DR Medhat MRCP

Male hypogonadism :
■ Causes :
1ry hypogonadism (testicular causes)
2ndry (hypogonadotrophic) hypogonadism
(hypothalamo-pituitary axis disease)
I. Testicular damage : I. Hypothalamic causes :
Cryptorchidism (testicular maldescent)
Trauma (torsion).
Tumours (teratoma).
Inflammation (mumps).
Irradiation.
Drugs (e.g cyclophosphamide).
Enzyme defects: 5α-reductase deficiency
Constitutional delay of pubrty.
Severe stress.
Severe muscular exercise (athlets)
Severe weight loss (anorexia nervosa)
Chronic illness
- CKD, liver cirrhosis/alcoholism.
- Cystic fibrosis / Celiac disease.
II. Gonadal (testicular) dysgenesis II. Pituitary causes :
e.g. Klinefelter’s syndrome
Deficient/abnormal androgen
receptors
Tumors : crainiopharyngioma
,prolactinoma, N-F pituitary adenoma
Trauma : head injury ,surgical removal
سؤال مهم Haemochromatosis
GnRH,FSH & LH Deficiency:
Idiopathic.
Kallman`s syndrome.
Klinefelter syndrome
- Congenital disorder associated with extra
–x chromosome(47,XXY karyotype)
- It`s the commonest chromosomal
abnormality causing hypogonadism in ♂
- It`s not inherited
2- Tall stature.
3- Lack of 2ndry sex
characters:
- Loss of pubic, abdominal
,chest ,UL & facial hair
- Small firm testes (< 4ml)
4- Gynaecomastia→↑ risk of
breast cancer.
5- Infertility.
6- ↑ gonadotropins (FSH/LH)
Kallmann syndrome
- Congenital disorder characterized by
GnRH & gonadotropins
↓(hypothalamic-pituitary)
- Inherited as X-linked recessive trait
(KAL-1 gene on X- chromosome)
1- Anosmia(hypoth)
2- Cleft lip/palate
3- Deafness.
4- Renal agenesis
5- Gynaecomastia
6- Lack of 2ndry sex
characters(delayed
puberty):
- No pubic/axillary hair
- Small penis/testes
7- Infertility
8- ↓/N (FSH &LH)
D. by chromosomal analysis (karyotyping) D by FISH(Fluorescent in situ hybridization)