What is Primary Acquired Hypogonadism?
The primary acquired hypogonadism is a hypogonadal state as a result of exposure to the testicle of external or internal factors after birth.
Causes of Hypogonadism of the Primary Acquired
The causes of acquired hypogonadism are diverse. It can be the result of an infectious and inflammatory lesion of the testicles and adnexal genital organs (orchitis, orchi-epididymitis, epididymitis, deferentitis, vesiculitis), operations on the scrotum and inguinal areas (herniation, orchipexy) with careless attitude to the vessels of the testicles, the result of torsion of the spermatic cord , inversion of the testicles, developing varicocele, in which trophic testicles are disturbed. Household, military, sports injuries (all types of mechanical impact – bruises, falls, kicks, balls, etc.) lead to degenerative changes in the testicles. Severe injuries and especially testicular tumors often end in castration. It is believed that viral infections (in particular the mumps virus) suffered in childhood are complicated by orchitis. At the same time, degenerative processes are slow and progressive.
Spermatogenic epithelium is very sensitive to radiation. The degree of damage depends on the radiation dose (x-ray, radioactive substances, neutron). Industrial poisons (organic solvents, colchicine, bisulfate, pesticides), alcohol, some drugs (immunosuppressor cyclophosphamide), nitrofurans, tetracycline antibiotics, neomycin, large doses of hormonal drugs have a damaging effect on the testicles. In particular, nitrofurans (furadonin, furagin) inhibit spermatogenesis, reduce sperm motility. Prednisolone, hydrocortisone, dexamethasone (DMZ), sinestrol sharply inhibit the androgenic function of the testicles and negatively affect spermatogenesis at the level of spermatogonia and spermatids.
Extensive automation and electrification of the national economy led to the appearance of such production factors as hyperthermia, high humidity, vibration, and electromagnetic fields. Spermatogenesis is most sensitive to damaging factors; in particular, the high ambient temperature violates the normal synthesis and metabolism of sex hormones, which affects both the reproductive and sexual functions of men.
Adverse effects on the testicles are exerted by alternating currents of high frequency. Significantly affect the body and electromagnetic fields, staying in the zone of which violates the daily rhythm of the functioning of the regulatory systems of the human body, in particular the function of the hypothalamus, develops a diencephalic form of impotence. General vibration also negatively affects spermatogenesis. In the pathogenesis of sexual disorders as a result of harmful physical occupational influences, an important role is played by disorders of the autonomic nervous system, changes in the secretion and biosynthesis of catecholamines. Adverse effects on the testicles as hypothermia of the genital area, which provokes inflammatory and degenerative processes, and overheating.
Clinical and laboratory signs of hypogonadism are observed in chronic alcoholism. The direct toxic effect of alcohol on the testicular parenchyma has been established, as a result of which there are violations of spermatogenesis, leading to the appearance of pathologically altered spermatozoa in the seminal fluid. In such patients, not only a decrease in the number, but also the appearance of a large number of biologically defective sperm cells in the seminal fluid was detected, which is characterized by an increase in the immobile forms of sperm cells (65.6%) and morphologically defective sperm cells (69.3%). the appearance of young cells in the ejaculate. All this indicates inhibition of spermatogenesis at the stage of spermatids.
Pathogenesis during Primary Acquired Hypogonadism
The pathogenetic mechanisms of primary acquired hypogonadism correspond to the same mechanisms of primary congenital hypogonadism. The degree of violation of the hypothalamic-pituitary system depends on the degree and location of damage to the elements of the testicles. Most often, there is a predominant damage to the generative structures, in such cases the follicle-stimulating activity of the adenohypophysis (FSH) increases and normal remains or there is a slightly increased luteinizing activity (LH). Changes in the pituitary-gonadal system can be reversible or persistent depending on the degree (dose) of damage, the duration of exposure, the age at which the patient is. Prolonged exposure to a damaging factor also leads to impaired endocrine function of the testicles with the gradual development of androgen deficiency.
Primary acquired hypergonadotropic hypogonadism can manifest itself either in the type of total damage to the testicles, or in primary isolated damage to the interstitial tissue of the testicles, and more often in the type of primary tubular insufficiency (false Klinefelter syndrome). No true reasons have been established for the predominantly one or another nature of the damage.
Symptoms of Primary Acquired Hypogonadism
If the influence of harmful factors occurs in adulthood, then there is a regression of secondary sexual characteristics, extrapulmonary signs of testicular insufficiency (heroderma, vascular and muscle hypotension) appear, sexual desire decreases or disappears, an erection is weakened, oligo- and azoospermia develop.
Primary acquired deficiency of the germinal epithelium (false Klinefelter syndrome). The clinical picture corresponds to the true Klinefelter syndrome: patients of high growth, eunuchoid physique, with the manifestation of gynecomastia (and without it), secondary sexual characteristics are not sufficiently developed. The testicles are small, often dense, the size of the penis is on the lower border of the norm. Intelligence saved.
Diagnosis of Primary Acquired Hypogonadism
Primary acquired testicular endocrinocyte insufficiency is accompanied by a sharp decrease in testosterone production, leading to an increase in the level of LH in the blood. FSH secretion remains normal or slightly elevated, indicating that the tubules remained intact or were less affected. In patients, there are all signs of hypogonadism, by the puberty period eunuchoid features are formed, in adults, fertility is reduced.
Differential diagnosis with other forms of hypogonadism is based on determining the level of T, FSH, LH. The hCG test is negative. Karyotype 46XY, PX – negative.
Primary Acquired Hypogonadism Treatment
Treatment with androgens according to the substitution principle, taking into account the degree of hypoandrogenization and age.