Androgen deficiency in hypothalamus and pituitary gland diseases

Androgen deficiency in hypothalamus and pituitary gland diseases Filatova Varvara 20. 02.

The structure of the presentation Point one – normal hormonal regulation of the testicular function and effects of androgens Point two — hypothalamus/pituitary diseases Point three – clinical case

Hormonal regulation of the testicular function and effects of androgens. Eberhard Nieschlag Hermann M. Behre Susan Nieschlag (Editors) Andrology Male Reproductive Health and Dysfunction

Male hypoangrogenism can be classified : the level of the hypothalamic-pituitary-testicular cell population initially impaired the period of life when the gonadal function begins to fail.

Classification of disorders of testicular function Hypothalamus/pituitary: Kallmann syndrome Prader-Labhart-Willi syndrome Constitutionally delayed puberty Secondary disturbance of Gn. RH secretion Hypopituitarism Hyperprolactinemia

Kallmann syndrome is a rare (1: 10 000 persons) disorder that occurs in familial and sporadic forms. Clinical features include anosmia, facial asymmetry, color blindness, renal anomalies, microphallus, and cryptorchidism. Hormone evaluation reveals low testosterone, low LH, and low FSH levels. Virilization and fertility can be achieved when FSH and LH are given to stimulate testis function.

G enetic and molecular basis of Kallmann syndrome

Prader-(Labhart-)Willi Syndrome Prader-Willi syndrome (1: 20, 000 persons) Clinical features include genetic obesity, retardation, small hands and feet, and hypogonadism The single gene deletion associated with this condition is found on chromosome 15. Similar to Kallmann syndrome, spermatogenesis can be induced by exogenous FSH and LH.

p. Juan Carreno de Miranda

Constitutionally delayed puberty Delayed puberty (pubertas tarda) is present in a boy by definition if pubertal development (genital development, testicular growth) has not started by the age of 14 years.

Isolated LH Deficiency (Pasqualini syndrome): Eunuchoid body proportions Absence Virilization with Spermatogenesis LH and testosterone levels are low-normal. Isolated FSH Deficiency: Oligospermia to Azospermia Normal Virilization LH and testosterone levels are normal. Hypopituitarism

Hyperprolactinemia Eberhard Nieschlag Hermann M. Behre Susan Nieschlag (Editors) Andrology Male Reproductive Health and Dysfunction

Romijn JA: Chapter 13 — Hyperprolactinemia and prolactinoma. In: Eric Fliers MK and JAR, editor. Handbook Clin Neurol. Elsevier. 2014 Hormonal axis regulating testosterone production.

Patient 52 y/o Complaints erectile dysfunction ( for 3 years) blurred vision headache weakness Signs bilateral optic disc pallor and atrophy bitemporal hemianopia ICD-10 -CM Diagnosis Code. E 22.

Magnetic resonance image of a macroprolactinoma

Hormone 04. 2006 01. 2007 06. 2008 prolactin testosterone N LH N N Low normal FSH N N Low normal Т 4 N N Low normal TSH N N Low normal

Dopamine agonist Treatment Dostinex 0, 5 mg 4 times per week MRI year later Control of prolactin level 3 months later Walia R, Bhansali A, Dutta P, et al. : Recovery pattern of hypothalamo-pituitary-testicular axis in patients with macroprolactinomas after treatment with cabergoline. Indian J Med Res.

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