Hypogonadotropic hypogonadism: zizindikiro, chithandizo

Monga ulamuliro, hypogonadotropic hypogonadism kugwirizana ndi underdevelopment ziwalo kugonana ndi sekondale makhalidwe kugonana. Mafuta ndi mapuloteni kuwombola mu kudwala komanso chosemphana kamene kamayambitsa kunenepa, cachexia, matenda a dongosolo chigoba ndi wonongeka za mtima.

Ndi madokotala njira kuchitira?

Tikumbukenso kuti osiyana mwamuna ndi mkazi hypogonadotropic hypogonadism.

Matendawa ndi mankhwala a matenda ikuchitika ichitikire endocrinologists, obstetricians ndi gynecologists, endokrinolongami ngati wodwalayo ndi mkazi, ndipo andrology, ngati wodwalayo - mwamuna.

Chifukwa cha mankhwalawa mankhwala timadzi. Ngati anakhumba wasonyeza opaleshoni opaleshoni pulasitiki.

Monga matenda zimagawidwa?

Hypogonadism kungakhale pulayimale ndi sekondale. Mawonekedwe yaikulu ya minofu testicular kuphwanya atayambitsa magwiridwe chifukwa chilema testes lapansi. pa chromosomal mlingo kuvutika imfayo hypoplasia kapena aplasia testicular minofu, amene akuwonekera, pakalibe kapena osakwanira katulutsidwe wa androgens kupanga awo mapangidwe zonse ziwalo zoberekera ndi sekondale makhalidwe kugonana.

Hypogonadotropic hypogonadism amuna yafotokozedwera infantilism zamatsenga.

Mawonekedwe sekondale amayamba ndi kuphwanya dongosolo pituitary England, kuchepetsa gonadotrophic ntchito kapena kugonjetsedwa kwake hypothalamic malo amene zimakhudza pa pituitary England ndi nthawi ntchito zake. matenda amasonyeza matenda okhudza ubongo.

Onse pulayimale ndi sekondale mawonekedwe kungakhale kobadwa nako kapena kugula. The kudwala zingachititse osabereka wamwamuna mu 40-60% ya milandu.

The zimayambitsa matenda kwa amuna

Low tochepa androgens bwino zimayamba ndi kuchepa ndi kuchuluka kwa timadzi opangidwa ndi chikhalidwe pathological kapena testes okha, kuphwanya ubongo imene imalamulira kutentha ndi pituitary ntchito.

Ndi etiology chachikulu chiwonetsero cha matenda tinganene kuti:

• kobadwa nako underdevelopment zopangitsa kugonana, umene umachitika pa nthenda ya kumtundu wa khalidwe,
• aplasia wa machende.

Zinanso zinthu zina monga:

• kuphwanya mbadwa testicular;
• kukhudzana ndi poizoni;
• Morning;
• Zotsatira zosungunulira pa maziko wopanda feteleza, nitrofurans, mankhwala mowa, tetracycline, zochokera mankhwala timadzi mlingo waukulu, etc.
• opatsirana chikhalidwe cha matenda (mumps, chikuku, orchitis, vesicles);
• pamaso pa matenda cheza;
• kuthi kudwala wa testes ya;
• kupotoza wa chingwe spermatic;
• volvulus wa testes ya;
• atrophic ndondomeko pambuyo opaleshoni;
• excision wa chophukacho ya;
• opaleshoni ku scrotum lapansi.

Mu chachikulu hypogonadism kuchepa msinkhu wa androgens m'magazi zimawonedwa. Akufotokozera ayankhe compensatory wa zopangitsa kwa adrenal, kumaonjezera yopanga gonadotropins.

Kupanga yachiwiri kutsogolera ubongo imene imalamulira kutentha ndi pituitary matenda (njira yotupa, zotupa, chosokoneza cha mtima kudwala chitukuko yoopsa).

Kulimbikitsa chitukuko cha hypogonadism sekondale mungathe:

• pituitary adenoma, kupoletsa kukula timadzi;
• adrenocorticotropic timadzi (matenda Cushing a);
• prolactinoma;
• kukanika kwa pituitary England kapena ubongo imene imalamulira kutentha pambuyo opaleshoni;
• okalamba ndondomeko, zomwe zimayambitsa kuchepa kwa testosterone m'magazi.

Mu mawonekedwe sekondale amalembedwa kuchepetsa gonadotrophins, chifukwa mu kupanga kuchepa androgen ndi testes lapansi.

Mtundu wina wa matenda, zimakhudza anthu, ndi kuchepetsa kupanga umuna ndi wabwinobwino testosterone index. Kawirikawiri pali kuchepa madzi a testosterone mu kambiri umuna.

Symptomatology wa matenda amuna

Hypogonadotropic hypogonadism anthu ali mawonetseredwe ake matenda. Iwo amayamba ndi zaka wodwalayo ndi mlingo wa insufficiency androgen.

Ngati machende ndi chidwi ndi mnyamata pamaso msinkhu, ndiye anapanga syndrome lililonse. Mafupa motero amakhala yakusatetezeka lalikulu. Ichi ndi chifukwa akuchedwa mu ossification m'dera kukula. Phewa ndi pachifuwa komanso zomwe zikutsalirazi kumbuyo chitukuko, nthambi yaitali, chigoba minofu ndi bwino anakamba.

Kunenepa zingaoneke mtundu wamkazi, gynecomastia, gipogenitalizme kuti zikusonyezedwa yaing'ono kukula mbolo, wopanda makwinya mu scrotum ndi, testicular hypoplasia, ndi underdevelopment ya prostate, pakalibe tsitsi mu malo ena obisika, pa underdevelopment wa m'mphako ya kamvekedwe mkulu wa mawu.

Mu mawonekedwe yachiwiri ya matenda pafupipafupi anati thupi mkulu, okwera adrenal kotekisi ntchito, mkhutu chithokomiro ntchito.

Ngati ntchito testicular yafupika pambuyo kutha msinkhu, zizindikiro za matenda monga hypogonadotropic hypogonadism, unkagwiritsidwa ofooka.

Anaona zochitika izi:

• kuchepetsa testes;
• pang'ono thupi tsitsi nkhope ndi thupi;
• imfa ya khungu elasticity ndi kupatulira;
• utachepa ntchito kugonana;
• matenda autonomic.

The kuchepa kukula testicular nthawi zonse kugwirizana ndi wotsikirapo kupanga umuna. Izi zimapangitsa osabereka, pali mgwirizano wa makhalidwe sekondale kugonana, amalembedwa minofu kufooka, kutopa.

Matenda a hypogonadism anthu

Matendawa amapangidwa ndi anthropometry, kufufuza ndi palpation wa maliseche, kuwunika zizindikiro matenda digiri msinkhu.

X-ray Kupenda chingatithandize amayang'anitsitsa zaka fupa. Kudziwa machulukitsidwe wa densitometry fupa mchere ntchito. Pamene x-ray wa sella turcica anatsimikiza ndi kukula kwake ndi kukhalapo kwa zotupa.

Chiwerengero cha zaka fupa limalola nthawi ossification dzanja olowa ndi dzanja kudziwa pamene isanayambike msinkhu. Iwo ayenera kuganizira kuthekera ina (odwala anabadwa kum'mwera) ndipo kenako (odwala anabadwa mu kumpoto) ossification, komanso chakuti matenda osteogenesis bwino zimayamba ndi zinthu zina.

Research pa umuna zasayansi amatilola kulankhula za zinthu monga asafe kapena oligospermia.

Atalonjeza zili mahomoni kuti:

• gonadotropins kugonana;
• kwathunthu ndi ufulu testosterone ;
• luteinizing timadzi;
• GnRH;
• antimyullerovsky timadzi;
• prolactin;
• estradiol.

Pamene mawonekedwe yoyamba ya matenda index wa gonadotropins m'mwazi kuchuluka ndi sekondale - downgraded. Nthawi zina mlingo wawo ndi mu malamulo kusokonekera.

Khama la seramu estradiol zofunikira pamene symptomatic feminization ndi kuwonetseredwa yachiwiri ya matenda pa nkhani ya zotupa mu testes ndi kubala esitirojeni, kapena zotupa mu zopangitsa kwa adrenal.

Index zili ketosteroids mu mkodzo mwina labwinobwino kapena yafupika. Ngati mukukayikira pamaso pa kusanthula Klinefelter syndrome khromozomu wasonyeza akugwira.

Testicular biopsy sangathe kupereka mauthenga matenda zolondola.

chithandizo

Chithandizo cha hypogonadism hypogonadotropic umalimbana kuchotseratu chachikulu cha kudwala lapansi. Cholinga cha mankhwala lagona pa ntchito zopewera zimene zimathandiza kuti normalization chitukuko cha kugonana, kuchepetsa wotsatira minofu testicular ndi testicular kuthetsa osabereka. Therapy wochititsidwa kuyang'aniridwa wa urologist ndi m'thupi yemwenso.

Kodi kwathetsa hypogonadotropic hypogonadism anthu? Chithandizo kumatengera zifukwa zingapo:

• mawonekedwe matenda a matenda;
• azikhala wonongeka ya ubongo imene imalamulira kutentha, ndi pituitary England ndi ziwalo zoberekera;
• kupezeka pamodzi pathologies;
• nthawi yatsoka ndi matenda;
• wodwalayo zaka.

Chithandizo milandu wamkulu kukonza pa kaperekedwe ka androgens ndi kuthetsa kukanika kugonana. Osabereka, amene anauka mu mawonekedwe a hypogonadism kobadwa nako, chithandizo sangakhale.

Pankhani ya maonekedwe chachikulu cha kuvutika kobadwa nako kapena matenda anapeza pa ngozi maselo endocrine mu testes ntchito ogalamutsa. Anyamata ankachitira wothandizila si m'thupi, ndi wamkulu odwala - mankhwala zochokera timadzi (androgen ndi gonadotropins pa mlingo zing'onozing'ono).

Ngati palibe kubwerera ntchito testicular kukuonetsedwa m'malo mankhwala androgen ndi testosterone. Kutenga mahomoni ikuchitika moyo.

Pamene mawonekedwe yachiwiri ya matenda ana ndi akulu ayenera kugwiritsa ntchito timadzi gonadotropin. Ngati ndi kotheka, iwo pamodzi ndi mahomoni kugonana.

Amasonyezanso ndi zobwezeretsa mankhwala ndi thupi.

Opaleshoni ndi matenda ndi kuti ndikasendeza ndi n'kuwasanganiza ndi cryptorchidism, ntchito opaleshoni pulasitiki mbolo underdeveloped. Ndi cholinga achisangalalo zodzikongoletsera kwa dzira implantation kupanga zochokera (pakalibe testis undescended mu zonse m'mimba).

Opaleshoni ntchito pamene pogwiritsa ntchito njira microsurgical, pamodzi ndi ulamuliro wa chitetezo cha m'thupi, timadzi ta m'thupi komanso chiwalo ookedwa.

Pa mankhwala mwadongosolo amachepetsa androgen insufficiency, tikupitiriza chitukuko cha makhalidwe sekondale kugonana, pang'ono yafupika potency, yafupika maonekedwe a kufooka kwa mafupa ndi zaka fupa kwanthawi.

Kodi matenda akazi

Hypogonadotropic hypogonadism azimayi amakhala ndi underdevelopment wa ntchito kugonana ndi kuchuluka zopangitsa yamchiberekero. Pulayimale kobadwa nako mawonekedwe chifukwa kuwonongeka underdevelopment kapena yamchiberekero mu nthawi neonatal.

Iwo kutsitsa ulimi wa mahomoni kugonana, umene ukuchititsa kuti kuwonjezeka mlingo wa gonadotropins, zomwe Zimachititsa mazira.

Mu kusanthula mlingo mkulu wa mahomoni kuti yotithandiza follicles ndi lutein, komanso pamlingo wochepa timafunika. Yafupika mlingo timafunika amachititsa manja kapena underdeveloped wamkazi Ziwalo zoberekera, zopangitsa mammary, pakalibe kusamba.

Ngati ntchito yamchiberekero anali chakhungu pamaso msinkhu, ndiye pali chosowa makhalidwe sekondale kugonana.

Hypogonadotropic hypogonadism mu akazi yaikulu monga mmene zinthu zotsatirazi:

• matenda obadwa nawo pa mlingo majini;
• kobadwa nako hypoplasia wa thumba losunga mazira ndi;
• njira opatsirana (chindoko, TB, Mumps, walitsa, opaleshoni kuchotsa thumba losunga mazira ndi);
• kugonjetsedwa kwa chilengedwe autoimmune;
• syndrome, testicular feminization ;
• polycystic mazira.

Secondary hypogonadotropic hypogonadism mu akazi akupezeka kudwala wa pituitary ndi ubongo imene imalamulira kutentha. Iwo kusiyana ndi otsika zili zina kutha kwa yopanga gonadotropins zonse ntchito yamchiberekero. Zimenezi zinayambitsa ndi kutupa kwa dera ubongo. Matendawa ali wokondwa sichikupindulitsani ndipo limodzi ndi kuchepa mu mlingo wa padzuwa la gonadotropins kuti thumba losunga mazira ndi.

Kodi matenda monga hypogonadotropic hypogonadism mu akazi, ndi mimba? Kulanga intrauterine chitukuko cha mwana wosabadwayo nawonso anakhudzidwa ndi zosayembekezereka matenda.

Zizindikiro mu akazi

Bright zizindikiro za nyengo mwana wobala - ndi kuphwanya msambo, kapena kupanda kwake.

Mlingo wochepa wa mahomoni wamkazi kumabweretsa underdevelopment a ziwalo zoberekera, zopangitsa mammary, kuphwanya mafunsidwe a mafuta ndi limayamba tsitsi.

Ngati matenda ndi kobadwa nako mu chikhalidwe, sekondale makhalidwe kugonana siziwoneka. akazi anati pamaso pa mafupa a chiuno yopapatiza ndi matako mosabisa.

Ngati matenda zinalipo kale msinkhu, makhalidwe kugonana anaonekera kukhala wopulumutsidwa, koma mwezi kutsazikana maliseche minofu ya manja.

mathandizidwe ndi

Hypogonadism pamene pali kuchepa misinkhu esitirojeni ndi milingo kuenjezera gonadotropins. Kudzera ultrasound chovumbulutsidwa yafupika kukula chiberekero matenda ostepoporoz ndi kuchedwa mapangidwe mafupa a.

matenda chithandizo akazi

Kodi kwathetsa hypogonadotropic hypogonadism mu akazi? Chithandizo kumafuna m'malo mankhwala. Akazi anatumizidwa kulandira mankhwala timadzi kugonana (ethinyl estradiol).

Pankhani ya kuyamba kusamba mankhwala kulera m'kamwa munali estrogens ndi progestins, ndi kukonzekera "Triziston", "Trikvilar".

Amatanthauza "Klimov", "Trisekvens", "klimonorma" Kwalamulidwa kwa odwala patapita zaka 40.

Timadzi chithandizocho contraindicated zinthu zotsatirazi:

• khansa pa chifuwa ndi kumaliseche;
• mtima ndi mtima matenda;
• aimpso kulephera ndi chiwindi;
• thrombophlebitis.

kupewa

matenda monga hypogonadotropic hypogonadism, ali ndi madokotala ananena zawo zabwino. Kuteteza ndi maphunziro umoyo wa anthu ndi kuwunika amayi apakati komanso zinthu thanzi.