Hypogonadism. Clinical features. Male and Female
Simply put, this is diminished funciton of the gonads (testes or the ovaries) meaning reduciton in sex hormone production. The book looks at men and women separately, so that’s what we’ll do, because we’re boring!
Male hypogonadism
Male hypogonadism is an androgen deficiency. Primary hypogonadism indicates there is an anomaly in the testes (characterised by an increase in LH and FSH released from the anterior pituitary), while the secondary form is when there is a defect at the hypothalamus or pituitary resulting in decreased gonadotropins (LH, FSH or both). In some cases, we have combined primary and secondary hypogonadism.
Image: “Hypothalamic–pituitary–gonadal axis” by Artoria2e5, CC BY 3.0, via Wikimedia Commons.
There is a long list of potential causes, we have listed some below:
Primary causes
- Congenital disorders
- Klinefelter's (most common chromosomal)
- Myotonic dystrophy
- Acquired defects
- Orchitis
- Mumps (25% of cases) and other viruses
- Granulomatous diseases (e.g. TB)
- Iatrogenic
- Drugs
- Cytotoxic agents
- Ethanol
- Autoimmune testicular failure
- Associated with other organ specific disorder (e.g. addisons’, hashimotos)
Secondary causes
- Isolated gonadotropin-releasing hormone deficit
- Kallmann's syndrome
- Prader willi syndrome
- Pituitary hypoplasia
- Acquired
- Traumatic brain injury
- Neoplasm
- Pituitary adenoma
- Craniopharyngioma
- Infection
- Obesity
- Malnutrition
Symptoms of male hypogonadism depend on the age of disease onset:
- Pre-pubescent patients
- Small genitalia
- Lack of facial hair
- Failure of voice to deepen
- Inability to gain muscle mass
- Puberty onset hypogonadism
- Impaired sexual development
- Decreased testicular size
- Enlarged breasts
- Adult onset hypogonadism
- Erectile dysfunction
- Low sperm count
- Depressed mood
- Decreased libido
- Lethargy
- Sleep disturbance
- Osteoporosis
- Increased body fat
- Hot flushes
- Loss of body hair
- Sweating
Female hypogonadism
In females, hypogonadism is the inadequate function of the ovaries, leading to decreased production of oestrogen and progesterone. It can be primary (ovarian dysfunction) or secondary (failure of the hypothalamus or pituitary gland) again, termed, hypergonadotropic hypogonadism or hypogonadotropic hypogonadism respectively.
Again, female hypogonadism can be congenital or acquired. Lets take a look at the most common causes.
Primary
- Congenital
- Chromosomal/genetic (Turner, Fragile X) and metabolic (galactosaemia)
- Congenital adrenal hyperplasia
- Ovarian dysgenesis
- Acquired
- Iatrogenic (medication such as chlorambucil, or radiotherapy)
- AI diseases (e.g. autoimmune polyglandular syndrome type 1)
- Infections (mumps, TB, malaria, varicella)
- Bacterial infections (shigella)
Secondary
- Congenital
- Kallmann syndrome
- Acquired
- Mass effect of intracranial lesion
- Infiltrative disease (e.g. sarcoidosis, haemochromatosis)
- Infection (e.g. meningitis and TB)
- Pituitary apoplexy (bleeding into pituitary)
- Trauma
The clinical features again depend on age of presentation:
- Pre-puberty
- Leads to absent pubertal development - no pubic hair, primary amenorrhea