CLINICAL AND HORMONAL PROFILE OF HYPOGONADISM

Abstract

Introduction: Hypogonadism is an important problem with which many boys and girls present to the Medicine OPD. Hypogonadism is testicular failure which is due to genetic disorders (eg, Klinefelter’s syndrome), trauma, radiation, orchitis, chemotherapy, or undescended testes, is known as hypergonadotropic hypogonadism or primary hypogonadism. The clinical features of hypogonadism are sufficiently well recognized, the causes sufficiently well known, and the tests of the hypothalamic-pituitary-testicular axis sufficiently accurate to permit the diagnosis in most patients. Hypogonadism is one of the most common endocrine disorders in men and is characterized by low serum testosterone levels and/or low sperm counts with clinical signs and symptoms of androgen loss. Hypogonadism can be primary or secondary, congenital or acquired. The causes and management of primary and secondary hypogonadism and an overview of hypogonadism in older men are reviewed elsewhere. Gonadotropin deficiency or dysfunction in male individuals results a disease or damage to the hypothalamic-pituitary axis is known as hypogonadotropic hypogonadism, central hypogonadism, or secondary hypogonadism. Men especially which is older than 50 years might have low testosterone levels with functional abnormalities at multiple levels of the hypothalamic-pituitary-testicular axis. Several studied reported a high prevalence of low testosterone levels in men (hypogonadism) with T2DM. Gonadotropin releasing hormone (GnRH) deficiency is caused by impaired gonadotropin release in the setting of otherwise normal anterior pituitary anatomy and function and in the absence of secondary causes of hypogonadotropic hypogonadism. Individuals with normal GnRH have normal pituitary function tests and their hypogonadism typically responds to a physiologic regimen of exogenous.

Aim: The main aim of this study is to find out the type of hypogonadism as either hypogonadotropic or hypergonadotropic. 

Material and methods: This study is conducted in the department of Biochemistry in collaboration with Dept. of Medicine at Govt. Medical College and SVBC Hospital.  Total 50 patients were include in this study in which patients visiting out patients department (OPD) of medicine.  Patients with the age above 12 years with underdeveloped secondary sexual characters, delayed puberty were included in this study. Individuals with chronic systemic illness, abuse drugs or alcohol and undergone cancer chemotherapy or radiotherapy were excluded in this study.  Detailed history of the patients was taken from the patients like height, weight and arm span with general and systemic examination to rule out any systemic illness were noted. Estimation of hormonal levels was noted from all patients. Radiological examination like X-ray Cone View Sella, X-ray left forearm and X-ray left wrist was done for asses the bone age and epiphyseal fusion. MRI Brain (Sella) was also done to rule out structural causes of pituitary dysfunction.

Result: Total 50 patients were included in this study. Out of 50 patients 44 (88%) patients were males and remaining were female (12%).  Among total patients 39 (78%) were below 18 years of age and remaining were above 18 years were 11(22%). Most common etiology was idiopathic hypogonadotropic hypogonadism patient with bilateral anarchic or vanishing testis syndrome.

Conclusion:  Most common age group below 18 years of age has presentation of hypogonadism which is more common in Males than in female. The most common cause is Idiopathic hypogonadotropic hypogonadism is shown in male. Height, weight and Arm span varied significantly between Males of hypogonadotropic hypogonadism and hypogonadotropic hypogonadism. Therefore, significant correlation existed between total testosterone and LH in males, whereas height and arm span correlated well in both males and females.

Keywords:  Hypogonadism, Testosterone, Hypergonadotropic hypogonadism, Hypogonadotropic hypogonadism