Hypogonadism differential diagnosis: Difference between revisions

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{{Hypogonadism}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hypogonadism]]
{{CMG}}
{{CMG}} {{AE}} {{AEL}}  
 
==Overview==
==Overview==
Hypogonadism must be differentiated from [[diseases]] that cause [[delayed puberty]] or [[infertility]]. These diseases include [[Congenital disease|congenital diseases]] as [[Klinefelter syndrome]], [[Kallmann syndrome]] and [[cryptorchidism]]. The diseases also include [[testicular torsion]] and [[orchitis]] in males, [[polycystic ovary syndrome]], [[pelvic inflammatory disease]], and [[endometriosis]] in females.
==Differentiating Hypogonadism from other Diseases==
==Differentiating Hypogonadism from other Diseases==
* Hypogonadism must be differentiated from diseases that cause delayed puberty and infertility. These diseases include congenital diseases as Klinefelter syndrome, Kallmann syndrome and cryptorchidism. The diseases include also  
Hypogonadism must be differentiated from [[diseases]] that cause [[delayed puberty]] or [[infertility]]. These diseases include [[Congenital disease|congenital diseases]] as [[Klinefelter syndrome]], [[Kallmann syndrome]] and [[cryptorchidism]]. The diseases also include [[testicular torsion]] and [[orchitis]] in males, [[polycystic ovary syndrome]], [[pelvic inflammatory disease]], and [[endometriosis]] in females.<ref name="fertstert2004">{{Citation|last = Denschlag|first = Dominik, MD|last2 = Clemens|first2 = Tempfer, MD|last3 = Kunze|first3 = Myriam, MD|last4 = Wolff|first4 = Gerhard, MD|last5 = Keck|first5 = Christoph, MD|title = Assisted reproductive techniques in patients with Klinefelter syndrome: A critical review|journal = Fertility and Sterility|volume = 82|issue = 4|pages = 775–779|date = October 2004|year = 2004|doi = 10.1016/j.fertnstert.2003.09.085}}</ref><ref name="pmid17462053">{{cite journal| author=Virtanen HE, Bjerknes R, Cortes D, Jørgensen N, Rajpert-De Meyts E, Thorsson AV et al.| title=Cryptorchidism: classification, prevalence and long-term consequences. | journal=Acta Paediatr | year= 2007 | volume= 96 | issue= 5 | pages= 611-6 | pmid=17462053 | doi=10.1111/j.1651-2227.2007.00241.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17462053  }}</ref><ref name="pmid19679025">{{cite journal| author=Schmitz D, Safranek S| title=Clinical inquiries. How useful is a physical exam in diagnosing testicular torsion? | journal=J Fam Pract | year= 2009 | volume= 58 | issue= 8 | pages= 433-4 | pmid=19679025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19679025  }}</ref><ref name="pmid19378875">{{cite journal |vauthors=Trojian TH, Lishnak TS, Heiman D |title=Epididymitis and orchitis: an overview |journal=Am Fam Physician |volume=79 |issue=7 |pages=583–7 |year=2009 |pmid=19378875 |doi= |url=}}</ref><ref name="pmid21490048">{{cite journal |vauthors=Stewart A, Ubee SS, Davies H |title=Epididymo-orchitis |journal=BMJ |volume=342 |issue= |pages=d1543 |year=2011 |pmid=21490048 |doi= |url=}}</ref><ref name="AMN">{{cite web | author = Christine Cortet-Rudelli, Didier Dewailly | title =Diagnosis of Hyperandrogenism in Female Adolescents| work =Hyperandrogenism in Adolescent Girls | url=http://www.health.am/gyneco/more/diagnosis-of-hyperandrogenism-in-female/ | year = 2006 | month= Sep 21 | publisher=Armenian Health Network, Health.am}}</ref><ref>{{cite journal |author=Legro RS, Barnhart HX, Schlaff WD |title=Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome|journal=N Engl J Med|volume=356 |issue=6 |pages=551-566 |year=2007 |pmid=17287476 |doi=}}</ref><ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref><ref name="pmid11949938">{{cite journal| author=Murphy AA| title=Clinical aspects of endometriosis. | journal=Ann N Y Acad Sci | year= 2002 | volume= 955 | issue=  | pages= 1-10; discussion 34-6, 396-406 | pmid=11949938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11949938  }}</ref>
{| class="wikitable"
! colspan="2" |Diseases
!Clinical findings
!Diagnosis
!Manangement
|-
| rowspan="3" |Congenital diseases
|[[Klinefelter syndrome]]
|
* Language learning impairment
 
* [[Neuropsychological]] testing often reveals deficits in [[executive functions]]
* Delays in motor development
|
* [[Karyotype|Karyotyping]]
* [[Semen analysis]]
* [[Serum]] [[estradiol]] levels (a type of [[estrogen]])
* [[Serum]] [[follicle stimulating hormone]]
* [[Serum]] [[luteinizing hormone]]
* [[Serum]] [[testosterone]]
|
* [[Testosterone]] [[therapy]] may be indicated to treat the symptoms of the disease.
|-
|[[Kallmann syndrome]]
|
* Hypogonadism
* [[Anosmia]]
|
* [[Serum]] [[follicle stimulating hormone]]
* [[Serum]] [[luteinizing hormone]]
* [[Serum]] [[testosterone]]
* [[Gonadotropins|Gonadotropin hormones]]
|
* [[Testosterone|Testosterone replacement therapy]]
* [[Estrogen]] replacement therapy (in females)
|-
|[[Cryptorchidism]]
|
* [[Empty scrotum]]
* [[Inguinal]] fullness
|
* [[Ultrasonography]] may be indicated to locate the [[gonads]]
|
* Treatment of cryptorchidism is mainly surgical in order to reduce the risk of malignancy
* [[Orchiopexy]] surgery is recommended in order to reposition the undecsended testes.
|-
| rowspan="2" |Male diseases
|[[Testicular torsion]]
|
* Sudden onset of severe [[pain]] in one [[testicle]], with or without a previous predisposing event
* [[Swelling]] within one side of the [[scrotum]] (scrotal swelling)
* [[Nausea]] or [[vomiting]]
* [[Lightheadedness]]
* Bell clapper deformity of [[testes]] on examination
|
* Scrotal [[ultrasound]]
* [[Urinalysis]] to exclude [[bacterial infection]]
|Management is mainly surgical through detorsion and fixation of the affected [[testes]].
|-
|[[Orchitis]]
|
* [[Scrotum|Scrotal]] [[swelling]]
* [[Scrotal pain]]
* [[Lower urinary tract infections|urinary tract infections]]
* [[Nausea]], [[vomiting]] and [[chills]]
* [[Prehn's sign]] positive
* [[Costovertebral]] angle [[tenderness]] 
* [[Fever]]
|
* [[Urethral]] [[Gram stain]]
* [[Urinalysis]]
* [[Urine culture]]
* [[PCR]] to detect the presence of ''[[Neisseria gonorrheae]]'' and ''[[Chlamydia trachomatis]]''
* Scrotal [[ultrasound]] is the diagnostic [[imaging]] of choice in cases of acute scrotum.
|
* [[Bed rest]] and limitation of [[physical activity]]
* Use of cold packs
* [[Analgesia]]
* [[Non-steroidal anti-inflammatory drugs]] ([[NSAIDs]])
* [[Levofloxacin]] in [[bacterial infeciton]].
|-
| rowspan="3" |Female diseases
|[[Polycystic ovarian syndrome]] (PCOS)  
|
* [[Amenorrhea]]
* [[Oligoamenorrhea]]
* [[Ovarian cysts]]
* [[Pelvic pain]]
* [[Dysparuenia]]
* [[Acne]]
* [[Hirsutism]]
* [[Anxiety]] and [[depression]]
* [[Sleep apnea]]
|
* Blood [[testosterone]] level
* [[LH]] and [[FSH]] levels
* Pelvic ultrasound
|
* [[Clomiphene citrate]] and [[metformin]] to manage infertility.
* [[Cyproterone acetate]] for the treatment of acne and hirsutism.
* [[Spironolactone]] 
|-
|[[Pelvic inflammatory disease]]
|
* Bilateral [[abdominal pain]]
* [[Abnormal uterine bleeding]]
* [[Urinary frequency]]
* Abnormal [[vaginal discharge]]
* [[Fever]]
* Decreased [[bowel sounds]]
|
* [[Nucleic acid amplification technique|Nucleic acid amplification tests]] is the best laboratory test for [[PID]].
* [[Transvaginal ultrasound|Transvaginal utrasonography]]
|
* Broad spectrum [[antibiotics]]
 
* [[Hospitalization]]
|-
|[[Endometriosis]]
|
* [[Dyspareunia]]
* [[Nausea and vomiting|Nausea]] and vomiting
* Intermenstrual spotting
* Prolonged [[menstrual bleeding]] and increased amount of [[bleeding]] ([[menorrhagia]])
* [[Acute abdomen]]
|
* Features of [[iron deficiency anemia]] may be present such as:
** Low [[MCV]],
** Low [[Mean cell haemoglobin|MCHC]]
** Elevated RBC distribution width
 
* Elevated levels of [[CA-125|serum cancer antigen-125]] in some cases.<sup>[[Endometriosis laboratory findings#cite note-pmid12521524-1|[1]]]</sup>
* Increased levels of [[interleukin 1]], chemoattractant protein-1 and [[Interferon-gamma|interferon gamma]] may be present in patients with [[endometriosis]]. These are useful markers to monitor the disease activity and progression.<sup>[[Endometriosis laboratory findings#cite note-pmid28189296-2|[2]]]</sup>
|Medical therapy:
* [[Gonadotropin-releasing hormone agonist|Gonadotrophin releasing hormone agonists]]
* [[Oral contraceptive|Oral contraceptive pills]]
* [[Aromatase inhibitor|Aromatase inhibitors]]
Surgery:
* Conservative removal of the [[endometrial]] tissues by laser or electrocautry
* Definitive surgery[[hysterectomy]] with [[Salpingo-oophorectomy|bilateral salpingo-oophorectomy]].
|}


==References==
==References==

Latest revision as of 18:24, 25 February 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]

Overview

Hypogonadism must be differentiated from diseases that cause delayed puberty or infertility. These diseases include congenital diseases as Klinefelter syndrome, Kallmann syndrome and cryptorchidism. The diseases also include testicular torsion and orchitis in males, polycystic ovary syndrome, pelvic inflammatory disease, and endometriosis in females.

Differentiating Hypogonadism from other Diseases

Hypogonadism must be differentiated from diseases that cause delayed puberty or infertility. These diseases include congenital diseases as Klinefelter syndrome, Kallmann syndrome and cryptorchidism. The diseases also include testicular torsion and orchitis in males, polycystic ovary syndrome, pelvic inflammatory disease, and endometriosis in females.[1][2][3][4][5][6][7][8][9][10]

Diseases Clinical findings Diagnosis Manangement
Congenital diseases Klinefelter syndrome
  • Language learning impairment
Kallmann syndrome
Cryptorchidism
  • Treatment of cryptorchidism is mainly surgical in order to reduce the risk of malignancy
  • Orchiopexy surgery is recommended in order to reposition the undecsended testes.
Male diseases Testicular torsion Management is mainly surgical through detorsion and fixation of the affected testes.
Orchitis
Female diseases Polycystic ovarian syndrome (PCOS)
Pelvic inflammatory disease
Endometriosis Medical therapy:

Surgery:

References

  1. Denschlag, Dominik, MD; Clemens, Tempfer, MD; Kunze, Myriam, MD; Wolff, Gerhard, MD; Keck, Christoph, MD (October 2004), "Assisted reproductive techniques in patients with Klinefelter syndrome: A critical review", Fertility and Sterility, 82 (4): 775–779, doi:10.1016/j.fertnstert.2003.09.085
  2. Virtanen HE, Bjerknes R, Cortes D, Jørgensen N, Rajpert-De Meyts E, Thorsson AV; et al. (2007). "Cryptorchidism: classification, prevalence and long-term consequences". Acta Paediatr. 96 (5): 611–6. doi:10.1111/j.1651-2227.2007.00241.x. PMID 17462053.
  3. Schmitz D, Safranek S (2009). "Clinical inquiries. How useful is a physical exam in diagnosing testicular torsion?". J Fam Pract. 58 (8): 433–4. PMID 19679025.
  4. Trojian TH, Lishnak TS, Heiman D (2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
  5. Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
  6. Christine Cortet-Rudelli, Didier Dewailly (2006). "Diagnosis of Hyperandrogenism in Female Adolescents". Hyperandrogenism in Adolescent Girls. Armenian Health Network, Health.am. Unknown parameter |month= ignored (help)
  7. Legro RS, Barnhart HX, Schlaff WD (2007). "Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome". N Engl J Med. 356 (6): 551–566. PMID 17287476.
  8. Brunham RC, Gottlieb SL, Paavonen J (2015). "Pelvic inflammatory disease". N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.
  9. Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
  10. Murphy AA (2002). "Clinical aspects of endometriosis". Ann N Y Acad Sci. 955: 1–10, discussion 34-6, 396–406. PMID 11949938.

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