Sex

Hypogonadotropic Hypogonadism

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Hypogonadotropic Hypogonadism, Hypogonadotropic Causes of Delayed Puberty, Hypogonadotropic Causes of Primary Amenorrhea, Sexual Infantilism due to Gonadotropin Deficiency, Secondary Hypogonadism

  • Definition
  • Hypogonadotropic Hypogonadism
  1. Decreased functional activity of ovaries or Testes
  2. Results from pituitary failure to secrete gonadotropins
  3. Results in delayed Sexual Development and growth delay
  • Etiology
  1. Central defect of Hypothalamic-Pituitary Axis
  2. Low gonadotropin
  • General
  1. Late eunuchoid body proportions
  2. Grow normally during childhood
    1. Fail to have pubertal growth spurt
    2. Growth retardation is recent event
    3. Plot growth velocity!!
  • Causes
  • Endocrine
  1. Multiple tropic hormone deficiency
  2. Isolated Growth Hormone (Somatotropin) deficiency
    1. Severe growth retardation (>3 SD from mean)
    2. Long duration of growth retardation since childhood
    3. Height Retardation exceeds Weight retardation
    4. Proportionate dwarfism
    5. Immature round face
    6. Mild truncal fat distribution
  3. Isolated Gonadotropin deficiency
    1. Kallmann's Syndrome
    2. Congenital adrenal hypoplasia
    3. Isolated LH or FSH deficiency
  4. Other endocrine disorders
    1. Hypothyroidism
    2. Diabetes Mellitus
    3. Glucocorticoid excess (Cushing Syndrome)
      1. Growth delay mild if adrenal sex steroid increased
    4. Hyperprolactinemia
  • Causes
  • CNS
  1. CNS insult due to infection, radiation or trauma
  2. Brain Tumor
    1. Craniopharygioma
    2. Astrocytoma
    3. Hypothalamic glioma
    4. Pituitary tumor (e.g. Prolactinoma)
  • Causes
  • Miscellaneous
  1. Prader-Willi Syndrome
    1. Obesity
    2. Short Stature
    3. Mild Mental Retardation
  2. Systemic Conditions
    1. Chronic gastrointestinal conditions
    2. Chronic Kidney Disease
    3. Gaucher's Disease
    4. Cystic Fibrosis
    5. Sickle Cell Anemia
    6. Human Immunodeficiency Virus infection
  3. Medications
    1. Chronic Opioid use (86% of users)
  4. Nutritional deficiency OR extreme energy expenditure
    1. Female Athlete Triad
    2. Psychogenic
      1. Weight Retardation exceeds Height Retardation
      2. Anorexia
      3. Bulimia
  5. Constitutional Delay in Growth and Development
    1. Compare siblings and parental growth
    2. Calculate target height from parental contribution