Secondary hypogonadism – a syndrome that occurs mainly due to hypothalamic-pituitary insufficiency, leading to a decrease in the production of gonadotropic hormones, followed by a decrease in the secretion of androgens.
Etiology. The causes of secondary hypogonadism can be traumatic injury or pituitary tumor, genetic nanism, diseases leading to hormonal imbalance (hypothyroidism, diabetes, etc.), severe somatic diseases, etc.
Pathogenesis. The pathogenesis of secondary hypogonadism is based on insufficient production of gonadotropic hormones with a subsequent decrease in the secretion of androgens.
Pathological anatomy. In the “typical” form of hypogonadism, the volume, histological structure and consistency of the testes are the same as before puberty. Histologically, in the seminiferous tubules, an undifferentiated germ epithelium with early spermatogonia is noted. Sustentocytes and testicular glandulocytes develop. With partial (incomplete) hypo supisma, the germinal epithelium of the seminiferous tubules differentiates early, but the interstitial tissue is poorly developed.
Laboratory data. Blood levels of gonadotropic hormones and testosterone are lowered. Urinary excretion of gototropod hormones, testosterone and 17-Cc is reduced.
Diagnostic tests. To assess the functional state of the testicles, a test with human chorionic gonadotropin is carried out. The sample is based on the stimulation by chorionic gonadotropin of testicular glandulocytes producing androgens. Chorionic gonadotropin is injected intramuscularly at 1500 IU daily for 5 days, followed by determination of the excretion of 17-CU in the urine. In patients with secondary hypogonadism, in contrast to the primary excretion of 17-COP with urine increases.
Radiodiagnosis. In the case of hypogonadism of the central genesis, craniography often reveals tumors of the hypothalamic-pituitary region. In the case of secondary hypo hypovisualism that arose in the prepubertal period, radiological data are the same as in primary hypogonadism.
Diagnosis and differential diagnosis. The diagnosis of secondary pogonadism is established on the basis of anamnesis, a characteristic clinical picture and laboratory data.
Differential diagnosis – see “Primary hypogonadism.”
Forecast. The prognosis for life is determined by the underlying disease.
Treatment. Chorionic gonadotropin is prescribed in courses (the action is close to GSIK) in 1500 IU intramuscularly 2–3 times a week for 6–8 weeks with breaks of 1-2 months. In the absence of an effect after 6–8 courses of treatment, substitution therapy with male sex hormones is prescribed. You can prescribe the treatment of serum gonadotropin (close to the action of FSH) in combination with preparations of the male sex mountains monov.