Hypogonadism differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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 include also testicular torsion and orchitis in males, polycystic ovary syndrome, pelvic inflammatory disease and endometriosis in females.
Diseases Clinical findings Diagnosis Manangement
Congenital diseases Klinefelter syndrome Clinical features of Klinefelter syndrome are as the following:[1]
  • Language learning impairment
  • Neuro-psychological testing often reveals deficits in executive functions.
  • Delays in motor development
Kallmann syndrome Clinical features of Kallmann syndrome include:
  • Hypogonadism
  • Anosmia
Cryptorchidism
Male diseases Testicular torsion Patients of testicular torsion usually present with following:[2]
  • 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 Clincial features of orchitis include the following:[3][4]
Female diseases Polycystic ovarian syndrome (PCOS) Possible clinical findings in cases of PCOS:[5]
  • Amenorrhea
  • Oligoamenorrhea
  • Ovarian cysts
  • Pelvic pain
  • Dysparuenia
  • Acne
  • Hirsutism
  • Anxiety and depression
  • Sleep apnea
  • Blood testosterone level
  • LH and FSH levels
  • Pelvic ultrasound
Pelvic inflammatory disease Patients usually present with the following:[7][8]
  • Broad spectrum antibiotics
  • Hospitalization
Endometriosis Clinical features of endometriosis include the following:[9] 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. 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.
  3. Trojian TH, Lishnak TS, Heiman D (2009). "Epididymitis and orchitis: an overview". Am Fam Physician. 79 (7): 583–7. PMID 19378875.
  4. Stewart A, Ubee SS, Davies H (2011). "Epididymo-orchitis". BMJ. 342: d1543. PMID 21490048.
  5. 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)
  6. 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.
  7. Brunham RC, Gottlieb SL, Paavonen J (2015). "Pelvic inflammatory disease". N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.
  8. Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.
  9. 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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