Male Hypogonadism. Part II: Etiology, Pathophysiology, and Diagnosis

A. Seftel

Int J Impot Res. 2006;18(3):223-228.

Table 1. Differential Diagnosis of Male Hypogonadism
Primary (hypergonadotropic) hypogonadism
Testicular disorders (primary gonadal failure)
Undescended testes
Acquired bilateral torsion of testes
Orchitis (e.g. mumps orchitis)/cryptorchidism
Vanishing-testes syndrome (congenital anorchism or prepubertal functional castrate)
Seminiferous tubule dysgenesis (Klinefelter syndrome)
Pure gonadal dysgenesis (46XX and 46XY)
Sweyer syndrome (phenotypic female with gonads and genitalia identical to gonadal dysgenesis)
Noonan (Boonevie-Ullrich) syndrome
Hemochromatosis
Impaired Leydig cell activity
Inborn errors of testosterone biosynthesis
Leydig cell hypoplasia
Testicular unresponsiveness (LH receptor failure?)
Androgen-resistant states and enzyme defects
Testicular feminization (absence of androgen receptors)
Incomplete androgen insensitivity (Reiffenstein syndrome)
5-Reductase deficiency
External testicular insults
Trauma
Radiation treatment
Chemotherapy
Autoimmune syndromes (e.g. anti-Leydig cell antibody-associated disorders)
Sertoli-cell only syndrome

Secondary (hypogonadotropic) hypogonadism
GnRH deficiency
Hypothalamic lesions
Tumors
Encephalitis
Granuloma
Abscess
Craniopharyngioma
Isolated GnRH deficiency
Idiopathic (Kallmann syndrome or fertile-eunuch syndrome)
Prader-Willi syndrome
Lawrence-Moon-Bardet-Biedl syndrome
Alström syndrome
Fertile-eunuch syndrome
Familial cerebellar syndrome

Hyperprolactinemia
Prolactinoma
Certain drugs
Hemochromatosis
Neurosarcoid
Myotonic dystrophy

Pituitary disorders (gonadotrophin deficiency)
Isolated LH deficiency
Pasqualini syndrome
Eunuchoidism
Absent secondary sexual characteristics
Oligospermia
Tumors
Pituitary infarction, apoplexy
Empty sella syndrome
Hemochromatosis
Cranial trauma with or without pituitary-stalk transection
Irradiation
Hypophysitis

FSH=follicle-stimulating hormone; GnRH=gonadotropin-releasing hormone; LH, luteinizing hormone.
Sources: AACE guidelines^[2] and Rehman et al.^[4]

Table 2. Agents That May Cause low Circulating Testosterone
Cytotoxic agents
Spironolactone

Corticosteroids, ketoconazole, aminoglutethimide, ethanol
Decrease Leydig-cell testosterone production
Anticonvulsants, hepatic microsomal liver enzyme inducers
Augment testosterone metabolism
Gonadotropin-releasing hormone agonists, estrogens, anabolic steroids, psychotropic medications, post-transplant immunosuppressants, corticosteroids, ethanol
Reduce gonadotropin secretion

Adapted with permission from Hameed et al.^[3]

Comments

processing....

Male Hypogonadism. Part II: Etiology, Pathophysiology, and Diagnosis

Comments

Most Popular Articles

What to Read Next on Medscape

About

Membership

Apps

WebMD Network

Editions

Male Hypogonadism. Part II: Etiology, Pathophysiology, and Diagnosis

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Comments

Most Popular Articles

What to Read Next on Medscape

More from This Journal

Latest News & Perspective

Recommended Reading

Drugs Related to Hypogonadism

Most Popular Articles

Recommendations

Email This

Find Us On

About

Membership

Apps

WebMD Network

Editions