Hypogonadotropic hypogonadism: zviratidzo, kurapwa

Kazhinji, hypogonadotropic hypogonadism chokuita underdevelopment pabonde nhengo uye yechipiri zvepabonde maitiro. Mafuta uye mapuroteni mukutsinhana ari zvokurwara uyewo akambokanganiswa, izvo zvinokonzera kufutisa, cachexia, zvirwere zviri skeletal ezvinhu uye atadze kushanda zvakanaka mumwoyo.

Nenzira vanachiremba kugarisana?

Zvinofanira kucherechedzwa kuti siyana vechirume hypogonadotropic hypogonadism.

Chirwere uye kurapwa zvirwere rinoitwa anorenda endocrinologists, obstetricians uye gynecologists, endokrinolongami kana murwere ari mukadzi, uye andrology, kana murwere ari - murume.

Hwaro mishonga kemikari mishonga. Kana kutsvakwa kuratidzwa pokuvhiyiwa, epurasitiki kuvhiya.

Sezvo chirwere iri Classified?

Hypogonadism inogona nesekondari. The chikuru chimiro testicular zvinyama mutemo akafurira functionality nokuda zvakakanganisika ari testes. panguva chromosomal pamwero abnormalities anogona kutsamwisa hypoplasia kana aplasia testicular rinenge riri kunoratidzwa pasina kana kukwana secretion kuti androgens wavo kugadzirwa zvizere inotungamirwa nhengo dzokubereka nadzo uye yechipiri zvepabonde unhu.

Hypogonadotropic hypogonadism mune varume runoratidzwa vanoziva remangwana kana zvinofunga infantilism.

The chimiro yechipiri anokonzerwa kutyora pituitary shwanu mamiriro, achidzikisa ayo gonadotrophic nerevane kana kukundwa hypothalamic nzvimbo kuti kuva nezvahunoita pamusoro pituitary shwanu uye inodzora kwayakaita. Hosha kunooneka chirwere chepfungwa.

Vose nesekondari chimiro zvingava vachiberekwa kana vawana. The zvokurwara anogona kukonzera varume kushaya mbereko muna 40-60% nyaya.

Zvinokonzera hosha nevanhu

Low rakawanda androgens zvinogona kukonzerwa vasanyanye uwandu mahormone anobudiswa neboka pathological mamiriro kana testes pachavo, kutyora hypothalamus uye pituitary chaitika.

By etiology chikuru nekuratidza chirwere chinogona kunzi:

• vachiberekwa underdevelopment pabonde omumuviri, kunoitika apo vaberekwe vakaremara hunhu,
• aplasia pamusoro manhu.

Predisposing zvingakonzera zvinosanganisira:

• kutyora testicular dzinza;
• kugarotamba zvine chepfu;
• mishonga;
• Solvent migumisiro riri makemikari hwaro, nitrofurans, mishonga yokuuraya zvipembenene, doro, tetracycline, kwakavakirwa kemikari zvinodhaka munyika dzakakwirira mishonga, nezvimwewo.
• kutapuriranwa yezvakaita chirwere (mumps, gwirikwiti, orchitis, vesicles);
• kuvapo nemwaranzi kurwara;
• akawana zvokurwara of testes;
• nokuvhiringidza spermatic tambo;
• volvulus of testes;
• atrophic muitiro pashure kuvhiyiwa;
• excision of heniya;
• Kuvhiya ari scrotum.

In chikuru hypogonadism kuderera mune mwero androgens muropa riri kuchengetwa. Nezvechinhu chimwe compensatory kwaiita adrenal omumuviri, anowedzera kugadzirwa gonadotropins.

Kuumba yechipiri kutungamirira hypothalamus uye pituitary zvirwere (anogumbura urongwa, namamota, nyonganyonga yacho vascular zvokurwara fetus).

Inoita kuti pave yechipiri hypogonadism anogona:

• pituitary adenoma, generating kukura kemikari;
• adrenocorticotropic kemikari (Cushing chirwere);
• prolactinoma;
• dysfunction of pituitary shwanu kana hypothalamus pashure kuvhiyiwa;
• vasachembera, izvo chinoita vasanyanye kuti testosterone muropa.

In yechipiri chimiro akacherekedza rutapudzo pamusoro gonadotrophins, zvichiguma kugadzirwa kuderera androgen pedyo testes.

Chimwe chimiro chirwere, chinobata varume, ndiko kuderedza kugadzirwa dzisingaoneki kwomuzvarirwo testosterone indekisi. Kashoma pane kuderera testosterone mumatunhu ari chakaipa pamwero urume.

Symptomatology chirwere nevanhu

Hypogonadotropic hypogonadism nevanhu ine kuonekwa zvekuchipatara. Vari anokonzerwa murwere zera uye mwero androgen insufficiency.

Kana manhu Vakundwa ne mukomana asati pakuyaruka, ipapo akaumba chaiwo syndrome. Saka marangwanda anova disproportionately guru. Izvi imhaka imwe kunonoka ari Ossificação em iri kukura wongoramba. Papfudzi uye bhokisi vari lagging mumashure kukura, maoko nemakumbo vari refu, skeletal tsandanyama ari havaratidzi yakatanga.

Kufutisa inogona kuchengetwa pamusoro hadzi mhando, gynecomastia, gipogenitalizme inoratidzwa duku kukura mboro, hapana wrinkles ari scrotum, testicular hypoplasia, ari underdevelopment kweprostate, kusavapo bvudzi munzvimbo pubic nzvimbo, underdevelopment ari dokeriro, muprista inzwi.

In kuratidzwa yechipiri zvirwere kazhinji vakachengeta mukuru muviri uremu, yakakwirira adrenal cortex basa, havachanyatsogoni thyroid oparesheni.

Kana testicular basa ipfupi pashure pakuyaruka, zviratidzo zvirwere zvakadai hypogonadotropic hypogonadism, dzinogona kurondwa simba.

Vaichengeta zvinotevera zvakavapo:

• kuderera kwemitambo testes;
• shoma muviri bvudzi pachiso uye muviri;
• kurasikirwa ganda elasticity uye rive dete;
• ungaderedza pabonde basa;
• autonomic zvirwere.

The kuderera testicular kukura anogara chokuita kuderedzwa dzisingaoneki kugadzirwa. Izvi zvinokonzera kushaya mbereko, pane regression pamusoro yechipiri pabonde zvatariswa, kwakaratidzwa tsandanyama simba, kurukutika.

Chirwere kuti hypogonadism nevanhu

Chirwere chinoitwa nevanhu anthropometry, rokuongorora uye palpation pakati sikarudzi, tinyatsonzwisisa sokuora zviratidzo dhigirii kuyaruka.

X-ray Kuongorora kuchabatsira kuti vaongorore mafupa zera. Kuziva saturation repfupa chicherwa densitometry inoshandiswa. Apo maekisirei ari sella turcica kunoyerwa kwayo ukuru uye kuvapo anomera.

Uchimutarira repfupa zera achibvumira yatinenge Ossificação em ari pamwe ruoko uye chiningoningo kuona apo pakatanga pakuyaruka. Zvinofanira kufungawo mukana imwe yapfuura (varwere vakaberekerwa kumaodzanyemba) uye gare gare (varwere vakaberekerwa kuchamhembe) Ossificação em, uyewo kuti osteogenesis nyonganyonga inogona kukonzerwa nezvimwe zvinhu.

Research pamusoro urume rabhoritari kunoita kuti titaure pamusoro ezvinhu akadai senitrogen kana oligospermia.

Zvinoratidzwa zviri mahormone dzakadaro:

• pabonde gonadotropins;
• zvachose uye vakasununguka testosterone ;
• luteinizing kemikari;
• GnRH;
• antimyullerovsky kemikari;
• prolactin;
• estradiol.

Kana chikuru muchimiro indekisi hosha gonadotropins muropa yakawedzera uye yechipiri - downgraded. Dzimwe nguva aenzane iri redistribution mitemo.

Kutsunga serum estradiol zvakafanira apo symptomatic feminization uye kuratidzwa yechipiri zvirwere panyaya namamota vari testes inobereka estrogen, kana mapundu mukati adrenal mumasero.

Indekisi zviri ketosteroids vari weti kungava zvakajairika kana kuderedzwa. Kana uchifungidzira pamberi Klinefelter chirwere chromosome ongororo dzakaratidza vakabata.

Testicular biopsy haasi kupa mashoko zvakarurama zvawanikwa.

mabatiro

Mabatirwo hypogonadotropic hypogonadism nechinangwa kubvisa huru mhaka zvokurwara. Vavariro yokurapa nhema mumabasa kudzivirira kuti pave normalization zvepabonde kukura, haizopereri rutapudzo pamusoro testicular zvinyama uye testicular achabvisa kushaya mbereko. ARV kuitwa pasi kutarisira chiremba wezvedundira uye endocrinologist.

Sei yakapedza hypogonadotropic hypogonadism nevanhu? Treatment hunotsamira zvinoverengeka on:

• navanachiremba chimiro chirwere;
• kwokuomerwa atadze kushanda zvakanaka pamusoro hypothalamus, iyo pituitary shwanu uye dzokubereka nadzo;
• Kuwanikwa coexisting pathologies;
• nguva panowanikwa chirwere;
• murwere zera.

Treatment nyaya mukuru kuti aruramise kwevari androgens uye kubvisa zvepabonde dysfunction. Kushaya mbereko, izvo zvakamuka muchimiro vachiberekwa hypogonadism, kurapwa haagoni kuva.

Kana chezvinhu siyana vachiberekwa abnormalities kana vawana chirwere panguva yakachengeteka kwemakemikari anobudiswa masero ari testes akashandiswa muviri. Boys vabatwe dzisiri hormone vamiririri, uye varwere mukuru - zvinodhaka kwakavakirwa kemikari (androgen uye gonadotropins mune mishonga diki).

Kana pasina negadziriro yeparutivi nerevane testicular kunoratidzwa androgen yokutsiva marapirwo uye testosterone. Kutora mahormone anoiswa hwose.

Kana yechipiri chimiro chirwere muvana uye vakuru vanofanira kushandisa kemikari gonadotropin. Kana zvakakodzera, vari pamwe chete pabonde mahormone.

Also kuratidzwa kuri rokudzorera kurapwa, uye kurovedza muviri.

Mashandiro pamwe chirwere ndiko ndinobvisa ovary pamwe cryptorchidism, kushandiswa epurasitiki kuvhiya mu underdeveloped mboro. Tiine zvizorwa chinangwa kuita zai muchibereko chakaita zvokugadzirwa inobva (pasina undescended testis ari abdominal mhango).

Kuvhiya rinoshandiswa paaishandisa microsurgical unyanzvi, pamwe kudzorwa zvirwere, mahomoni, uyewo akasima nenyere.

Munguva enderana kurapa zvinoderedza androgen insufficiency, anoenderera mberi kuvandudzwa yechipiri pabonde zvatariswa, zvishoma akaderedza potency, kwakaderedza kuratidzirwa osteoporosis uye mapfupa zera lag.

Ko chirwere vakadzi

Hypogonadotropic hypogonadism vakadzi kunoratidzwa underdevelopment pabonde nerevane ikawanda mumasero ovarian. Primary vachiberekwa fomu nokuda underdevelopment kana ovarian kukuvadzwa mune neonatal munguva.

Zvinonzi achideredza kugadzirwa dzepabonde mahormone, iyo chinokurwadzai kuwedzera huwandu gonadotropins, izvo inotokonya ovaries.

Mune Kuongororwa mukuru mwero mahormone inotokonya follicles uye lutein, uyewo pasi kwevari inonzi estrogen. Kwakaderedza mwero inonzi estrogen kunokonzera atrophy kana underdeveloped hadzi nhengo dzokubereka nadzo, mammary omumuviri, kusavapo kumwedzi.

Kana ovarian basa rakanga vasingadzoreki pamberi pakuyaruka, zvino pane kushayikwa yechipiri dzepabonde zvatariswa.

Hypogonadotropic hypogonadism vakadzi vari chikuru sezvinoratidzwa zvinotevera ezvinhu:

• Vachiberekwa zvirwere panguva majini chechetere;
• vachiberekwa hypoplasia of ovaries;
• kutapuriranwa urongwa (njovhera, tibhii, Mumps, irradiation, kuvhiya nokubviswa ovaries);
• pokukundwa autoimmune hunhu;
• urwere, testicular feminization ;
• polycystic ovaries.

Secondary hypogonadotropic hypogonadism vakadzi rikaitika zvokurwara pamusoro pituitary uye hypothalamus. Zvinonzi kusiyaniswa yakaderera kugutsikana kana zvakakwana kumira pagadzirwe gonadotropins inodzora ovarian ushande. Izvi zviri kukonzerwa kuzvimba uropi nharaunda. zvirwere izvi vane kukuvadza zvazvinoita uye vari pamwe vasanyanye padanho nokufumura gonadotropins kuna ovaries.

Sei zvirwere zvakadai hypogonadotropic hypogonadism vakadzi, uye pamuviri vari? Kwakaomarara intrauterine kukura ari mudumbu inogona kukanganiswa panowanikwa chirwere.

Zviratidzo vakadzi

Bright zviratidzo nekubereka nguva - kutyora kumwedzi, kana kushaiwa kwayo.

The pasi pamwero hadzi mahormone kunotungamirira underdevelopment dzepabonde nhengo, mammary omumuviri, kutyora deposition mafuta uye dzakaonda muviri bvudzi.

Kana hosha iri vachiberekwa zvakasikwa, yechipiri zvepabonde maitiro haamo. Vakadzi akaona kuvapo rakamanikana chiuno uye sandara magaro.

Kana chirwere yakaitika pamberi pakuyaruka, dzezvepabonde unhu akazviratidza kuramba kuponeswa, asi mwedzi wakagumiswa dzokubereka nadzo tishu atrophy.

SERVICING iri

Hypogonadism kana pane kuderera inonzi estrogen mumatunhu uye zvibereko kwevari gonadotropins. Kuburikidza Ultrasound dzakaratidzei akaderedzwa kukura dumbu chirwere ostepoporoz uye kunonoka paumbwe marangwanda.

kurapwa chirwere vakadzi

Sei yakapedza hypogonadotropic hypogonadism vakadzi? Treatment kunosanganisira chitsividzo mishonga. Vakadzi basa kuti kurapwa uye pabonde mahormone (ethinyl estradiol).

Kana kutanga kuenda kumwedzi varayire dzinogamuchidzanwa nhumbu ane estrogens uye progestins, uye kugadzirira "Triziston", "Trikvilar".

Rinoreva "Klimov", "Trisekvens", "klimonorma" ushandiswe varwere pashure pemakore 40.

Kemikari kurapwa iri contraindicated anotevera ezvinhu:

• kenza bundu iri nebandauko sikarudzi;
• mwoyo uye vascular zvirwere;
• renal kukundikana uye chiropa;
• thrombophlebitis.

dziviriro

zvirwere zvakadai hypogonadotropic hypogonadism, ane yakanaka fungidziro. Kudzivirira ndiko dzidzo hutano hwevanhu uye richiona vakadzi pamuviri, uyewo mumabasa utano.