Hypogonadism.pdf

Hypogonadism Reduced or absent sex hormone production by gonads (testes/ovaries) Primary: Disorder of gonads Secondary: Hypothalamus/pituitary disease (Loss of LH/FSH) Male Hypogonadism Primary hypogonadism o Low Testosterone o High LH/FSH o HYPERgonadotropic hypogonadism Secondary hypogonadism o Lo...

Hypogonadism Reduced or absent sex hormone production by gonads (testes/ovaries) Primary: Disorder of gonads Secondary: Hypothalamus/pituitary disease (Loss of LH/FSH) Male Hypogonadism Primary hypogonadism o Low Testosterone o High LH/FSH o HYPERgonadotropic hypogonadism Secondary hypogonadism o Low Testosterone o Low-normal LH/FSH o HYPOgonadotropic hypogonadism Clinical Features: o Vary with age of onset o Pre-puberty: Failure to undergo normal puberty o Adult § Decreased energy § Decreased libido § Infertility § Loss of sexual hair, muscle mass, bones (untreated for years) Complications of Male Hypogonadism Depends on when it develops (fetal, puberty, adulthood) o Abnormal genitalia o Enlarged male breasts (gynecomastia) o Infertility o Erectile dysfunction o Osteoporosis o Poor self-image Primary Male Hypogonadism Secondary Male Hypogonadism Klinefelter syndrome (47,XXY) Pituitary tumors Myotonic dystrophy (genetic disorder, progressive muscle weakness) Pituitary apoplexy (Hemorrhage into gland) Swyer syndrome: Gonadal dysgenesis Kallmann syndrome (GnRH deficiency/anosmia) Mumps: Damage the testis 5:1 male ratio Female Hypogonadism Presents w amenorrhea Primary hypogonadism o Low Estrogen o High LH/FSH Secondary hypogonadism o Low Estrogen o Low-normal LH/FSH HIV/AIDS Inflammatory disease (Sarcoidosis, TB) Medications Obesity Aging Amenorrhea Absence of menstruation Primary: failure to menstruate by 15 Secondary: Cessation of menses Primary Amenorrhea Pituitary disorders o Hypopituitarism o Kallmann syndrome Ovarian disorders o Turner syndrome – most common cause o PCOS in adolescence (androgen excess) Anatomic disorders o Mullerian agenesis (absent vagina/uterus) Mullerian Agenesis Mayer-Rokitansky-Küster-Hauser Syndrome Underdevelopment of Mullerian system Congenital absence of vagina No Cervix No Uterus 1° amenorrhea Normal 2° sexual characteristics o Breasts o Pubic hair o Functional Ovaries o Normal hormone levels Primary Ovarian Insufficiency Premature Ovarian Failure o Hypergonadotropic hypogonadism o < 40 years of age o Clinical features similar to menopause o Hot flashes o Vaginal dryness o Low Estrogen o Elevated FSH/LH Secondary Amenorrhea Selected Causes o Pregnancy (anovulation) o Menopause o Hyperprolactinemia o Thyroid disease o Hyper and hypothyroid o Anovulation o Multiple mechanisms Cushing’s syndrome (corticosteroids) o Cortisol suppresses GnRH o Low LH/FSH o Low estradiol Cirrhosis o Disruption of hormone metabolism o Variable levels of testosterone, estradiol, and prolactin Spironolactone o Anti-androgen (disrupts estrogen/androgen balance) o Anti-diuretic o May stimulate progesterone receptors Diagnostic tests o hCG o Prolactin o TSH o FSH (↑ FSH in ovarian failure) o Brain MRI (exclude pituitary mass) Functional Hypothalamic Amenorrhea Common cause 2° amenorrhea Decrease GnRH secretion Low serum estradiol LH/FSH low or normal Risk factors: o Eating disorders o Excessive exercise o Weight loss o Stress o Inadequate nutrition can lead to alterations in hormone levels, menstrual irregularities Asherman Syndrome Uterine adhesions (usually following uterine surgery) Adhesions/fibrosis of endometrium Infertility 2° amenorrhea 90% cases from uterine curettage o Dilation and curettage (“D&C”) o Cervix dilated, uterus scraped with a curette o Damage to the regenerative layer (basalis) o Often done after pregnancy/miscarriage to remove tissue Menstrual Irregularities: causing changes in menstrual bleeding patterns Infertility: severe adhesions obstruct fallopian tubes or interfere with implantation, leading to infertility or recurrent miscarriages Pelvic Pain: During menstruation Pregnancy Complications: Placental abnormalities, preterm, miscarriage