The Diagnosis And Treatment Of Gonadotropic Hypogonadism

Background:Male gonadotropic hypogonadism is a pathological condition that males still have no significant signs of secondary sexual characteristics development and testicular enlargement at the age of 14 years or above two standard deviations of the average age due to malfunction of the hypothalamus or pituitary,or caused by testicular failure. The former is callled hypogonadotropic hypogonadism, or secondary hypogonadism. the latter is named hypergonadotropic hypogonadism, or primary hypogonadismClinically, this disease is often misdiagnosed or wrongly treated or delayed treated due to lack of sufficient knowledge of the etiology and pathogenesis, which caused irreparable damage to patients.The main objective of this research was to analyze the clinical features and to assess treatment effect of 120 male patients with gonadotropic hypogonadism from department of andrology in the First Hospital of Jilin University during October 2005 to May 2009.Objective:To study the clinical characteristics, diagnosis and treatment of Male gonadotropic hypogonadismMethods:120 data of male outpatients with gonadotropic hypogonadism from department of andrology in the First Hospital of Jilin University during October 2005 to May 2009.was retrospectively analyzed,its clinical features and treatment effect was evaluated.Results:According to serum sexual hormone level,50 cases with hypergonadotropic hypogonadism including 42 cases with Klinefelter syndrome, and 8 cases with acquired hypergonadotropic hypogonadism (3 caused by serious testicular injury,3 with a clear history of mumps,2 cases with bilateral cryptorchidism) were diagnosed.Besides,70 cases of hypogonadotropic hypogonadism including 49 patients with idiopathic hypogonadotropic hypogonadism and 21 patients with Kallmann syndrome were diagnosed. Different treatment was given according to different hormone levels,and patients with hypergonado- tropic hypogonadism was given Testosterone undecanoate 40mg,3 times daily po, or 500mg, daily per 6-8 weeks, im. And patients with hypogonadotropic hypogonadism was administered human Chorionic Gonadotropin (HCG),1500IU, and human menopausal gonadotropin (HMG),75-150IU,2 times/week, Testosterone undecanoate 40 mg twice, po, was given simultaneously. After 1-2 years'follow-up, patients with hypogonadotropic hypogonadism received a significant treatment effect, and the effective rate was over 95%. Patients with hypergonadotropic hypogonadism also improved significantly in testicular volume and penile erection.Conclusion:Male gonadotropic hypogonadism represented by Klinefelter syndrome and idiopathic hypogonadotropic hypogonadism is the most common organic disease that impacts male gonad development, causing male infertility. Patients with hypergonadotropic hypogonadism can receive significantly improvement in sexual desire and penile erection by androgen replacement therapy for whole life. Earlier initial treatment can also improve development of sex organs and secondary sexual characteristics. It is of little significance in improvement of reproductive function.However, to patients with hypogonadotropic hypogonadism, HCG combined with HMG therapy can improve development of adolescent secondary sexual characteristics, and can restore testosterone production and spermatogenesis, with no obvious side effects. At the same time, It can increase semen density in patients with asthenozoospermia and solve fertility problems. In addition, patients with larger testicular volume can obtain better treatment effect. It has no effec to olfactory dysfunction for patients with Kallmann syndrome.