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    Hypogonadism

    Gonadal deficiency

    Hypogonadismoccurs when the body's sex glands produce little or no hormones. In men, these glands (gonads) are the testes. In women, these glandsare the ovaries.

    Causes

    The cause of hypogonadismis primary or central. In primary hypogonadism, the ovaries or testes themselves do not function properly. Causes of primary hypogonadism include:

    • Certain autoimmune disorders
    • Genetic and developmental disorders
    • Infection
    • Liver and kidney disease
    • Radiation
    • Surgery

    The most common genetic disorders that cause primary hypogonadism are Turner syndrome (in women) and Klinefelter syndrome (in men).

    In central hypogonadism, the centers in the brain that control the gonads (hypothalamus and pituitary) do not function properly. Causes of central hypogonadism include:

    • Bleeding
    • Certain medicines, including steroids and opiates
    • Genetic problems
    • Infections
    • Nutritional deficiencies
    • Iron excess (hemochromatosis)
    • Radiation
    • Rapid, significant weight loss
    • Surgery
    • Trauma
    • Tumors

    A genetic cause of central hypogonadism that also takes away the sense of smell is Kallmann syndrome in males. The most common tumors affecting the pituitary are craniopharyngioma in children and prolactinoma in adults.

    Symptoms

    Girls who have hypogonadism will not begin menstruating. Hypogonadism can affect breast development and height in girls. If hypogonadism occurs after puberty, symptoms include:

    • Hot flashes
    • Loss of body hair
    • Low libido
    • Menstruation stops

    In boys, hypogonadism affects muscle and beard development and leads to growth problems. In men the symptoms are:

    • Breast enlargement
    • Decreased beard and body hair
    • Muscle loss
    • Sexual problems

    If a brain tumor is present (central hypogonadism), there may be:

    • Headaches or vision loss
    • Milky breast discharge (from a prolactinoma)
    • Symptoms of other hormonal deficiencies (such as hypothyroidism)

    People with anorexia nervosa who diet to the point of starvation and those who lose a lot of weight very quickly, such as after gastric bypass surgery, may also have central hypogonadism.

    Exams and Tests

    Tests may be done that check:

    • Estrogen level (women)
    • FSH level and LH level
    • Testosterone level (men)

    Other tests may include:

    • Blood tests for anemia and iron
    • Genetic tests
    • Prolactin level (milk hormone)
    • Sperm count
    • Thyroid level

    Sometimes imaging tests are needed, such as a sonogram of the ovaries. If pituitary disease is suspected, an MRI or CT scan of the brain may be done.

    Treatment

    Hormone-based medicines may be prescribed.For girls and women,estrogen and progesteronecome in the form of a pill or skin patch. For boys and men, testosterone can be givenas a skin patch, skin gel, a solution applied to the armpit, a patch applied to the upper gum, or by injection.

    For women who have not had their uterus removed, combination treatment with estrogen and progesteronemay decrease the chance of developing endometrial cancer. Women with hypogonadism who have low sex drivemay alsobe prescribedlow-dose testosterone.

    In some women, injections or pills can be used to stimulate ovulation. Injections of pituitary hormone may be used to help male patients produce sperm. Other people may need surgery and radiation therapy.

    Outlook (Prognosis)

    Many forms of hypogonadism are treatable and have a good outlook.

    Possible Complications

    In women, hypogonadism may cause infertility. Menopause is a form of hypogonadism that occurs naturally and can cause hot flashes, vaginal dryness, and irritability as a woman's estrogen levels fall. The risk of osteoporosis and heart disease increase after menopause.

    Some women with hypogonadism take estrogen therapy, especially those who have early menopause (premature ovarian failure).But there is an increased riskof breast cancer and heart disease when hormone therapy is used long-termto treat menopause symptoms.

    In men, hypogonadism results in loss of sex drive and may cause:

    • Impotence
    • Infertility
    • Osteoporosis
    • Weakness

    Men normally have lower testosterone as they age, but the decline is not as dramatic or steep as the decline in sex hormones that women experience.

    When to Contact a Medical Professional

    Talk to your doctor if you notice:

    • Breast discharge
    • Breast enlargement (men)
    • Hot flashes (women)
    • Impotence
    • Loss of body hair
    • Loss of menstrual period
    • Problems getting pregnant
    • Problems with your sex drive
    • Weakness

    Both men and women should call their health care provider if they have headaches or vision problems.

    Prevention

    Maintain normal body weight and healthy eating habits to prevent anorexia nervosa. Other causes may not be preventable.

    References

    Ali O, Donohoue PA. Hypofunction of the testes. In: Kliegman RM, Stanton BF, St. Geme JW III , et al., eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 577.

    Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: An Endocrine Society Clinical Practice guideline. J Clin Endocrinol Metab. 2010;95:2536-2559.

    Kansra AR, Donohoue PA. Hypofunction of the ovaries. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 580.

    Swerdloff RS, Wang C. The testis and male sexual function. In: Goldman L, Schafer AI. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 242.

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          Tests for Hypogonadism

            Review Date: 12/22/2012

            Reviewed By: Nestoras Mathioudakis, MD, Assistant Professor of Medicine, Division of Endocrinology & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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