{"id":4407450,"date":"2022-11-05T07:57:59","date_gmt":"2022-11-05T11:57:59","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/?p=4407450"},"modified":"2023-03-16T04:51:04","modified_gmt":"2023-03-16T09:51:04","slug":"primary-vs-secondary-hypogonadism","status":"publish","type":"post","link":"https:\/\/myendoconsult.com\/learn\/primary-vs-secondary-hypogonadism\/","title":{"rendered":"Primary vs Secondary hypogonadism"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/hypogonadism-doctor-examinng-a-patient.jpg\" sizes=\"auto, (max-width: 940px) 100vw, 940px\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/hypogonadism-doctor-examinng-a-patient.jpg 940w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/hypogonadism-doctor-examinng-a-patient-300x251.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/hypogonadism-doctor-examinng-a-patient-768x644.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/hypogonadism-doctor-examinng-a-patient-624x523.jpg 624w\" alt=\"hypogonadism doctor examinng a patient\" width=\"940\" height=\"788\" \/><\/p>\n<h2>What is hypogonadism ?<\/h2>\n<p>Hypogonadism in a male is defined as a decrease in one or both of the two major functions of the testes, that is spermiogensis (<strong>sperm production) <\/strong>or androgen (<strong>testosterone) production<\/strong>.<\/p>\n<p>Hypogonadism can result from either an insult to the testes (primary hypogonadism) or the hypothalamus or pituitary (secondary hypogonadism).<\/p>\n<h2>Comparison of primary vs secondary hypogonadism<\/h2>\n<table width=\"620\">\n<tbody>\n<tr>\n<td width=\"309\"><strong>Primary hypogonadism<\/strong><\/td>\n<td width=\"310\"><strong>Secondary hypogonadism<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"309\">Serum testosterone concentration and sperm count are below normal<\/td>\n<td width=\"310\">Serum testosterone concentration and the sperm count are also below normal<\/td>\n<\/tr>\n<tr>\n<td width=\"309\">Serum LH and FSH concentrations are above normal.<\/td>\n<td width=\"310\">Serum LH and FSH concentrations are normal or reduced.<\/td>\n<\/tr>\n<tr>\n<td width=\"309\">More likely to be associated with a decrease in sperm production than in testosterone production.<\/td>\n<td width=\"310\">Secondary hypogonadism is associated with a proportionate reduction in testosterone and sperm production.<\/td>\n<\/tr>\n<tr>\n<td width=\"309\">Testes is usually small (measured with an orchidometer)**<\/td>\n<td width=\"310\">Testes may be normal in size<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>**Although many testicular diseases damage both the seminiferous tubules and the Leydig cells, they usually damage the seminiferous tubules to a greater degree.<\/p>\n<h2>Causes of primary hypogonadism<\/h2>\n<p>Causes of primary hypogonadism in males can include congenital abnormalities and acquired diseases.<\/p>\n<p><strong>Congenital abnormalities:<\/strong><\/p>\n<ul>\n<li>Klinefelter syndrome (and other chromosomal abnormalities)<\/li>\n<li>Mutation in the FSH and LH receptor genes<\/li>\n<li>Cryptorchidism<\/li>\n<li>Varicocele<\/li>\n<li>Disorders of androgen synthesis, and<\/li>\n<li>Myotonic dystrophy.<\/li>\n<\/ul>\n<p><strong>Acquired diseases:<\/strong><\/p>\n<ul>\n<li>Infections (especially mumps)<\/li>\n<li>Radiation<\/li>\n<li>Alkylating agents<\/li>\n<li>Ketoconazole<\/li>\n<li>Glucocorticoids<\/li>\n<li>Environmental toxins<\/li>\n<li>Trauma<\/li>\n<li>Testicular torsion<\/li>\n<li>Autoimmune damage<\/li>\n<li>Chronic systemic illnesses<\/li>\n<li>Hepatic cirrhosis<\/li>\n<li>Chronic renal failure<\/li>\n<li>AIDS<strong>\u00a0<\/strong><\/li>\n<\/ul>\n<h2>Causes of secondary hypogonadism<\/h2>\n<p>Causes of secondary <a href=\"https:\/\/myendoconsult.com\/learn\/clomid-or-testosterone-injections-in-male-hypogonadism\/\">hypogonadism in males<\/a> can include congenital abnormalities and acquired diseases.<\/p>\n<p><strong>Congenital :<\/strong><\/p>\n<ul>\n<li>Isolated GnRH deficiency (without anosmia, Kallman syndrome or associated with adrenal hypoplasia congenita)<\/li>\n<li>GnRH deficiency with mental challenges (e.g., Prader-Willi syndrome)<\/li>\n<li>Idiopathic anterior pituitary insufficiency<\/li>\n<li>Congenital malformations with craniofacial anomalies<\/li>\n<\/ul>\n<p><strong>Acquired:<\/strong><\/p>\n<ul>\n<li>Brain Tumors (craniopharyngiomas, meningiomas, gliomas, germinomas, astrocytomas)<\/li>\n<li>Functional gonadotropin deficiency (malnutrition, acute illness, chronic systemic disease, eating disorders, post-anabolic steroid abuse, hypothyroidism, <a href=\"https:\/\/myendoconsult.com\/learn\/prolactinoma\/\">prolactinoma<\/a>, Cushing&#8217;s disease)<\/li>\n<li>Infiltrative conditions (histiocytosis X, <a href=\"https:\/\/myendoconsult.com\/learn\/hypercalcemia-related-to-granulomatous-disease\/\">granulomatous diseases<\/a>, hemochromatosis)<\/li>\n<li><a href=\"https:\/\/myendoconsult.com\/learn\/pituitary-apoplexy\/\">Pituitary apoplexy<\/a><\/li>\n<li>Illicit drugs (opioids, cannabinoids, anabolic steroids)<\/li>\n<\/ul>\n<h2>Klinefelter&#8217;s syndrome vs Kallmann&#8217;s syndrome<\/h2>\n<table>\n<tbody>\n<tr>\n<td width=\"312\"><strong>Klinefelter&#8217;s syndrome<\/strong><\/td>\n<td width=\"312\"><strong>Kallmann&#8217;s syndrome<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"312\">hypergonadotropic hypogonadism<\/td>\n<td width=\"312\">hypogonadotrophic hypogonadism<\/td>\n<\/tr>\n<tr>\n<td width=\"312\">No anosmia<\/td>\n<td width=\"312\">Often associated with anosmia.<\/td>\n<\/tr>\n<tr>\n<td width=\"312\">At risk for autoimmune diseases<\/td>\n<td width=\"312\">No risk for autoimmune disease<\/td>\n<\/tr>\n<tr>\n<td width=\"312\">Poor academic record<\/td>\n<td width=\"312\">Normal intelligence<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>What are the clinical features of Klinefelter&#8217;s syndrome<\/h2>\n<p>Kleinefelter&#8217;s syndrome (KS) is a congenital abnormality that causes primary hypogonadism. KS occurs during meiotic division when there is non-disjunction of either parent&#8217;s sex hormones resulting in a 47, XXY genotype.<\/p>\n<p><strong>Clinical features include:<\/strong><\/p>\n<ul>\n<li>Small and firm testes<\/li>\n<li>Low sperm count and infertility<\/li>\n<li>Eunuchoid Stature<\/li>\n<li>Gynaecomastia<\/li>\n<\/ul>\n<p>Patients are also more susceptible to various autoimmune diseases such as systemic lupus erythematosus, <a href=\"https:\/\/myendoconsult.com\/learn\/diabetes-mellitus\/\">diabetes mellitus<\/a>, rheumatoid arthritis, and Sjogren&#8217;s syndrome.<\/p>\n<p>Also, atrophy and damage to the seminiferous tubules and Leydig cells lead to low testosterone levels and high gonadotropin (FSH and LH) levels.<\/p>\n<p>KS is diagnosed based on karyotyping. Androgen replacement is required to maintain quality of life, muscle development, secondary sexual characteristics, and bone strength. Furthermore, some patients can have their own children using a combination of testicular sperm extraction and IVF techniques, such as intracytoplasmic sperm injection.<\/p>\n<h2>The hypothalamic Pituitary Testicular Axis<\/h2>\n<p><a href=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/male-hypogonadism-HPA-axis.jpg\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"15f1ca8\" data-elementor-lightbox-title=\"male hypogonadism HPA axis\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/male-hypogonadism-HPA-axis.jpg\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/male-hypogonadism-HPA-axis.jpg 940w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/male-hypogonadism-HPA-axis-300x251.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/male-hypogonadism-HPA-axis-768x644.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/male-hypogonadism-HPA-axis-624x523.jpg 624w\" alt=\"The hypothalamic pituitary gonadal axis in a male\" width=\"640\" height=\"537\" aria-describedby=\"gallery-1-4407464\" \/><\/a>The hypothalamic pituitary gonadal axis in a male<\/p>\n<p>Testosterone is produced by Leydig cells of the testes under trophic stimulation by LH (produced by the anterior pituitary gland).Sperms are produced by seminiferous tubules under stimulation by a high intra-testicular concentration of testosterone. Also, FSH acts on Sertoli cells of the seminiferous which promotes the production of both sperm and inhibin B.<\/p>\n<p>Extratesticular testosterone for patients on exogenous testosterone therapy does not increase sperm production. Indeed, testosterone monotherapy reduces sperm count and renders patients temporarily infertile.<\/p>\n<p>Circulating testosterone inhibits both LH and FSH secretion. FSH production is also inhibited by inhibin B, a product of the Sertoli cells of the seminiferous tubules.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>What is hypogonadism ? Hypogonadism in a male is defined as a decrease in one or both of the two major functions of the&hellip;<\/p>\n","protected":false},"author":1,"featured_media":4407451,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[96],"tags":[],"class_list":["post-4407450","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-endocrine-reviews-reproduction"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/4407450","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/comments?post=4407450"}],"version-history":[{"count":36,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/4407450\/revisions"}],"predecessor-version":[{"id":4415703,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/posts\/4407450\/revisions\/4415703"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media\/4407451"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4407450"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/categories?post=4407450"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/tags?post=4407450"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}