Kev Hypogonadism

Hypogonadism tshwm sim thaum lub qog ua haujlwm ntawm lub cev ua me ntsis los yog tsis muaj cov tshuaj hormones. Hauv cov txiv neej, cov qog (gonads) yog cov noob qes. Hauv cov poj niam, cov qog no yog cov zes qe menyuam.

Qhov ua rau kom mob hypogonadism tuaj yeem yog thawj (kuaj cov qe lossis zes qe menyuam) lossis theem nrab (muaj teeb meem ntawm lub caj pas lossis hypothalamus). Hauv thawj yam hypogonadism, zes qe menyuam lossis kuaj lawv tus kheej tsis ua haujlwm zoo. Cov ua rau thawj hypogonadism suav nrog:

• Qee qhov teeb meem tiv thaiv kab mob autoimmune
• Kev mob caj ces thiab kev loj hlob tsis zoo
• Kab mob
• Mob siab thiab mob raum
• Tawg (rau gonads)
• Kev phais mob
• Kev poob plig
  

Feem ntau cov kev tshwm sim caj ces uas ua rau thawj qhov hypogonadism yog Turner syndrome (hauv cov poj niam) thiab Klinefelter syndrome (hauv cov txiv neej).

Yog tias koj twb muaj lwm cov teeb meem autoimmune zoo koj yuav muaj feem ntau dua rau qhov ua kom lub cev puas tsuaj rau gonads. Cov no tuaj yeem suav cov kev cuam tshuam uas cuam tshuam rau lub siab, cov qog adrenal, thiab cov thyroid caj pas, nrog rau hom ntshav qab zib hom 1.

Hauv nruab nrab hypogonadism, cov chaw hauv lub hlwb uas tswj cov gonads (hypothalamus thiab pituitary) tsis ua haujlwm zoo. Cov ua rau nruab nrab hypogonadism suav nrog:

• Mob tsis nco qab
• Los ntshav hauv thaj chaw ntawm lub pituitary
• Noj tshuaj, xws li glucocorticoids thiab opiates
• Kev txiav tawm anabolic steroids
• Cov caj ces muaj teeb meem
• Kab mob
• Kev noj haus tsis txaus
• Hlau ntau heev (hemochromatosis)
• Kev tawg (rau qhov pituitary lossis hypothalamus)
• Sai sai, qhov ceeb thawj poob phaus (suav nrog kev poob phaus tom qab phais mob phais)
• Kev Phais Mob (pob txha pob txha phais nyob ze rau qhov pituitary)
• Kev poob plig
• Lub pob hlav

Kev mob caj ces ntawm central hypogonadism yog Kallmann syndrome. Coob tus neeg muaj tus mob no kuj muaj qhov tsis hnov ​​tsw.

Kev coj khaub ncaws yog qhov laj thawj tshaj plaws rau hypogonadism. Nws yog qhov ib txwm muaj ntawm txhua tus poj niam thiab tshwm sim hauv nruab nrab thaj tsam hnub nyoog 50. Testosterone qib qis hauv cov txiv neej raws li lawv hnub nyoog, zoo ib yam. Qhov ntau ntawm cov testosterone nyob rau hauv cov ntshav qis dua nyob hauv ib tus txiv neej 50 txog 60 xyoo dua li nws nyob hauv ib tus txiv neej 20 txog 30 xyoo.

Cov menyuam ntxhais uas mob hypogonadism yuav tsis pib ua khaub ncaws. Hypogonadism tuaj yeem cuam tshuam lawv kev loj hlob ntawm lub mis thiab qhov siab. Yog tias hypogonadism tshwm sim tom qab tiav nkauj tiav nraug, cov tsos mob hauv cov poj niam suav nrog:

• Kub muag kub
• Zog thiab lub zog hloov pauv
• Kev coj los ua tsis xwm yeem lossis nres

Hauv cov tub hluas, hypogonadism cuam tshuam rau cov leeg nqaij, hwj txwv, qhov chaw mos thiab lub suab. Nws tseem ua rau cov teeb meem kev loj hlob. Rau cov txiv neej cov tsos mob yog:

• Lub mis o
• Lub cev poob
• Tsawg tus txaus siab rau kev sib deev (tsis tshua muaj siab libido)

Yog tias mob hlwb lossis lwm lub hlwb qog ua lub hauv paug (nruab nrab hypogonadism), tej zaum yuav muaj:

• Mob taub hau lossis lub zeem muag poob
• Kev tso kua mis tawm hauv lub cev me (los ntawm prolactinoma)
• Cov tsos mob ntawm lwm qhov kev muaj cov tshuaj hormonal (xws li hypothyroidism)

Feem ntau cov hlav uas cuam tshuam rau cov pituitary yog craniopharyngioma hauv cov menyuam yaus thiab prolactinoma adenomas hauv cov neeg laus.

Koj yuav tsum tau muaj kev ntsuam xyuas los kuaj:

• Qib Estrogen (poj niam)
• Follicle stimulating lawm (qib FSH) thiab luteinizing lawm (LH) qib
• Qib testosterone (tus txiv neej) - kev txhais lus ntawm qhov kev ntsuas no hauv cov txiv neej laus dua thiab cov txiv neej rog yuav yog qhov nyuaj yog li cov txiaj ntsig yuav tsum tau tham nrog tus kws tshaj lij hormone (endocrinologist)
• Lwm yam kev ntsuas ntawm pituitary muaj nuj nqi

Lwm yam kev ntsuam xyuas yuav suav nrog:

• Kuaj ntshav rau anemia thiab hlau
• Kev tshuaj ntsuam caj ces suav nrog karyotype kom kuaj cov qauv chromosomal
• Qib Prolactin (mis tsis txaus)
• Cov phev suav
• Kev ntsuam xyuas cov thyroid

Qee zaum kev ntsuam xyuas cov duab yog qhov xav tau, xws li sonogram ntawm zes qe menyuam. Yog tias pom muaj tus mob pituitary, yuav ua MRI lossis CT scan ntawm lub paj hlwb.

Tej zaum koj yuav tau noj tshuaj pab raws li cov tshuaj hormones. Estrogen thiab progesterone siv rau cov menyuam ntxhais thiab poj niam. Cov tshuaj tuaj raws li ib qho tshuaj ntsiav lossis tawv nqaij. Testosterone tshuaj yog siv rau cov tub thiab txiv neej. Cov tshuaj tuaj yeem muab ua kom tawv nqaij, tso tawv nqaij, ib qho kev daws teeb meem rau thaj qhov tso, ib thaj yog siv rau cov pos hniav sab saud, lossis los ntawm kev txhaj tshuaj.

Rau cov poj niam uas tsis tau raug tshem tawm lawv lub tsev menyuam, kev sib txuam nrog kev kho mob nrog estrogen thiab progesterone yuav txo tau txoj hmoo ntawm kev muaj mob qog nqaij hlav endometrial. Cov poj niam uas muaj hypogonadism uas tsis nrog txiv neej pw ua ke yuav tseem tau muab cov tshuaj testosterone tsawg los yog lwm tus txiv neej hormone hu ua dehydroepiandrosterone (DHEA).

Hauv qee tus pojniam, tuaj yeem siv tshuaj lossis ntsiav tshuaj tuaj yeem siv los txhawb kev ov ov. Kev hno cov tshuaj pituitary yuav siv los pab cov txiv neej ua phev. Lwm tus neeg yuav xav phais mob thiab siv hluav taws xob kho yog tias muaj lub caj dab pituitary lossis hypothalamic ua rau muaj qhov tsis zoo.

Ntau hom duab ntawm hypogonadism kho tau thiab muaj qhov pom zoo.

Rau cov poj niam, hypogonadism yuav ua rau ntxiv lawm tshob. Kev coj khaub ncaws yog ib hom mob hypogonadism uas tshwm sim ib txwm muaj. Nws tuaj yeem ua rau kub yaj, lub ntsej muag vaum thiab ua lub siab ntev thaum cov tshuaj estrogen poob. Txoj kev pheej hmoo rau osteoporosis thiab kab mob plawv ntxiv tom qab lawm.

Qee tus poj niam uas mob hypogonadism noj tshuaj estrogen kho, feem ntau yog cov uas muaj hnub lawm. Tab sis kev siv tshuaj kho qog ntev mus ntev yuav ua rau muaj kev pheej hmoo mob cancer mis, ntshav txhaws thiab mob plawv (tshwj xeeb tshaj yog cov poj niam laus). Cov poj niam yuav tsum nrog lawv tus kws kho mob tham txog cov kev pheej hmoo thiab txiaj ntsig ntawm kev kho tus mob menopausal.

Rau cov txiv neej, hypogonadism ua rau poob ntawm kev sib deev tsav thiab yuav ua rau:

• Cuam meem txom
• Ntxiv lawm tshob
• Kab mob hauv
• Neeg tsis muaj zog

Cov txiv neej ib txwm muaj qis testosterone thaum lawv hnub nyoog. Txawm li cas los xij, qhov kev poob qis hauv cov qib hormone tsis yog loj heev npaum li cov poj niam.

Tham nrog koj tus kws kho mob yog tias koj pom:

• Kev tshem tawm mis
• O mis (txiv neej)
• Kub kub (pojniam)
• Cuam meem txom
• Poob ntawm lub cev plaub hau
• Poob poj niam coj khaub ncaws
• Teeb meem xeeb tub
• Cov teeb meem nrog koj tus txiv neej tsav
• Neeg tsis muaj zog

Tus txiv neej thiab tus poj niam yuav tsum hu rau tus kws kho mob yog tias lawv muaj mob taub hau lossis muaj teeb meem tsis pom kev.

Tswj kev tawm dag zog, lub cev nyhav thiab kev noj zaub mov zoo yuav pab tau qee qhov xwm txheej. Lwm qhov laj thawj yuav tsis tiv thaiv tau.

Gonadal tsis muaj peev xwm; Cov khoom siv tsis ua hauj lwm hnyav; Ovarian tsis ua haujlwm; Testosterone - hypogonadism

• Gonadotropins

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Bhasin S, Brito JP, Cunningham GR, li al. Testosterone txoj kev kho nyob rau hauv cov txiv neej nrog hypogonadism: ib qho Kev Ntseeg Kev Ncaj Ncees Endocrine Society. J Clin Endocrinol MetabCov. 2018; 103 (5): 1715-1744. PMID: 29562364 pubmed.ncbi.nlm.nih.gov/29562364/.

Styne DM. Lub tswv yim ua haujlwm thiab cuam tshuam ntawm kev ua tiav. Hauv: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Phau Ntawv ntawm PediatricsCov. 21st ed. Philadelphia, PA: Elsevier; 2020: chap 26.

Swerdloff RS, Wang C. Lub testis thiab txiv neej hypogonadism, ntxiv lawm tshob, thiab kev sib deev tsis txaus ntseeg. Hauv: Goldman L, Schafer AI, eds. Goldman-Cecil TshuajCov. 26th ed. Philadelphia, PA: Elsevier; 2020: cha 221.

van den Beld AW, Lamberts SWJ. Endocrinology thiab kev laus. Hauv: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Phau Ntawv ntawm EndocrinologyCov. Xab 14th. Philadelphia, PA: Elsevier; 2020: chap 28.