Hypogonadism

General characteristic of a disease

The hypogonadism at men is the disease caused by deficit of hormones androgens in an organism. Depending on an etiology of a disease it is accepted to distinguish primary hypogonadism and a secondary form of a disease (it – a hypogonadotropic hypogonadism). Primary form of a disease which is characterized by the increased level of gonadotropic hormones in an organism is quite often called a hyper gonadotropic hypogonadism.

Pathology takes the leading place on prevalence among the male diseases caused by functional insufficiency of gonads.

Primary hypogonadism at men

Primary hypogonadism can be inborn. The disease is demonstrated by testicular insufficiency of testicles or their total absence (anorchism). Pathology is shown during the pre-natal period. The boy is born with a penis whose sizes there is much less norm, and also with an underdeveloped scrotum.

Further symptoms of primary hypogonadism of an inborn form appear at teenage age. Young men with primary hypogonadism have so-called "eunuchoid" type of a skeleton, excess body weight, gynecomastia signs (increase in a breast), small degree of pilosis.

Inborn primary hypogonadism – the frequent phenomenon at Klaynfelter, Reyfenstein, Shereshevsky-Turner, Nunan and Del Castillo's genetic syndromes.

Men can also have acquired primary hypogonadism. This form of a disease is the most widespread and occurs on average at every fifth man with the diagnosed infertility.

The acquired primary hypogonadism develops as a result of an inflammation of seminal glands at:

• orchitis (inflammation of testicles),
• vesiculitis (inflammation of seed bubbles),
• to differentita (inflammation of seed cords),
• epididymite (inflammation of appendages of testicles),
• infectious parotitis (mumps),
• to chicken pox.

The provocative factor of the acquired primary hypogonadism finds possible also a cryptorchism (not omission of testicles in a scrotum). Injuries or radiation injury of testicles can provoke functional insufficiency of gonads of the man.

Also idiopathic form of primary hypogonadism at men with the obscure etiology of a disease is possible.

At the acquired primary hypogonadism at teenage age there is no formation of secondary sexual characteristics. At adult men the disease leads to increase in body weight, decrease in a libido, disturbances of an erection and spermatogenesis, to reduction of expressiveness of male sexual characters and development of infertility.

Secondary hypogonadism at men

The secondary or hypogonadotropic hypogonadism can also be inborn. It develops at disturbances of secretion of hormones a hypophysis and a hypothalamus. The secondary hypogonadism accompanies the following genetic diseases:

• Paskualini's syndrome,
• Meddok's syndrome,
• Pradera-Willie's syndrome.

Development of a hypogonadotropic hypogonadism - also not a rarity at cranyopharyngiomas (brain epithelium tumors).

The acquired secondary hypogonadism develops as a result of complications of inflammatory processes in a brain. Meningitis, an arachnoiditis, an encephalomeningitis, encephalitis, etc. can provoke them.

At them not only function of gonads suffers, but also there are other pathologies of gipotalamo-pituitary system: disturbances of secretion of a thyroid gland, thermal control, weight and linear growth.

Diagnosis of a hypogonadism at men

Inborn primary hypogonadism is diagnosed if at the newborn boy testicles at a palpation are not probed. Are applied to confirmation of the diagnosis by ultrasonography of bodies of a small pelvis and a hormonal blood analysis.

Characteristic symptoms of a disease are testosterone indicators below norm, the high level of luteinizing and follicle-stimulating hormones at primary hypogonadism and deficit is higher than the specified hormones at a hypogonadotropic hypogonadism.

In diagnosis of a secondary hypogonadism at men KT, MPT, and also a brain electroencephalography are applied.

For clarification of the reasons of a hypogonadism of primary or secondary form genetic differential diagnosis of pathology is carried out.

Treatment of a hypogonadism at men

In treatment of a hypogonadism replacement therapy is applied by male sex hormones. At lifelong continuous administration of drugs, since teenage age, at the boy secondary sexual characteristics form. In most cases it is possible to keep sexual function also.

Treatment of the hypogonadism provoked by a cryptorchism, preferential surgical. The recommended age of an operative measure - 1-1,5 years. The provision of a neopushcheny small egg in belly space is higher, the earlier there are irreversible processes in fabrics of seminal glands. They lead to the acquired primary hypogonadism and infertility.

Treatment of a hypogonadism of a hypogonadotropic form consists in therapy of a basic disease. Surgical or beam treatment of a hypogonadism is carried out at brain tumors.

The strategy of replaceable treatment of a hypogonadism of a secondary form depends on extent of disturbances of production of hormones gipotalamo-pituitary system and age of the patient.

If there is no need to keep spermoobrazuyushchy function of the patient, treatment of a hypogonadism of a hypogonadotropic form is carried out by means of testosterone.

At young men and boys of teenage age the short course of testosteronovy therapy is applied, and for normalization of a spermatogenesis at a hypogonadotropic hypogonadism drugs of gonadotropic hormones are used.