小结
定义
病史和体格检查
关键诊断因素
- 性欲减退
- 自发晨勃的减少
- 勃起功能障碍
- 男性乳房发育
- 不育症
- 小阴茎
- 小睾丸
- 阴囊分裂或发育不全
- 隐睾，尤其是双侧隐睾
- 身材比例失调
- 两颞测偏盲
- 轻度创伤性骨折
- 身高减少
- 嗅觉丧失
其他诊断因素
- 体力降低以及容易疲劳
- 青春期缺失或青春期发育不全
- 阴囊发育不良、色素减退和缺乏皱褶
- 肌肉质量及力量的减少
- 腋毛和阴毛脱落
- 胡须减少
- 注意力以及记忆力较差
- 情绪低落或不稳定
- 睡眠障碍
- 潮热及盗汗
- 身材高大
- 面部皱纹
危险因素
- 遗传性疾病
- 2型糖尿病
- 使用烷化剂、阿片类药物或糖皮质激素
- 外源性性激素及GnRH类似物的应用
- 高催乳素血症
- 鞍旁肿瘤或垂体大腺瘤卒中
- 睾丸损伤
- 感染
- 精索静脉曲张
诊断性检查
首要检查
- 血清总睾酮
需考虑的检查
- 性激素结合球蛋白（SHBG）
- 计算的游离睾酮
- 血清黄体生成素（LH）或卵泡刺激素（FSH）
- 精液分析
- 全血细胞计数 (FBC）
- 血清催乳素
- 血清转铁蛋白饱和度和铁蛋白
- 垂体 MRI 检查
- 基因检测
- 双能 X 射线吸收法（DEXA 或 DXA）
治疗流程
非性腺疾病
目前无生育要求：原发性性腺功能减退症
目前无生育要求：中枢性性腺功能减退症
目前有生育要求：原发性性腺功能减退症
目前有生育要求：中枢性性腺功能减退症
撰稿人
作者
Richard Quinton, MD FRCP(Edin)
Consultant and Senior Lecturer
Department of Endocrinology, Diabetes & Metabolism
Newcastle upon Tyne Hospitals
Translational & Clinical Research Institute
University of Newcastle upon Tyne
Newcastle upon Tyne
UK
利益声明
RQ has received speaker fees from Besins Healthcare UK. RQ is an author of a reference 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
利益声明
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.
鸣谢
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.
利益声明
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.
同行评议者
Randal J. Urban, MD
Professor
Department of Internal Medicine
University of Texas Medical Branch
Galveston
TX
利益声明
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
利益声明
NK declares that she has no competing interests.
鉴别诊断
- 垂体大腺瘤
- 催乳素瘤
- 高催乳素血症
更多 鉴别诊断指南
- 男性性腺功能减退症睾酮替代疗法指南
- 生育力问题：评估和治疗
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