Hypogonadism

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Classification according to ICD-10
E28.3 Primary ovarian failure
E29.1 Testicular hypofunction
E23.0 Hypopituitarism - Hypogonadotropic hypogonadism
ICD-10 online (WHO version 2019)

Hypogonadism is an endocrine disorder of the gonads (gonads). Most often the hypogonadism ( gonodic insufficiency ) of men ( male hypogonadism ), i.e. the lack of or reduced hormonal activity of the testicle, is meant. A female hypogonadism is charakteristiert by lack of estrogen or progesterone production (or lack of ovulation missing corpus luteum formation)

Classification

The classification of hypogonadism is based on the underlying disorder.

  • Hypergonadotropic hypogonadism : Here the disorder is at the level of the gonads (gonads, i.e. ovaries and testes). Despite sufficient stimulation from the higher-level hormone centers, the ovaries or testes produce too few hormones or gametes. Typical congenital disorders are Klinefelter syndrome in men and Turner syndrome in women . Hypergonadotropic hypogonadism is also known as primary hypogonadism .
  • Hypogonadotropic hypogonadism: Due to a disruption of the superordinate centers, too few of the hormones that control the gonads are produced. So the disorder lies in the pituitary gland or hypothalamus . Due to the lack of these hormones, the testicles or ovaries are not stimulated enough, but are basically functional. Typical diseases are pituitary adenomas or congenital disorders such as B. the Kallmann syndrome , furthermore direct damage to the anterior pituitary gland in hemochromatosis. Hypogonadotropic hypogonadism is also known as secondary hypogonadism when the disorder is in the pituitary gland and tertiary hypogonadism when the disorder is in the hypothalamus.
  • Hemochromatosis (iron overload) as the cause

Symptoms

The most important leading symptom of hypogonadism is the restriction or even loss of libido and potency. Those affected complain of an unfulfilled sex life. In addition, there are a number of unspecific symptoms that could basically be assigned to different diseases. Patients complain of tiredness, weakness and listlessness. The risk of being overweight is also increased. The underfunction of the testicles leads to androgen deficiency with different effects depending on the age and possibly to reduced or absent fertility ( infertility ). An example of a reproductive disorder alone is Kartagener's syndrome .

Hypogonadism in childhood leads to the absence of puberty (so-called eunuchism ). If hypogonadism does not appear until adulthood, there is, among other things, a regression of the primary and secondary sexual characteristics and fertility disorders. The development of osteoporosis is also common .

Illustration of a man with regression of primary and secondary sexual characteristics

Aging man's hypogonadism

The hypogonadism of aging men (late-onset hypogonadism, " climacteric virile ") is attributed to the decline in testicular function in old age. It is characterized by lowered testosterone levels and the associated disorders. The errors are u. a.

In the context of syndromes

Hypogonadism (formerly sometimes called "eunuchoidism") can also occur in the context of syndromes :

therapy

Testosterone preparations with different galenics are available for symptoms that require treatment . Diagnosis is based on clinical and medical laboratory tests. If the testosterone level is below 12 nmol / l, testosterone replacement therapy is indicated. There are now different dosage forms for a testosterone substitute: tablets, syringes or gels. The latter are currently establishing themselves as the “most natural” variant. They are always applied in the early morning, when the natural testosterone level is highest in men. Many patients find the dosage to be the easiest and most pleasant with a gel. On the other hand, testosterone replacement therapy is not recommended for aging men, as its effectiveness has not been proven and it is associated with considerable risks.

forecast

Hypogonadism is usually good to treat. There is currently evidence that the symptoms of those affected can be improved by the therapy and that the risk of osteoporosis can also be reduced. A meta-analysis has shown that hormone replacement therapy may also lower the risk of developing obesity .

See also

literature

  • Ludwig Weissbecker: diseases of the gonads. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 1025-1033, here: pp. 1027-1032 ( Die Gonadeninsufficiency ).

Web links

Individual evidence

  1. ↑ Carlos Thomas (Ed.): Special Pathology. Schattauer Verlag, 1996, ISBN 3-7945-1713-X , p. 379.
  2. ↑ a b c d e f g Dohle et al .: Guideline Male Hypogonadism . In: Krause & Pachernegg GmbH (Ed.): J. Reproduktionsmed. Endocrinol . tape 10 (5-6) . Krause & Pachernegg GmbH, Gablitz 2013, p. 279-292 .
  3. ↑ Bernfried Leiber (founder): The clinical syndromes. Syndromes, sequences and symptom complexes . Ed .: G. Burg, J. Kunze, D. Pongratz, PG Scheurlen, A. Schinzel, J. Spranger. 7., completely reworked. Edition. tape 2 : symptoms . Urban & Schwarzenberg, Munich et al. 1990, ISBN 3-541-01727-9 .
  4. ↑ a b Dysplasia, ectodermal, Berlin type. In: Orphanet (Rare Disease Database).
  5. ↑ Conductive hearing loss - malformations of the outer ear. In: Orphanet (Rare Disease Database).
  6. ↑ Marc B. Garnick. Testosterone Replacement Therapy Faces FDA Scrutiny. In: JAMA. December 11, 2014. doi: 10.1001 / jama.2014.17334
  7. ↑ Reichle: Testosterone Deficiency: What Does Substitution Do? In: Frank H. Mader (Ed.): The general practitioner . No. 18 . Verlag Kirchheim + Co GmbH, Mainz 2015, p. 24-26 .