Presentation
Highly practical and updated with the latest available data, this second edition of Male Hypogonadism: Basic, Clinical and Therapeutic Principles cogently presents a large body of scientific information on male reproductive endocrinology to provide a [books.google.com]
Colon sections presented regular glands and surface epithelium. The lamina propria was edematous and congested with mild increased inflammatory cells Colon sections presented regular glands and surface epithelium. [pubs.sciepub.com]
(testing protocol) Testosterone, estradiol, LH, FSH, cortisol, DHEA, DHEAS 17 if hCG elevated tumor in mediastinum klinefelter karyotype testicular ultrasound responsible for bone formation breast tissue incomplete premature puberty due to presentation [brainscape.com]
A suggested algorithm for the evaluation of the child with pubertal delay is presented in Figure 2. [kallmannsyndrome.wordpress.com]
Entire Body System
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Delayed Male Puberty
male puberty inadequate gonadal steroid secretion due to defection LH FSH from anterior pituitary due to defective production of GnRH from hypo pituitary secondary male hypogonadism, low T, and or sperm with low or inappropriately LH and LSH indicates [brainscape.com]
Ambler GR ; Androgen therapy for delayed male puberty. Curr Opin Endocrinol Diabetes Obes. 2009 Jun16(3):232-9. Soliman AT, De Sanctis V ; An approach to constitutional delay of growth and puberty. [patient.info]
Respiratoric
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Hyposmia
[…] are not limited to, the following: Turner syndrome (females) - Short stature and gonadal failure; abnormality of X chromosome Noonan syndrome - Turner phenotype but normal karyotype; often with abnormalities of pubertal development Kallmann syndrome - Hyposmia [emedicine.medscape.com]
1 Findings suggestive of chronic disease Overt chronic illness signs or symptoms Short Stature Slow growth rate Bone Age less than Chronological age Differential Diagnosis Anorexia Nervosa Malnutrition Kallmann's Syndrome Hypopituitarism Anosmia or Hyposmia [fpnotebook.com]
A history of anosmia or hyposmia points to Kallmann syndrome, which is the result of a rare genetic mutation and can affect boys and girls. [endocrinenews.endocrine.org]
It may also be associated with inability (anosmia) or reduced ability (hyposmia) to smell. Many hypothalamic (GnRH) and pituitary (LH and FSH) synthesis and secretory defects result in hypogonadotropic hypogonadism. [kallmannsyndrome.wordpress.com]
Indeed, delayed puberty has a significant genetic basis often demonstrating an autosomal dominant mode of inheritance, with or without incomplete penetrance. [ 3 ] The presence of an absent or abnormal sense of smell (anosmia or hyposmia) strongly suggests [pubs.sciepub.com]
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Hoarseness
Acne face, facialhair and slight alteration voice (hoarseness) are seen. Next, pubarche begins in conjunction with penile enlargement. The last stage is a dramatic increase in growth velocity. [lecturio.com]
Urogenital
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Testicular Mass
Testicular functional damage Viral orchitis Cytotoxic drugs/irradiation Tumour See Testicular mass Vanishing testis syndrome Severe chronic illness Severe nutritional deficiency, including Anorexia nervosa Gross zinc deficiency Zinc. [rcpa.edu.au]
Workup
Initial workup should include a thorough history, physical examination, and targeted investigations. No single test is considered foolproof for differentiation between CDGP and hypogonadotropic hypogonadism (HH). [journals.lww.com]
Females should also undergo a workup for primary amenorrhea before a diagnosis of CDGP is made. Children with transient hypogonadotropic hypogonadism may achieve fertility after the underlying cause is addressed. [lecturio.com]
[…] healthy physical development. [2] Delay of puberty may also occur due to various causes such as malnutrition, various systemic diseases, or defects of the reproductive system ( hypogonadism ) or the body's responsiveness to sex hormones. [2] Initial workup [en.wikipedia.org]
X-Ray
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Delayed Bone Age
Turner Syndrome) Radiation exposure Head Trauma Brain Tumor Constitutional delay of growth and Puberty (60% of boys, 30% of girls) Most common cause of Delayed Puberty (diagnosis of exclusion) Consistent findings Delayed Bone Age Family History of Delayed [fpnotebook.com]
Bone age: a delayed bone age may occur in CDGP, growth hormone deficiency and hypothyroidism. Bone age is established by a wrist X-ray. MRI or CT scan of the pituitary and surrounding structures may be indicated. [patient.info]
Delayed bone age is also seen in children with gonadal failure, hypogonadotropic hypogonadism and children with chronic illness. If a tumor is suspected, prolactin and hCG levels may aid in diagnosis. [lecturio.com]
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Increased Bone Density
Note: calcium supplementation during adolescence results in increase bone density -- small breast mound -- sparse pubic hair -- breasts grow some -- more pubic hair -- areola sticks out from breast -- adult pubic hair on mons only -- areola recesses - [quizlet.com]
Treatment
treatment, environmental factors, obesity and aging. [books.google.com]
[…] related to, or used in the treatment of this condition. [drugs.com]
Various treatment methods are available for the delivery of external testosterone: Injections - weekly / bi-weekly / 3 monthly Gel - daily application Patches - daily application Buccal patches - daily application of patch worn on the gum Capsusles - [delayed-puberty.com]
Treatment for early puberty in males is generally a shot treatment using the drug Lupron. Shots are given every three months until deemed unnecessary by a medical professional. [mcsodoctors.com]
Once we've approved your claim, you'll get the private treatment you need. 3 And we’ll pay for treatment After you've been treated, send us your invoices. [aviva.co.uk]
Prognosis
This is defined as physiologic hypogonadotropic hypogonadism. [8] Extremely elevated LH and FSH levels are indicative of gonadal dysfunction (ie, pathologic hypergonadotropic hypogonadism) and convey a poor prognosis for spontaneous pubertal development [emedicine.medscape.com]
During a period of 0.9 years which included the period of treatment with depot testosterone, mean growth velocity increased to 8.8 (1.9) cm/year ( P P Key words Constitutional delay Testosterone Sexual maturation Height prognosis Abbreviations CDGP constitutional [link.springer.com]
Etiology
GDPP - gonadotropin dependent premature puberty due to etiology early pituitary hypothalamic gonadal axis idiopathic CNS lesions (harmartomas, astrocytoma, pinealoma, optic hypothalamic glioma) CNS irradiation Genetics (gain of function in Kisspepten [brainscape.com]
Although delayed puberty is a common pediatric endocrine condition, determining its etiology can present a hefty clinical challenge. [endocrinenews.endocrine.org]
Etiologies of central precocious puberty Causes of precocious puberty may be central (central nervous system) or peripheral (gonads, adrenal glands, etc.). [lecturio.com]
Treatment depends on the etiology. McCune-Albright Syndrome. [aafp.org]
Although constitutional growth delay is the most common etiology in both boys and girls, careful assessment is needed, particularly in girls, to identify children with temporal pubertal delay who have such underlying conditions as hypergonadotropic hypogonadism [kallmannsyndrome.wordpress.com]
Epidemiology
Epidemiology Exact prevalence of delayed puberty is not known. [patient.info]
Two key types of Precocious Puberty: Central precocious puberty Peripheral Activation of HPA axis Elevated LH and FSH Elevated testosterone/estradiol No HPA axis activation Gonadal or exogenous sex steroids Epidemiology Race may, in part, determine the [lecturio.com]
This finding is consistent with epidemiological data and confirms that some mechanisms regulating pubertal onset in males and females might be different. [bmcpediatr.biomedcentral.com]
"Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms". Human Reproduction Update (Review). 20 (4): 582–93. doi : 10.1093/humupd/dmu007. PMID 24619876. [en.wikipedia.org]
Pathophysiology
The focus then turns to the pathophysiology and treatment of hypogonadism and other forms of testicular dysfunction, such as Klinefelter syndrome, cryptorchidism, and disorders of the pituitary, as well as reproductive and endocrine consequences of cancer [books.google.com]
Lewkowitz-Shpuntoff HM, Hughes VA, Plummer L, et al ; Olfactory phenotypic spectrum in idiopathic hypogonadotropic hypogonadism: pathophysiological and genetic implications. J Clin Endocrinol Metab. 2012 Jan97(1):E136-44. doi: 10.1210/jc.2011-2041. [patient.info]
Osteoporosis in men: diagnosis, pathophysiology, and prevention. Medicine (Baltimore) 1990 ;69: 137 –52 6. Johnston CC Jr, Slemenda CW, Melton LJ III.. Clinical use of bone densitometry. N Engl J Med 1991 ;324: 1105 –9 7. Ott SM.. [nejm.org]
Prevention
Prevention Most causes of delayed sexual development cannot be prevented. To help reduce the chance, make sure your child maintains a healthy lifestyle. This includes making sure your child is eating well and getting nutrients. [wmhs.com]
“We can say with obesity that prevention is key, and in many cases when we are too late for prevention, dietary changes and more exercise are very important.” SOURCE: bit.ly/1PjqvuR Pediatrics, online January 27, 2016. [reuters.com]
[…] from sending the “start puberty” signal conditions that prevent the ovaries or testes from being able to respond to the “start puberty” signal certain genetic conditions, such as Klinefelter’s syndrome in boys and Turner syndrome in girls 3. [childrenshospital.org]
Centers for Disease Control and Prevention. [consumer.healthday.com]