Primary hypogonadism

DES is a synthetic estrogen that inhibits ovulation by affecting release of pituitary gonadotropins. Some of its uses include treatment for hypogonadism, primary ovarian... 

The estradiol transdermal system is indicated in the treatment of vasomotor symptoms associated with menopause. It is also used to treat female hypogonadism, primary ovarian failure, atrophic conditions (atrophic vaginitis or kraurosis vulvae), and in the prevention of osteoporosis (see Estrogen and Figure 48). 

Estrone or estropipate is used in the treatment of atrophic vaginitis and menopausal symptoms, female hypogonadism, primary ovarian failure, after castration, or in prostatic cancer (see also Figure 48). 

Estrogens are most commonly used as a component of combination contraceptives or as hormone replacement therapy in postmenopausal women. Benefits in postmenopausal women include relief of moderate to severe vasomotor symptoms and decreased risk of osteoporosis. Hormone replacement therapy also may be used in vaginal and vulvar atrophy and in hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure. Less commonly, select breast or prostate cancer... 

Hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure-Treatment usually is initiated with a dose of 1 to 2 mg daily, adjusted as necessary to control presenting symptoms determine the minimal effective dose for maintenance therapy by titration. 

Replacement therapy - Replacement therapy in hypogonadism associated with a deficiency or absence of endogenous testosterone. Prior to puberty, androgen replacement therapy is needed for development of secondary sexual characteristics. Prolonged treatment is required to maintain sexual characteristics in these and other males who develop testosterone deficiency after puberty. Appropriate adrenal cortical and thyroid hormone replacement therapy are still necessary, however, and are of primary importance. 

Primary hypogonadism (congenital or acquired) Test cu ar failure due to cryptorchidism, bilateral torsion, orchitis, vanishing testis syndrome, or orchidectomy Klinefelter syndrome, chemotherapy, or toxic damage from alcohol or heavy metals. 

In men testosterone administration is indicated for primary hypogonadism, e.g. in Klinefelter syndrome or after orchidectomy, and for hypopituitarism. 

Testicular failure may occur before puberty and present as delayed puberty and the eunuchoid phenotype, or after puberty, with the development of infertility, impotence, or decreased libido in otherwise fully virilized males. The source of hypogonadism can be testicular, as occurs in primary hypogonadism, or it may result from abnormalities of the hypothalamic-pituitary axis, as in secondary hypogonadism. 

Female hypogonadism PO 2.5-7 5 mg/day in divided doses for 20 days rest 10 days. Female castration, primary ovarian failure PO Initially, 1.25 mg/day cyclically. Breast cancer PO 10 mg 3 times/day for at least 3 mo. 

Atrophic vaginitis, female castration, female hypogonadism, kraurosis vulvae, menopausal symptoms, primary ovarian failure, prostatic carcinoma IM Initially, 0 1 or0 5... 

Female hypogonadism, castration, primary ovarian failure PO 1 25-7 5 mg/day for 21 days then off for 8-10 days. Repeat if bleeding does not occur by end of off cycle. Prevention of osteoporosis PO 0.625 mg/day (25 days of 31-day cycle/mo). 

Primary hypogonadism Estrogens have been used for replacement therapy in estrogen deficient patients (treatment of amenorrhoea). 

G. Other considerations Recombinant follitropin alfa has been designated an orphan product for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure. 

Primary hypogonadism Estrogen therapy mimicking the natural cyclic pattern, and usually in combination with progestins is instituted to stimulate development of secondary sex characteristics in young women (11 to 13 years of age) with hypogonadism. 

By contrast, deficiency of 17-hydroxylase results in impaired ability of the gonads (as well as the adrenals) to synthesize androgens (males) or estrogen (females) patients subsequently manifest with problems typically associated with primary hypogonadism. Deficiency of 17-hydroxylase is similar to that of 11 (3-hydroxylase in that there is adrenal overproduction of min-eralocorticoids, resulting in sodium retention and high blood pressure. Differential diagnosis is usually facilitated by examination of the complete profile of adrenocortical steroid hormones. 

Long-standing nutritional zinc deficiency has been reported to cause primary hypogonadism in human subjects (, 2. Deficiency of zinc occurring in association with certain diseases has also been reported to affect adversely testicular function ( ). 

In experimental animals, zinc-restricted diet is known to produce primary hypogonadism ( ). 

Polyglandular autoimmune syndrome type II (Addison s disease, primary hypothyroidism, primary hypogonadism, diabetes, and pernicious anemia)... 

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