Gonadal Disorders In Males: Hypogonadism, Its Causes And The Infleunce Of Testicular Atrophy In Its Pathology
Hypogonadism: A Gonad Male Disorder
Testicular hypofunction at any age leads to functional and morphological abnormalities depending upon the age of onset and duration of the disorder.
Causes of Primary hypogonadism
Disorders involving male sexual differentiation:
- Chromosomal sex disorders:
- Klinefelter’s syndrome (XXY),
- XX male,
- Mixed gonadal dysgenesis (X/XY)
- True hermaphroditism (XX/XY)
- Ullrich-Turner syndrome (XO/XY) and others
- Heredofamilial disorders (e.g. Noonan’s syndrome).
- Developmental disorders occurring in normal genotypic males (46 XY):
- Germinal cell aplasi, and
- Abnormalities in the outflow tract for sperms.
- Male pseudohermaphroditism:
- Dyshormonogenesis (androgen biosynthetic defects),
- Androgen insensitivity disorders, and
- Persistent Mullerian duct syndrome.
Adult testicular failure (Acquired): Failure of semineferous tubules such as:
- Idiopathic type
- Primary testicular disease
- Orchitis occurring in mumps, lepromatous leprosy and other infections,
- Neurological disease, e.g. paraplegia, dystrophia myotonica,
- Acquired disorders like varicocele,
- Drugs, e.g. cyclophosphamide, spironolactone, cyproterone, furosemide, cimentidine, heroin, medroxyprogesterone
- Hepatic and renal failure
- Autoimmune disorders, and
- Accidental or surgical trauma and irradiation.
- Hypopituitarism (hypogonadotropic hypogonadism) and
Testicular Atrophy In Hypogonadism
The seminiferous tubules account for the size and volume of the testes. Normally, the adult testes measure 12 to 25 ml in volume. In the prepubertal period, its volume is only 2 ml. Testicular size in adults does not depend upon age. Pre-pubertal damage to the testes leads to small and firm testes. Damage in the post-pubertal period renders the testes small and soft. Testicular atrophy in adults may be due to hypopituitarism or due to primary testicular damage. In testicular atrophy, both spermatogenesis and testosterone production are affected to varying degrees.
Testicular atrophy with sterility may be part of liver failure, renal failure, spinal cord lesions and dystrophia myotonia. Thermal or physical trauma and irradiation of the abdomen and scrotum may lead to testicular atrophy. In lepormatous leprosy, direct invasion by the organisms results in panhypogonadism. Testicular atrophy may follow orchitis due to mumps echo virus or group B arboviruses. Rarely, in autoimmune disorders, antibodies to basement membrane of the testes develop and lead to testicular failure.
Selective Involvement Of Testicular Components
Seminiferous tubules atrophy: Occasionally, the seminiferous tubules may show pure germinal cell aplasia. Such patients have infertility, azoospermia, and loss of sperm precursors. The seminiferous tubules contain only the ‘Sertoli cells only’ syndrome. The secondary sexual characters are well developed. Plasma FSH level is raised.
Deficiency of Leydig Cells: This condition leads to eunuchoidism. In this condition, the genitalia are infantile with small soft testes and the scrotum lacks rugosity. Hair growth on the face, pubis, axillae and body is scanty. Temporal baldness does not develop. The voice remains high-pitched. Muscle development is poor.
© 2014 Funom Theophilus Makama