Endocrine System >
Hypogonadism

Impaired function of the gonads (testes or ovaries) to produce sex hormones (testosterone or oestrogen and progesterone) and/or gametes (sperm or ova).”

  • Primary hypogonadism – insufficient sex hormone production
  • Secondary hypogonadism – insufficient gonadotrophin-releasing hormone (GnRH) and/or gonadotropins (LH and FSH)
Aetiology
  • Primary hypogonadism:
    • Congenital abnormalities:
      • Klinefelter syndrome (male)
      • Turner syndrome (female)
    • Acquired gonadal injury
      • Torsion
      • Irradiation
  • Secondary hypogonadism
    • Pituitary or hypothalamic disorders
      • Kallman’s syndrome
      • Prader-Willi syndrome
      • Prolactinoma
Pathophysiology
  1. Impaired function of gonads
  2. Reduced production of sex hormones
  3. Reduced secondary sex characteristics and infertility
Clinical Presentation
  • Males
    • Testicular hypoplasia
    • Decreased libido
    • Gynaecomastia
    • Erectile dysfunction
    • Loss of facial and pubic hair
    • Delayed puberty
    • Decreased lean body mass.
  • Females
    • Delayed puberty:
      • Primary amenorrhoea
      • Slow or absent breast growth
    • Loss of body hair
    • Decreased libido
    • Secondary amenorrhoea.
Investigations
  • Serum testosterone or oestrogen levels
  • Serum LH and FSH levels
  • Serum GnRH levels
  • Bone scan (osteoporosis, delayed epiphyseal closure)
  • Genetic testing for chromosomal abnormalities
  • Serum prolactin (prolactinoma).
  • Primary hypogonadism
    • High FSH and LH
    • Low testosterone/oestrogen/progesterone
  • Secondary hypogonadism
    • Low FSH and LH
    • Low testosterone/oestrogen/progesterone
Management
  • Treat underlying cause (e.g. bromocriptine for prolactinoma)
  • Hormone replacement therapy
    • If prepubertal – testosterone (male) or oestrogen (female)
    • If postpubertal – LHRH or HCG (male) or LHRH or LH and FSH (female)
Complications
  • Infertility
  • Impotence
  • Osteoporosis
  • Low self-esteem

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