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Evaluation and Investigation of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
GH deficiency and ACTH hyposecretion can be demonstrated by an inadequate response to the insulin tolerance test or glucagon stimulation test. The glucagon stimulation test can be performed when insulin is contraindicated (adrenal insufficiency, coronary artery disease, or seizure disorders). Basal LH, FSH, and sex hormone levels can be measured and are sufficient to establish the diagnosis of hypogonadism. The GnRH stimulation test is now rarely used. Thyroid function tests (TSH, T4, T3) can confirm secondary hypothyroidism, and the TRH test is generally not required.
McCune−Albright Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Hyperthyroidism in MAS can be treated with thioamides (propylthiouracil), methimazole, and radioiodine (for tissue ablation), while thyroidectomy is useful for persistent hyperthyroidism. Growth hormone excess in MAS is treated with octreotide, dopamine agonists, and growth hormone receptor antagonists (e.g., pegvisomant). Hypogonadism can be treated with hormone replacement therapy. Oral phosphorus replacement can be done for hypophosphatemia, and for hypophosphatemia rickets, calcitriol therapy can be given.
Genetic Causes of Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Amr Abdel Raheem, Mohamed Wael Ragab, Tarek M. A. Aly
Impairment of gonadotropin secretion may result from decreased gonadotropin-releasing hormone (GnRH) production, which leads to quantitative decrease in spermatogenesis. Hypogonadotropic hypogonadism can occur due to congenital or acquired causes. Monogenetic mutations account for around 50% of cases and contribute to CHH via several modes of inheritance, including monogenic autosomal or X-linked (dominant or recessive forms) and oligogenic [51]. Genetic mutations involving FGFR1, FGF8, and SOX10 disrupt embryonic development of GnRH neurons, whereas ANOS1 (formally KAL1), PROK2, PROK2R, and CHD7 impair migration of GnRH neurons from the olfactory placode to the hypothalamus. Other mutations that are associated with GnRH neuron dysregulation involve TAC3, TACR3, KISS1, KISS1R, and OTUD4 genes. Additionally, mutations of GnRH1 gene and its receptor (GnRHR) manifest with CHH [52]. In addition to hypogonadism, certain phenotypic features may be associated with some of the genetic causes of CHH, including anosmia (Kallmann syndrome), cryptorchidism, micro-penis, cleft lip or palate, and renal agenesis [51].
How can we mitigate treatment-associated morbidity in patients with germ cell tumors?
Published in Expert Review of Anticancer Therapy, 2021
Raj R. Bhanvadia, Fady J. Baky, John T. Lafin, Aditya Bagrodia
Radical orchiectomy is the first step in diagnosis, treatment, and prognostication in nearly all patients with GCT. There are an array of psychologic and physiologic concerns pre- and post-orchiectomy. Up to a third of men feel a sense of loss and shame after orchiectomy, and 10% may experience hypogonadism [3,4]. All patients should have a discussion of the risks and benefits of a testicular prosthesis, which has generally been associated with improved patient satisfaction, though a percentage of men (10–25%) have concerns about location, size, and interference with sexual function and physical activity [5,6]. While the overall incidence of clinical hypogonadism is low, monitoring for symptoms of hypogonadism with a history and physical exam is simple, cost effective, and allows workup and initiation of testosterone if indicated. In the approximately 2% of patients who develop second testicular primaries, androgen supplementation is requisite and should be coordinated at the time of orchiectomy. Nearly half of men have defects in spermatogenesis at the time of diagnosis, an important quality of life issue in the majority of young men diagnosed with GCT. Patients should be reassured that paternity rates exceed 90% after orchiectomy alone, but abnormalities in semen parameters should warrant discussion regarding further workup and cryopreservation should be discussed with all patients [7].
Cigarette smoking and its toxicological overview on human male fertility—a prospective review
Published in Toxin Reviews, 2021
R. Parameswari, T. B. Sridharan
Chronic cigarette smoking plays an important role in the pathogenesis of male reproductive health (Al-Turki 2015). It has been reported that cigarette smoking leads to the impairment of various sex hormones, like prolactin and estradiol, where its concentration is high in smokers compared with nonsmokers both the genders (Attia et al. 1989, Rockhill et al. 2019). Chronic cigarette smoking affects the testosterone secretion level in men. Either increased or decreased (hypogonadism) levels of testosterone can cause impaired fertility (Katherine et al. 2001). Studies show that elevated levels of testosterone are accompanied with increased levels of SHBG among cigarette smokers. A study reports that there is a correlation between testosterone levels and albumin, the sperm motility reduces when SHBG level is high (Field et al. 1994, Yang et al. 2019). Reduced level of testosterone can cause a gain in weight in men who stopped cigarette smoking completely and in those who reduced cigarette smokers. Increased risk of hypogonadism was noticed in such groups. The mechanism behind how cigarette smoking increases and/or decreases the total testosterone level is still unclear (Mitra et al. 2012).
The severity of hypogonadism symptoms and its risk factors among male employees of Tehran University of Medical Sciences
Published in The Aging Male, 2020
Elahe Afsharnia, Minoo Pakgohar, Hamid Haghani, Asma Sarani, Shahla Khosravi
Various studies have been conducted with respect to the risk factors of hypogonadism. Only the impact of few of these factors has been recognized, and most of these factors still have room for debate. In this regard, some studies have addressed the impact of factors such as age, BMI, cigarette consumption, educational status, employment, income, marital status, diabetes, and signs of hypogonadism [1,33–37]. Despite the aforementioned studies, there are still many doubts regarding the impact of each of these personal traits on hypogonadism. Given the problems threatening male health, the risk factors must be identified and dealt with to neutralize their effects. By detecting these factors, and through preventive measures, males can be safeguarded against the possible complications of this phenomenon [38] and also reduce its associated healthcare costs. For example, many individuals with hypogonadism who have multiple associated diseases, increased waist circumference and obesity can benefit from lifestyle changes such as weight reduction as well as testosterone replacement therapy (TRT) [39]. Multiple studies have indicated that the injection of testosterone undecanoate has led to a significant reduction in waist circumference and visceral fat, and has been introduced as an appropriate treatment of hypogonadism [40]. Bearing in mind the significance of hypogonadism, the scarcity of data in this field in Iran, and the conflicting information present in earlier literature, we sought to estimate the prevalence of hypogonadism and its determinant factors in males employed at Tehran University of Medical Sciences (TUMS).