Hipogonadismo em homens
Summary
Definition
History and exam
Key diagnostic factors
- diminuição da libido
- perda das ereções matinais espontâneas
- disfunção erétil
- anemia normocítica
- ginecomastia
- subfertilidade
- micropênis
- testículos pequenos
- escroto bífido ou hipoplásico
- criptorquidia, especialmente se bilateral
- desproporção segmentar
- hemianopsia bitemporal
- fraturas por baixo impacto
- perda de altura
- anosmia
Other diagnostic factors
- diminuição da energia e fadiga
- puberdade ausente ou incompleta
- hipoplasia escrotal, hipopigmentação e ausência de rugas
- diminuição da massa e da força muscular
- perda de pelos axilares e pubianos
- ausência de pelos faciais
- comprometimento de memória e baixa concentração
- humor deprimido ou lábil
- perturbação do sono
- fogacho e sudorese
- alta estatura
- enrugamento fino da pele facial
Risk factors
- anomalia genética
- diabetes mellitus do tipo 2
- uso de agentes alquilantes, opioides ou glicocorticoides
- uso de hormônios sexuais exógenos e análogos do GnRH
- hiperprolactinemia
- tumor parasselar ou apoplexia de macroadenoma hipofisário
- lesão testicular
- infecção
- varicocele
Diagnostic tests
1st tests to order
- testosterona sérica total
Tests to consider
- globulina ligadora de hormônios sexuais (SHBG) sérica
- testosterona livre calculada
- hormônio luteinizante/hormônio folículo-estimulante (LH/FSH) séricos
- análise de sêmen
- Hemograma completo
- prolactina sérica
- saturação sérica de transferrina e ferritina
- ressonância nuclear magnética (RNM) hipofisária
- teste genético
- absorciometria por dupla emissão de raios X (DEXA ou DXA)
Treatment algorithm
doença não gonadal
não desejando fertilidade atualmente: hipogonadismo primário
não desejando fertilidade atualmente: hipogonadismo secundário
desejando fertilidade atualmente: hipogonadismo primário
desejando fertilidade atualmente: hipogonadismo secundário
Contributors
Authors
Richard Quinton, MD FRCP(Edin)
Consultant Endocrinologist
Northern Region Gender Dysphoria Service
Tyne & Wear NHS Foundation Trust
Newcastle upon Tyne
UK
Honorary Reader in Reproductive Endocrinology
Department of Metabolism, Digestion and Reproduction
Imperial College London
UK
Disclosures
RQ has received speaker fees and an advisory board fee from Besins Healthcare UK, speaker fees from Androlabs, and was on an advisory board for Roche Diagnostics. RQ is an author of several references cited in this topic.
Channa N. Jayasena, PhD FRCP FRCPath
Consultant and Reader in Reproductive Endocrinology/Andrology
Department of Investigative Medicine
Hammersmith Hospital
Imperial College London
London
UK
Disclosures
CNJ has an investigator-led research grant from LogixX Pharma Ltd. CNJ is supported by a National Institute for Health Research (NIHR) Post-Doctoral Fellowship. CNJ is an author of several references cited in this topic.
Acknowledgements
Dr Richard Quinton and Dr Channa N. Jayasena would like to gratefully acknowledge Dr Charles Welliver, Dr T. Hugh Jones, Dr Milena Braga-Basaria, and Dr Shehzad Basaria, previous contributors to this topic.
Disclosures
CW has worked as a consultant for Coloplast, and as an investigator for Auxilium Pharmaceuticals, Mereo BioPharma, PROCEPT BioRobotics, and Repros; and he is a paid reviewer at Oakstone Publishing and BMJ Best Practice. CW also has a family member who is an employee at Bristol-Myers Squibb. THJ and SB are authors of references cited in this topic. MB declared that she had no competing interests.
Peer reviewers
Randal J. Urban, MD
Professor
Department of Internal Medicine
University of Texas Medical Branch
Galveston
TX
Disclosures
RJU declares that he has no competing interests.
Niki Karavitaki, MBBS, MSc, PhD
Consultant Endocrinologist
Oxford Centre for Diabetes, Endocrinology and Metabolism
Churchill Hospital
Oxford
UK
Disclosures
NK declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018 Aug;200(2):423-32.Full text Abstract
Jayasena CN, Anderson RA, Llahana S, et al. Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clin Endocrinol (Oxf). 2022 Feb;96(2):200-19.Full text Abstract
Matsumoto AM. Diagnosis and evaluation of hypogonadism. Endocrinol Metab Clin North Am. 2022 Mar;51(1):47-62. Abstract
Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 May 1;103(5):1715-44.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Síndrome de Klinefelter
- Macroadenoma hipofisário
- Prolactinoma
Больше ОтличияGuidelines
- Guidelines for testosterone replacement therapy in male hypogonadism
- Fertility problems: assessment and treatment
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