatropic hypogonadism) | |||
* Causations: | |||
*#Genetic: Klinefelter syndrome, Turner syndrome, Noonan syndrome, XY with SRY gene-immunity | |||
*# Acquired: [[MMP, Mumps|MMP]] | |||
==== Secondary hypogonadism ==== | ==== (2) Secondary hypogonadism ==== | ||
* Hypogonadotropic hypogonadism (HH) due to Hypopituitarism / Pituitary hypoplasia. | * In secondary hypogonadism, LH / FSH are normal or low, suggesting the problem is in the brain | ||
* | * Causations: | ||
*# [[Hypogonadotropic Hypogonadism|Hypogonadotropic hypogonadism]] (HH) due to Hypopituitarism / Pituitary hypoplasia. | |||
* Isolated hypogonadotropic hypogonadism (IHH)= Idiopathic or congenital hypogonadotropic hypogonadism (CHH): HH due to deficiency in or insensitivity to GnRH where the function and anatomy of the anterior pituitary is normal and secondary causes of HH are not present | *# Lack of hormone response is Androgen Insensitivity Syndrome | ||
* | *# Isolated hypogonadotropic hypogonadism (IHH)= Idiopathic or congenital hypogonadotropic hypogonadism (CHH): HH due to deficiency in or insensitivity to GnRH where the function and anatomy of the anterior pituitary is normal and secondary causes of HH are not present | ||
* | * | ||
*Examples are | |||
**[[PCOD, PCOS, Poly Cystic Ovarian Disease (Syndrome) remedies|PCOS]] | |||
**Kallmann syndrome | |||
**Hemochromatosis | |||
**Diabetes mellitus | |||
=== Central Hypogonadism === | === Central Hypogonadism === | ||
* Genetic disorders | * Central hypogonadism referring to CNS / Hypothalamic defects including: | ||
* Infections | ** Genetic disorders such as Kallmann syndrome (Abnormal hypothalamic development) | ||
* Pituitary disorders | ** Infections including HIV | ||
* | ** Pituitary disorders | ||
** Inflammatory diseases including sarcoidosis, [[MTB, Mycobacterium tuberculosis|MTB]] and histiocytosis | |||
=== Other === | |||
Hypogonadism can occur in other conditions, like Prader–Willi syndrome. | |||
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=== Hypogonadotrophic hypogonadism === | === Hypogonadotrophic hypogonadism === | ||
* It is a subtype of hypogonadism | * It is a subtype of hypogonadism | ||
* Late, incomplete or lack of development at puberty | * Late, incomplete or lack of development at puberty | ||
* Sometimes short stature or the inability to smell | * Sometimes short stature or the inability to smell | ||
* In females, a lack of breasts and menstrual periods, and in males a lack of sexual development, e.g., facial hair, penis and testes enlargement, deepening voice. | * In females, a lack of breasts and menstrual periods, and in males a lack of sexual development, e.g., facial hair, penis and testes enlargement, deepening voice. | ||
=== Clinic === | |||
* HH is a kind of Secondary/ Central [[hypogonadism]] | |||
* It means that problems with either the hypothalamus or pituitary gland affecting the hypothalamic-pituitary-gonadal axis ([[HPG axis]]) cause HH. | |||
* Hypothalamic disorders result from a deficiency in the release of GnRH | |||
* Pituitary gland disorders are due to a deficiency in the release of gonadotropins from the anterior pituitary. | |||
=== Two Types === | |||
# Congenital HH: CHH is due to genetic abnormalities resulting in non-functional GnRH secreting neurons or gonadotropic cell dysfunction in the anterior pituitary. CHH is divided into 2 subtypes depending on the condition of the olfactory system, anosmic HH (Kallman syndrome) and normosmic HH. | |||
# Acquired HH: AHH is an acquired form of the disease often occurring after sexual maturation and is not related to genetic defects. | |||
=== Acquired hypogonadotropic hypogonadism === | |||
* AHH is a postnatal onset of a GnRH releasing disorder and/or pituitary gonadotroph cell disorder. | |||
* There are many causes of AHH, mostly due to structural or functional abnormalities of HPG axis such as | |||
** [[Sarcoidosis]] | |||
** [[Hypopituitarism|Lymphocytic hypophysitis]] | |||
** Pituitary adenomas, craniopharyngiomas and other CNS tumours | |||
* Most of these patients have multiple pituitary hormone deficiencies. | |||
* Hyperprolactinaemia is the most common cause of AHH. It is a well-established cause of infertility in both male and female mammals. [[Prolactin]] inhibits GnRH neurons and therefore inhibits the subsequent release of LH, FSH and sex steroids. | |||
=== Entity / Miasms === | |||
MTB | |||
HPV |
Latest revision as of 00:11, 7 April 2023
Clinic
- Diminished functional activity of the gonads which results in diminished production of sex hormones.
- Hypoandrogenism (Low androgen e.g., testosterone)
- Hypoestrogenism (Low estrogen e.g., estradiol)
- Hypogonadism commonly referred to Low testosterone and other hormones including progesterone, DHEA, anti-Müllerian hormone, activin and inhibin.
- Spermatogenesis and Ovulation may be impaired which causes infertility.
- Hypogonadism can involve just hormone production or just fertility, but most commonly involves both.
- Hypopituitarism and Kallmann syndrome: Hypogonadism that affect hormone production more than fertility
- Klinefelter syndrome and Kartagener syndrome: Hypogonadism that affect fertility more than hormone production
Types
(1) Primary hypogonadism
- LH and/or FSH are usually elevated, since the main problem is in Testicles / Ovaries (Hyper-gonatropic hypogonadism)
- Causations:
- Genetic: Klinefelter syndrome, Turner syndrome, Noonan syndrome, XY with SRY gene-immunity
- Acquired: MMP
(2) Secondary hypogonadism
- In secondary hypogonadism, LH / FSH are normal or low, suggesting the problem is in the brain
- Causations:
- Hypogonadotropic hypogonadism (HH) due to Hypopituitarism / Pituitary hypoplasia.
- Lack of hormone response is Androgen Insensitivity Syndrome
- Isolated hypogonadotropic hypogonadism (IHH)= Idiopathic or congenital hypogonadotropic hypogonadism (CHH): HH due to deficiency in or insensitivity to GnRH where the function and anatomy of the anterior pituitary is normal and secondary causes of HH are not present
- Examples are
- PCOS
- Kallmann syndrome
- Hemochromatosis
- Diabetes mellitus
Central Hypogonadism
- Central hypogonadism referring to CNS / Hypothalamic defects including:
- Genetic disorders such as Kallmann syndrome (Abnormal hypothalamic development)
- Infections including HIV
- Pituitary disorders
- Inflammatory diseases including sarcoidosis, MTB and histiocytosis
Other
Hypogonadism can occur in other conditions, like Prader–Willi syndrome.
Signs / Symptoms
- Women: Amenorrhea, Decreased height+ Impaired Breast development Or Cessation of menstruation + Lowered libido + Loss of body hair + Hot flashes.
- Men: Impaired muscle + Impaired body hair development + Gynecomastia + Decreased height + Erectile dysfunction + Sexual difficulties.
- Central hypogonadism: Headaches + Impaired vision / Double vision + Milky discharge from the breast (Prolactin) + Symptoms caused by other hormone problems.
Hypogonadotrophic hypogonadism
- It is a subtype of hypogonadism
- Late, incomplete or lack of development at puberty
- Sometimes short stature or the inability to smell
- In females, a lack of breasts and menstrual periods, and in males a lack of sexual development, e.g., facial hair, penis and testes enlargement, deepening voice.
Clinic
- HH is a kind of Secondary/ Central hypogonadism
- It means that problems with either the hypothalamus or pituitary gland affecting the hypothalamic-pituitary-gonadal axis (HPG axis) cause HH.
- Hypothalamic disorders result from a deficiency in the release of GnRH
- Pituitary gland disorders are due to a deficiency in the release of gonadotropins from the anterior pituitary.
Two Types
- Congenital HH: CHH is due to genetic abnormalities resulting in non-functional GnRH secreting neurons or gonadotropic cell dysfunction in the anterior pituitary. CHH is divided into 2 subtypes depending on the condition of the olfactory system, anosmic HH (Kallman syndrome) and normosmic HH.
- Acquired HH: AHH is an acquired form of the disease often occurring after sexual maturation and is not related to genetic defects.
Acquired hypogonadotropic hypogonadism
- AHH is a postnatal onset of a GnRH releasing disorder and/or pituitary gonadotroph cell disorder.
- There are many causes of AHH, mostly due to structural or functional abnormalities of HPG axis such as
- Sarcoidosis
- Lymphocytic hypophysitis
- Pituitary adenomas, craniopharyngiomas and other CNS tumours
- Most of these patients have multiple pituitary hormone deficiencies.
- Hyperprolactinaemia is the most common cause of AHH. It is a well-established cause of infertility in both male and female mammals. Prolactin inhibits GnRH neurons and therefore inhibits the subsequent release of LH, FSH and sex steroids.
Entity / Miasms
MTB
HPV