Secondary Hypogonadism or Hypogonadotrope in Men

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-Definition:

Hypogonadism is a condition in which the testicles in men and the ovaries in women produce little or no sex hormone, with consequent sexual dysfunction and/or infertility.
Hypogonadotropic hypogonadism (HH) is a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus, it is also called secondary.
HH is caused by a lack of hormones that normally stimulate the ovaries or testicles: These hormones include gonadotropin-releasing hormone(GnRN), follicle-stimulating hormone (FSH), and luteotropic hormone (LH).

-Consequences:

The hypothalamus in the brain secretes (GnRH).
This hormone stimulates the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteotropic hormone (LH).
These hormones tell the female ovaries and male testicles to secrete hormones that lead to normal sexual development at puberty.
Any change in this chain of hormone release results in a lack of sex hormones. This prevents normal sexual maturation in children and normal functioning of the testicles and ovaries in adults.

-causes of HH:

Damage to the pituitary gland or hypothalamus from surgery, injury, tumors (craniopharyngioma), infection or radiation, empty sella turcica syndrome, selar aranoidocele, Rathke’s cyst, liver or kidney failure syndromes, among other causes,
Genetic abnormalities
High doses or prolonged use of opioids or steroid medications (glucocorticoids)
High level of prolactin (a hormone secreted by the pituitary or pituitary gland)
Intense and prolonged stress
Nutritional problems (both rapid weight gain and loss)
Long-term (chronic) illnesses, such as inflammation or chronic infections
Use of certain drugs such as heroin or the use or abuse of opioid medications
Certain conditions, such as iron overload (hemochromatosis)
Metabolic syndrome in men is known to lead to an altered hormonal profile. Obese men have elevated levels of estrone and estradiol and there is also an attenuation of the luteinizing hormone (LH) pulse amplitude, which leads to a decrease in testicular testosterone production.
The combination of these findings represents an isolated state of hypogonadotropic hypogonadism believed to be induced by negative feedback of hyperestrogenemia on pituitary secretion of LH. However, it is still unclear what impact these hormonal changes have on man’s reproductive potential.
There may also be a decreased or absent response of the target organs (skin, hair and prostate) to androgens (androgen resistance). Another way of looking at primary hypogonadisms is if the

-Cause is genetic:

as in the cases of these syndromes:
Klinefelter (XXY)
Ulrich-Noonan (or male Turner), is an alteration in chromosome 12, have cryptorchidism and is as common as Down syndrome.
Syndrome of only Sertoli cells or germinal aplasia, by polymorphisms in chromosome 11.
Reifenstein or testicular feminization, and 5-alpha-reductase deficiency, in which testosterone levels are normal, but not dehydrotestosterone levels. The
Kallmann is an inherited form of HH. Some people with this condition also have anosmia (loss of the sense of smell).
Prader-Willi is a genetic alteration with a clinical picture of obesity, short stature, hypogonadism, cryptorchidism and learning alterations, chromosome 15 deletions.
With proper hormone treatment, the person can begin puberty and fertility can be restored, in some cases.

-Diagnostic Tests for Hypogonadotropic Hypogonadism

Tests that may be done include:
Blood tests to measure various hormone levels
Luteinizing hormone response to GnRH
LH and FSH response to triptorelin stimulation (decapeptyl, GnRH analog) at 4 hours
Cerebral MRN
With proper hormone treatment, the person can begin puberty and fertility can be restored, in certain cases.

-Possible complications:

Delayed puberty
Infertility
Low self-esteem and part due to late onset of puberty and fertility problems.

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