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Hypogonadotropic hypogonadism
Gonadotropin deficiency; Secondary hypogonadism
Hypogonadism is a condition in which the male testes or the female ovaries produce little or no sex hormones.
Hypogonadism
Hypogonadism occurs when the body's sex glands produce little or no hormones. In men, these glands (gonads) are the testes. In women, these glands ...
Testes
The testes are 2 egg-shaped male reproductive organs located in the scrotum. They produce sperm and the male hormone, testosterone.
Hypogonadotropic hypogonadism (HH) is a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus.
Causes
HH is caused by a lack of hormones that normally stimulate the ovaries or testes: gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH).
Normally:
- The hypothalamus in the brain releases gonadotropin-releasing hormone (GnRH).
- This hormone stimulates the pituitary gland to release FSH and LH.
- These hormones tell the female ovaries or the male testes to release hormones that lead to normal sexual development in puberty.
- Any change in this hormone release chain causes a lack of sex hormones and prevents normal sexual maturity.
There are several causes of HH:
- Damage to the pituitary gland or hypothalamus from surgery, injury, tumor, infection, or radiation
- Genetic defects
- High doses or long-term use of opioid or steroid (glucocorticoid) medicines
- Severe stress
- Nutritional problems (both rapid weight gain or weight loss)
- Chronic medical diseases, including chronic inflammation or infections
-
Certain medical conditions, such as
iron overload
Iron overload
Hemochromatosis is a condition in which there is too much iron in the body. It is also called iron overload.
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Kallmann syndrome is an inherited form of HH. Some people with this condition also have anosmia (loss of the sense of smell).
Symptoms
Children:
-
Lack of development at puberty (development may be very late or incomplete)
- In girls, a lack of breasts and menstrual periods
- In boys, no development of sex characteristics, such as enlargement of the testes and penis, deepening of the voice, and facial hair
- Inability to smell (in some cases)
-
Short stature
(in some cases)
Short stature
A child who has short stature is much shorter than children who are the same age and sex. Your health care provider will go over your child's growth ...
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Adults:
- Loss of interest in sex (libido) in men
- Loss of menstrual periods (amenorrhea) in women
- Decreased energy and interest in activities
- Loss of muscle mass in men
- Weight gain
- Mood changes
Exams and Tests
Tests that may be done include:
- Blood tests to measure hormone levels such as FSH, LH, and TSH, prolactin, testosterone and estradiol
-
LH response to GnRH
LH response to GnRH
LH response to GnRH is a blood test to help determine if your pituitary gland can correctly respond to gonadotropin releasing hormone (GnRH). LH sta...
Read Article Now Book Mark Article - MRI of the pituitary gland/hypothalamus (to look for a tumor or other growth)
- Genetic testing
- Blood tests to check for iron level
Treatment
Treatment depends on the source of the problem, but may involve:
-
Injections of
testosterone
(in males)
Testosterone
A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone. The test described...
Read Article Now Book Mark Article - Slow-release testosterone skin patch (in males)
- Testosterone gels (in males)
- Estrogen and progesterone pills or skin patches (in females)
- GnRH injections
Outlook (Prognosis)
The right hormone treatment will cause puberty to start and may restore fertility. If the condition begins after puberty or in adulthood, symptoms will often improve with treatment.
Possible Complications
Health problems that may result from HH include:
- Delayed puberty
- Early menopause (in females)
- Infertility
- Low bone density and fractures later in life
- Low self-esteem due to late start of puberty (emotional support may be helpful)
- Sexual problems, such as low libido
When to Contact a Medical Professional
Call your health care provider if:
- Your child does not start puberty at the appropriate time
- You are a woman under 40 and your menstrual cycles stop
- You have lost armpit or pubic hair
- You are a man and you have decreased interest in sex
References
Haddad NG, Eugster EA. Delayed puberty. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric . 7th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 122.
Molitch ME. Anterior pituitary. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 224.
Silveira LF, Latronico AC. Approach to the patient with hypogonadotropic hypogonadism. J Clin Endocrinol Metab . 2013;98(5):1781-1788. PMID: 23650335 www.ncbi.nlm.nih.gov/pubmed/23650335 .
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Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
-
The pituitary gland - illustration
The pituitary is a gland attached to the base of the brain which secretes hormones that govern the onset of puberty, sexual development and reproductive function.
The pituitary gland
illustration
-
Pituitary hormones - illustration
The pituitary gland controls the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which govern the onset of puberty, sexual development and reproductive function.
Pituitary hormones
illustration
-
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
-
The pituitary gland - illustration
The pituitary is a gland attached to the base of the brain which secretes hormones that govern the onset of puberty, sexual development and reproductive function.
The pituitary gland
illustration
-
Pituitary hormones - illustration
The pituitary gland controls the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone), which govern the onset of puberty, sexual development and reproductive function.
Pituitary hormones
illustration
Review Date: 7/24/2015
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
