Secondary hypogonadism

Secondary hypogonadism is a syndrome caused by a decrease in the production of gonadotropic hormones of the anterior pituitary gland, resulting in a sharp decrease in estrogen secretion by the ovaries, and characterized by amenorrhea, the reverse development of secondary sexual characteristics, hypoplasia of the external genital organs and the uterus.

Etiology and pathogenesis. The cause of secondary hypogonadism can be diseases of the hypothalamic-pituitary system, accompanied by a violation of the relationship between the hypothalamus hypothalamus and the anterior pituitary gland (Symmonds-Skien syndrome, craniopharyngioma, persistent lactorrhea syndrome – amenorrhea, etc.). Secondary hypogonadism occurs in a number of endocrine diseases due to hormonal imbalance (hypothyroidism, congenital dysfunction of the adrenal cortex, Itsenko – Cushing disease, etc.). Secondary hypogonadism may occur after trauma. In a number of cases, mental injury causes depression of the function of the hypothalamic centers, which in turn leads to a decrease in the production of releasing factors and gonadotropic hormones. Secondary hypogonadism can be the result of a severe infection, nutritional distrophy, obesity, suffered by a girl at puberty.

Clinic. The clinical picture is generally caused by the underlying disease. Amenorrhea, reverse development of secondary sexual characteristics are noted. Hypoplasia of the uterus and external genital organs occurs.
Laboratory data. The level of gonadotropic hormones and estrogens in the blood and the excretion of gonadotropic hormones and estrogens in the urine are reduced.

Radiodiagnosis. When craniography (with the central genesis of hypogonadism), tumors of the intermethnic pituitary region (craniopharyngioma, etc.) are often found. In prepubertal secondary hypogonadism, radiological data are the same as in primary hypogonadism.

Diagnosis. The diagnosis is made on the basis of history, clinic and laboratory data. Differential diagnosis – see “Primary hypogonadism.”
Forecast. The prognosis of secondary hypogonadism is determined by the underlying disease.

Treatment. First of all, the main disease should be treated, which often leads to the elimination of secondary hypogonadism. Sometimes chorionic gonadotropin preparations are prescribed to stimulate the ovaries. Treatment with ovarian hormones (estrogens, progesterone) should be carried out carefully so as not to suppress the already damaged gonadotropic function of the pituitary gland. To stimulate the gonadotropic function of the pituitary gland, in some cases, clomiphene is prescribed.