Primary failure of kidney function
Endocrinology / / May 22, 2016
Diseases of male genital glands
customary to distinguish between primary and secondary testicular failure.When the primary - a pathological process directly affects the glandular tissue of the testis, with the secondary - first affects other organs and especially the diencephalic-pituitary system.
Etiology and pathogenesis
Congenital changes occur in the testes or aplasia or hypoplasia of varying degrees.At the same time as the causal elements are the mother's inadequate nutrition, severe mental and physical labor, infections, intoxication.
Inflammatory diseases of the testicles themselves may be accompanied by a failure of the function.Sometimes in tuberculous lesions or malignant tumors of the testicles there is a need for surgical castration, which leads to a syndrome anorchia.The same is observed in traumatic castration.
In congenital underdevelopment of testes observed degeneration of parenchymal cells, proliferation of connective tissue.Convoluted tubules are lined with sper
If due to lack of testicular function are added eunuchoid proportions of the body, the disease commonly called syndrome.In the absence of such proportions disease called hypogonadism.Clinical manifestations of a lack of testicular function largely depend on the age at which the changes will come in the testicles.When the so-called prepubertal eunuchoidism, along with the weak development of sexual organs and secondary sexual characteristics, there is increased growth of bones.Growth patients are usually tall, with disproportionately long limbs.
At full or partial switching off of gonadal function in adults there is a gradual reduction of the external genitalia and secondary sex characteristics.The clinical picture in this case is somewhat less pronounced.
In patients with varying degrees of insufficiency of sexual glands the skin, usually pale, wrinkled.Usually they look much younger than his years.Skeletal muscles are underdeveloped.
Mental development is rarely broken, but usually such a person was an increase in physical and mental fatigue.
underdeveloped larynx and thyroid cartilage, as is characteristic of her male structure, does not act.Voice remains high.
penis has a small size, as small testicles.The sensitivity of their lost, often they are located in the inguinal canal.In the study of ejaculate sperm are absent.Hypoplastic scrotum and not pigmented.Hairy armpits absent pubic - either as absent or - scarce and developed on the female type.The prostate gland is small.
Patients with testicular failure there is an increased catabolism of protein that is expressed in the increasing isolation of nitrogen and creatinine.Basal metabolic rate can be lowered.
In primary testicular failure usually have elevated urinary excretion of gonadotropin hormones resulting in a compensatory increase in their production in the anterior pituitary gland in response to the decreased production of male sex hormone.Pointing to the possibility of wasting the testes and oligospermia in patients with a normal amount of gonadotropins, in such cases there is a decrease in the reactivity of gonadotrophic stimulation.Isolation of 17-keto steroids in the urine reduced.The syndrome anorchia, is observed as a congenital anomaly or as a consequence of early castration (traumatic, surgical), the whole complex of symptoms is expressed most clearly.Genitals extremely small size, the secondary sexual characteristics are either absent or very poorly developed.Along with this there is the feminization manifesting gynecomastia, increased fat in the abdomen, thighs and pelvis, growth of pubic hair on the female type.Sexual failure develops during the first 6 months following castration in 75% of individuals undergoing surgery.In these patients, there is increased irritability, apathy, impaired memory, depression, aches and pains, profuse sweats, and so on. D.
In marked underdevelopment of testes outlook both in terms of recovery and significant improvement in the unfavorable.
Diagnosis and differential diagnosis
diagnosis of primary disease usually is simple and is made by the underdevelopment of the genital apparatus and the violation of the formation of the skeleton.It must, however, mention that sometimes delayed pubertal development is difficult to differentiate from a lack of function of the pituitary and gonads.
detection in urine excretion of puberty characteristic of 17-keto steroids and normal production of gonadotropins exclude pituitary infantilism.He also notes that the correct diagnosis can be made often only after observing a period of 6-12 months.Usually at this it allows a number of children and adolescents waive any therapy.
Often there are difficulties in the differential diagnosis between primary and secondary testicular failure.In such cases it is necessary to focus on the dysfunction of other endocrine glands.Thus, growth retardation may indicate a pituitary lesion.Reinforced skeletal growth with proportioned body eunuchoid indicates generally a primary lesion of the testicles.The increased amount of gonadotropins in the urine confirms the diagnosis.
differential diagnosis between primary failure and adipozo-genital dystrophy facilitated distinct clinical picture of the latter, in which the underdevelopment of the testicles is just one of the manifestations of the disease.Currently, in the differential diagnosis of different forms of hypogonadism attaches great importance to chromosomal analysis and testicular biopsy.
differential diagnosis between reducing the potency of neurogenic origin and on the basis of insufficient function of the testicles is not significant difficulties.Please note that during sexual neuroses of secondary sexual characteristics and sexual organs are well developed, and before the disease, sexual function was normal.
should be possible to eliminate the aetiological moments depressing testicular function - to provide adequate nutrition, to organize a rational alternation of work and rest, to establish a systematic treatment of opportunistic diseases (diabetes, tuberculosis, etc.).
When hypogonadotropic insufficiency of sexual glands entirely appropriate intramuscular injection of human chorionic gonadotropin.For adults, the optimal dose should be considered 1500-2000 units 2-3 times per week, for 3 months.A more frequent administration of the drug does not make sense, since the duration of the administered dose is equal to 2.5 to 3 days.In connection with the formation of antibodies to chorionic gonadotropin it should not be administered for a period of more than three months.Throughout the course of treatment Chorionic gonadotropin is prescribed vitamin E is 20-40 mg daily, and vitamin A - 50 000 units in the form of pellets or concentrate.
Serum gonadotropin recommend intramuscular injection of 1000 IU 2 times a week for 6-8 weeks.
On the issue of simultaneous application of serum human chorionic gonadotropin, and there is no consensus.Some believe that the stimulation of spermatogenesis can be achieved only with the help of human chorionic gonadotropin, while others sought the full development of reproductive organs only with the combined administration of human chorionic gonadotropin and serum.
If on the application of human chorionic gonadotropin is no effect when the secondary testicular failure, and when the primary failure from the very beginning is a replacement therapy.Recommend
also prescribe testosterone propionate 25 mg 3 times a week intramuscularly.After receiving pronounced effect in 1-1,5 months, you can go to a gradual reduction in dose (25-15-10 mg 2 times a week).It should stay on the lowest dose at which the effect is maintained.
It is understood that during replacement therapy can be expected to restore and maintain libido and potentio, as well as to enhance growth penis'a, facial hair and body hair.Lost spermatogenesis usually can not be restored.In the subsequent course of treatment can be repeated several times.The intervals between courses depend on the degree and duration of effect.
Instead of testosterone-propionate may be administered sublingually in a dose of methyltestosterone, 4 times higher than the dose of testosterone propionate.0.01 First usually administered 3-4 times a day with subsequent tapering effect after obtaining 0.005 3-4 times a day.
Recommend treatment evnuhoidizma start with small doses of testosterone propionate, raising them in the future as needed.Keep in mind that long-term use of androgens may suppress the normal production of gonadotropins.
Some authors use homotransplantation.
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in prevention of various forms of testicular failure primaryrole for measures to combat syphilis, tuberculosis and viral diseases that can damage the diencephalic-pituitary region and testicles.According to some authors, orchitis occurs in 18-35% of patients with mumps.This complication can lead to wasting of the testicles.
A significant role is also given to the timely treatment of cryptorchidism.
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