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09-SEPTEMBER-2008 02:07:44 - Hypogonadism Hypogonadism Classification and external resources ICD-10 E28..3,E29..1,E23..0 ICD-9 257.2 Hypogonadism is a medical term for a defect of the reproductive system that results in lack of function of the gonads ovaries or testes. The gonads have two functions: to produce hormones testosterone, estradiol, antimullerian hormone, progesterone, inhibin B, activin and to produce gametes eggs or 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. 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. Man with micropenis, hypogonadism and gynecomastia Man with micropenis, hypogonadism and gynecomastia Contents 1 Classification 1.1 by Congenital vs. acquired 1.2 by Hormones vs. fertility 1.3 by Affected system 2 Steroid use 3 Symptoms 3.1 In Men 3.2 In Women 4 Diagnosis 4.1 In Men 4.2 In Women 5 Treatment 6 References 7 External links Classification There are many possible types of hypogonadism and several ways to categorize them. by Congenital vs. acquired An example of congenital hypogonadism present at birth is Turner syndrome. An example of acquired hypogonadism develops in childhood or adult life is castration. by Hormones vs. fertility Hypogonadism can involve just hormone production or just fertility, but most commonly involves both. 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. Examples of hypogonadism that affect fertility more than hormone production are Klinefelter syndrome and Kartagener syndrome. by Affected system Hypogonadism is also categorized by endocrinologists by the level of the reproductive system that is defective. Hypogonadism resulting from defects of the gonads is traditionally referred to as primary hypogonadism. Examples include Klinefelter syndrome and Turner syndrome. Mumps is known to cause testicular failure, and in recent years has been immunized against in the US. A varicoceole can reduce hormonal production as well. Hypogonadism resulting from hypothalamic or pituitary defects are termed secondary hypogonadism or central hypogonadism referring to the central nervous system. Examples of Hypothalamic defects include Kallmann syndrome. Examples of Pituitary defects include hypopituitarism. An example of a hypogonadism resulting from the lack of hormone response is androgen insensitivity syndrome, where there are inadequate receptors to bind the testosterone, resulting in a female appearance despite XY chromosomes. Steroid use Please help improve this section by expanding it. Further information might be found on the talk page or at requests for expansion. June 2008 Hypogonadism may be induced by chronic use of 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 and in athletes using AAS illicitly. Hypogonadism may persist for some time after steroid use is discontinued, or indefinitely until treated. Symptoms In Men Effects of low testosterone in men may include: not all are present in any single individual Word Finding difficulty Dry Skin Cracking nails Fatigue Muscle loss/atrophy Frequent urination without infection Getting up at night to urinate Dementia-like memory loss Poor sleep secondary to achy muscles Poor libido Erectile Dysfunction Increasing weight Glucose intolerance early diabetes Cholesterol/Lipid abnormalities Slight increase size of breasts In Women Effects of low estrogen levels in women may include: not all are present in any individual Hot flashes Sleep disturbances Symptoms of urinary bladder discomfort like frequency, urgency, frequent infections, lack of lubrication, discharge Shrinking of breasts Diagnosis In Men Low Testosterone can be identified through a simple blood test performed by a laboratory, ordered by a physician. Normal testosterone levels are said to range from 298 - 1098 ng/dl, but most men with levels below 350 will benefit from treatment. Physicians measure gonadotropins LH and FSH to distinguish primary from secondary hypogonadism. In primary hypogonadism the LH and/or FSH are usually elevated, meaning the problem is in the testicles, whereas in secondary hypogonadism, both are normal or low, suggesting the problem is in the brain. In Women Similar to men, the LH and FSH will be used, particularly in women who believe they are in menopause. These levels changes during a woman's normal menstrual cycle, so the history of having ceased menstruation coupled with high levels aids the diagnosis of being menopausal. Commonly, the post-menopausal woman is not called hypogonadal Hypogonadism is often discovered during evaluation of delayed puberty, but ordinary delay, which eventually results in normal pubertal development, wherein reproductive function is termed constitutional delay. It may be discovered during an infertility evaluation in either men or women. Hypogonadism in older men is often overlooked by physicians, and may be a significant issue in the aging process. 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. Another feasible alternative is human chorionic gonadotropin hCG. For women estradiol and progesterone are replaced. Some types of fertility defects can be treated; some cannot. References External links Anabolic Steroid Induced Hypogonadism Homepage NIH eMedicine Anabolic Steroid Induced Hypogonadism Low testosterone information v d e Endocrine pathology: endocrine diseases E00-35, 240-259 Pancreas/ glucose metabolism Diabetes mellitus types: type 1, type 2, MODY, complications: coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy Hypoglycemia - Hyperinsulinism - Zollinger-Ellison syndrome - insulin receptor Rabson-Mendenhall syndrome - Insulin resistance Hypothalamic/ pituitary axes Pituitary Hyperpituitarism Acromegaly, Hyperprolactinaemia, SIADH Hypopituitarism Sheehan's syndrome, Kallmann syndrome, Growth hormone deficiency, Diabetes insipidus Adiposogenital dystrophy - Empty sella syndrome - Pituitary apoplexy - ACTH deficiency Thyroid Hypothyroidism Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre, Myxedema Hyperthyroidism Graves disease, Toxic multinodular goitre, Teratoma with thyroid tissue or Struma ovarii Thyroiditis De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's thyroiditis Euthyroid sick syndrome - Thyroid hormone resistance - Thyroid nodule Parathyroid Hypoparathyroidism Pseudohypoparathyroidism - Hyperparathyroidism Primary, Secondary, Tertiary Adrenal Adrenocortical hyperfunction: Cushing's syndrome Nelson's syndrome, Pseudo-Cushing's syndrome - Hyperaldosteronism Conn syndrome, Bartter syndrome CAH Lipoid, 3β, 11β, 17α, 21α Adrenal insufficiency Addison's disease, Waterhouse-Friderichsen syndrome - Hypoaldosteronism Gonads ovarian Polycystic ovary syndrome, Premature ovarian failure testicular 5-alpha-reductase deficiency, 17-beta-hydroxysteroid dehydrogenase deficiency general Hypogonadism, Delayed puberty, Precocious puberty Other Androgen insensitivity syndrome - Autoimmune polyendocrine syndrome - Carcinoid syndrome - Gigantism - Short stature Laron syndrome, Psychogenic dwarfism - Multiple endocrine neoplasia 1, 2 - Progeria - Woodhouse-Sakati syndrome - thymus Abscess of thymus, Thymus hyperplasia see also congenital, neoplasia Retrieved from http://en..org/wiki/Hypogonadism Categories: Reproductive system | EndocrinologyHidden categories: Articles to be expanded since June 2008 | All articles to be expanded Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français Italiano Polski Português SlovenÅ¡Ä?ina Suomi ä¸æ–‡ This page was last modified on 13 August 2008, at 17:2
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