MALE HYPOGONADISM AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN
AbstractBackground: Male hypogonadism is defined as ‘inadequate gonadal function, manifested bydeficiency in gametogenesis and/or secretion of gonadal hormones’. Signs and symptoms ofhypogonadism depend primarily on the age of onset. It can be classified according to the siteprimarily involved: the gonads, the hypothalamus, or the pituitary gland. The objective this studywas to determine the presentation and aetiology of male hypogonadism seen in a tertiary carehospital. Methods: This cross-sectional study was conducted at Endocrine Clinics, Aga KhanUniversity Hospital Karachi. Data of male patients with hypogonadism who attended clinicsduring January 2009 to August 2011 were reviewed. All male patients with clinical andbiochemical evidence of hypogonadism were included in the study. Patients with DiabetesMellitus, Metabolic Syndrome, Andropause, AIDS, Chronic Renal Failure, and Cirrhosis wereexcluded. Mean±SD were computed for quantitative variables. Frequency and percentages werecomputed for qualitative variables. Aetiology of male hypogonadism was categorised as primaryand secondary hypogonadism. Results: A total of 85 patients with male hypogonadism attendedthe endocrine clinic. Mean age of patients was 25±10 years. Clinical presentations were smallgenitalia (65%), absent secondary sexual characteristics (53%), not attained puberty (47%),infertility (53%), erectile dysfunction (41%) and loss of libido (29%). Seventy-three (86%)patients had hypogonadotrophic hypogonadism (secondary hypogonadism) and 12 (14%) patientshad hypergonadotrophic hypogonadism (primary hypogonadism). Among the patients withhypogonadotrophic hypogonadism 38 had idiopathic hypogonadotrophic hypogonadsim, 7 hadpituitary adenoma, 6 had empty sella syndrome, 3 had Kallman’s syndrome, and 1 patient hadhaemosiderosis due to thalassaemia major; 18 patients did not undergo brain imaging.Conclusion: Small genitalia, absent secondary sexual characteristics and infertility were the mainpresenting features of hypogonad men. Majority of patients had hypogonadotrophichypogonadsim.Keywords: Male Hypogonadism, Erectile dysfunction, Libido, Infertility
Petak SM, Nankin HR, Spark RF, Swerdloff RS, RodriguezRigau LJ; American Association of Clinical
Endocrinologists. American Association of Clinical
Endocrinologists Medical guidelines for clinical practice for
the evaluation and treatment of hypogonadism in adult male
patients—2002 update. Endocr Pract 2002;8:440–56.
Andrea M, Elisa G, Andrea L. Male hypogonadism. Pituitary
Rosenfield RL Clinical review 6: diagnosis and management of
delayed puberty. J Clin Endocrinol Metab 1990;70:559–62.
Weiss J, Crowley WF Jr, Jameson JL Normal structure of the
gonadotropin-releasing hormone (GnRH) gene in patients with
GnRH deficiency and idiopathic hypogonadotropic
hypogonadism. J Clin Endocrinol Metab 1989;69:299–303.
Green JS, Parfrey PS, Harnett JD, Farid NR, Cramer
BC, Johnson G, et al. The cardinal manifestations of BardetBiedl syndrome, a form of Laurence-Moon-Biedl syndrome. N
Engl J Med 1989;321:1002–9.
Habiby RL, Boepple P, Nachtigall L, Sluss PM, Crowley WF
Jr, Jameson JL. Adrenal hypoplasia congenita with
hypogonadotropic hypogonadism: evidence that DAX-1
mutations lead to combined hypothalmic and pituitary defects
in gonadotropin production. J Clin Invest 1996;98:1055–62.
Sykiotis GP, Hoang XH, Avbelj M, Hayes FJ, Thambundit A,
Dwyer A, et al. Congenital idiopathic hypogonadotropic
hypogonadism: evidence of defects in the hypothalamus,
pituitary, and testes. J Clin Endocrinol Metab 2010;95:3019–27.
Bianco SD, Kaiser UB. The genetic and molecular basis of
idiopathic hypogonadotropic hypogonadism. Nat Rev
Whitcomb RW, Crowley WF Jr. Clinical review 4: Diagnosis
and treatment of isolated gonadotropin-releasing hormone
deficiency in men. J Clin Endocrinol Metab 1990;70(1):3–7.
Citron JT, Ettinger B, Rubinoff H, Ettinger VM, Minkoff J,
Hom F, et al. Prevalence of hypothalamic-pituitary imaging
abnormalities in impotent men with secondary hypogonadism.
J Urol 1996;155(2):529–33.
Johnson AR Jr, Jarow JP. Is routine endocrine testing of
impotent men necessary? J Urol 1992;147:1542–3.
Nickel JC, Morales A, Condra M, Fenemore J, Sumdge DH.
Endocrine dysfunction in impotence: incidence, significance
and cost-effective screening. J Urol 1984;132:40–3.
Slag MF, Morley JE, Elson MK, Trence DL, Nelson
CJ, Nelson AE, et al. Impotence in medical clinic outpatients.
Rhoden EL, Estrada C, Levine L, Morgentaler A. The value of
pituitary magnetic resonance imaging in men with
hypogonadism. J Urol 2003;170(3):795–8.
Lubs HA Jr. Testicular size in Klinefelter’s syndrome in men
over fifty—Report of a Case with XXY/XY Mosaicism. N
Engl J Med 1962;267:326–31.
Boisen E. Testicular size and shape of 47, XYY and 47, XXY
men in a double-blind, double-matched population survey. Am
J Hum Genet 1979;31:697–70.