Primary hypogonadism
Primary hypogonadism is a syndrome caused by the direct effect of the pathological process on the testicular parenchyma.
Etiology. The causes of primary hypogonadism can be congenital and acquired. Congenital causes of testicular dysfunction include dysgenesis of the seminiferous tubules.
(Klinefelter syndrome), dysgenesis or aplasia of testicles, aplasia of germinal tissue. Acquired testicular dysfunction occurs due to trauma, surgical castration, tuberculosis, complications after orchitis on the basis of acute infections (epidemic parotitis, etc.), syphilis, gonorrhea, the effects of ionizing radiation, etc.
Pathogenesis. The basis of the pathogenesis of primary hypogonadism is insufficient production of androgens by the testes. As a result, underdevelopment of the genital organs, poor development of secondary sexual characteristics, delayed skeletal maturation occur.
(lack of anabolic effects of androgens on the bone matrix), etc.
Pathological anatomy. Histologically, biopsies of the testicles reveal the hyaline degeneration of the seminiferous tubules, the growth of connective tissue between them, and the absence of spermatogenesis. The prostate gland is atrophic.
The clinical presentation of the disease depends on the age at which the testicular damage occurred. With congenital hypoplasia of the testes or damage to their puberty, the so-called eunuchoidism arises, clinically manifested by tall stature with disproportionately long limbs. Often there is obesity with the deposition of fat on the female type, gineko mastic. Musculature is underdeveloped. The penis, scrotum and testicles in size are behind the age norm. Con testis loose or dense.
Secondary sexual characteristics are mild (poor ovulation of the pubis, often lack of facial and body hair). Libido weakened or absent. Patients are barren.
In case of a disease that has developed in the postpubertal period, there is no skeletal imbalance, which is due to the timely closing of the epiphyseal growth zones. Underdevelopment of genital organs is less pronounced. Libido is often preserved. Demasculation is noted: reduction of hair growth, reduction of muscular strength, progressive obesity of the female type, weakening of potency up to impotence. Owing to azoos permium, patients are sterile.
Laboratory data. In the blood, the testostero level is lowered, and gonadotropic hormones are elevated. Selection with
urine gonadotropic hormones significantly increased, and sterone dough and 17-ks lowered.
Radiodiagnosis. In congenital malformations of the testicles or damage to puberty on the x-ray genogram of the wrist with the wrist joint, there is a lagging of the bone age from the passport, which indicates a delay in the maturation of the skeleton. Osteoporosis is often noted in the bones of the wrist joint and spine. Craniography often reveals hyperpneumatization of the main sinus gland, small size of the Turkish saddle, and straightening (“juvenilization”) of its back. With prostatography, a sharp decrease in the prostate gland and a change in its shape are noted.
Diagnosis and differential diagnosis. The diagnosis of primary hypogonadism is established on the basis of anamnestic data, a characteristic clinical picture (eunuchoidism, insufficient development of the testicles, the penis, and secondary sexual characteristics) and laboratory data.
Primary hypogonadism is differentiated from secondary hypogonadism. The presence of secondary hypogonadism is indicated by anamnesis (the development of hypogonadism due to diseases of the hypothalamic-pituitary system, pituitary tumor, diabetes mellitus, hypothyroidism, etc.), the identification of the pathology of the Turkish saddle on roentgenograms of the skull ), decrease in excretion of gut of dotropny hormones with urine, etc.
Forecast. The prognosis for life is favorable, but there is no complete recovery.
Treatment. Substitution therapy is carried out with male sex hormones. Assign intramuscularly 5% oily solution of testosterone propionate 1 ml 1 time per week,
10% oil solution of testenat 1 ml once every 15 days susanonon-250 1 ml once a month. This preparation consists of 30 mg of testosterone propionate, 60 mg of testosterone phenylpropionate, 60 mg of testosterone isocaproate, and 100 mg of testosterone decanoate. Methyltestosterone is applied sublingually by 10 to 30 mg per day.