9. 유환관증의 경우 치료후 추후관찰 기간이 짧아 조정기능은 언급할 수 없으나, 성교능력을 유지하고, 조정기능을 유발하여, 유지할 수 있는 가장 좋은 방법은 human chorionic, gonadotropin과 human menopausal gonadotropin 병용치료인 것으로 생각되었다.
이상의 결과로 보아 남성 성선기능부전증 환자에서도 적절한 홀몬요법으로 정상인과 같은 성생활을 유지할 수 있고 특히 유환관증의 경우 장기간의 홀몬요법으로 정상적인 성생활과 생식도 가능한 것으로 생각된다.
Clinical investigation of male hypogonadism
Jae Yup Hong
Department of Medical Science The Graduate School Yonsei University
(Directed by Prof. Moo Sang Lee, M.D.)
Male hypogonadism refers to decrease in Leydig cell function, diminished or
absent spermatogenesis, or both defects in tandem.
The results of clinical investigation on 29 patients with male hypogonadism seen
in urology department of Severance hospital from May, 1980 to August, 1982 are
reported.
The results were as follows ;
1. Physical findings varied according to whether onset occurred before or after
puberty.
2. The major physical finding was delay in sexual maturation.
In addition, gynecomastia was found in 7 cases, hyposmia or anosmia in 4 cases,
secondary bilateral anorchia in 4 cases, cryptorchidism in 3 cases and mental
retardation in 1 case.
3. In patients with hypergonadotropic hypogonadism(eunuch group), testicular
volume was 2.5 : 0.8㎖.
In patients with hypogonatotropic hypogonadism(eunuchoid group), testicular
volume was 2.4 ± 1.8㎖.
4. In patients with hypergonadotropic hypogonadism, penile length was 4.4 ±
1.2cm.
In patients with hypogonadotropic hypogonadism, penile length was 2.8 ± 1.4cm.
5. In patients with hypergonadotropic hypogonadism, plasma FSH was 62.4 ±
6. The cause of hypergonadotropic hypogonadism was Klinefelter's syndrome in 5
cases, prepubertal traumatic bilateral anorchisms in 2 cases, postpubertal
bilateral anorchisms for seminoma or torsion in 2 cases. Testicular atrophy was
found in 3 cases, 2 cases having past history of mumps orchitis and 1 case having
past history of trauma. In 3 cases, no etiology could be identified.
7. The cause of hypogonadotropic hypogonadism was a Kallamnn's syndrome in 4
cases. In two other cases, a pituitary lesion was suspected but could not be
confirmed due to absence of pituitary hormone reserve function test. Two cases were
identified as gonadotropin deficiency with growth hormone deficiency.
8. In patients with hypergonadotropic hypogonadism, androgen replacement therapy
with a testosterone preparation was performed. After the treatment, improvement of
male secondary sex characteristics such as hair growth, voice change ,enlargement
of penis size and scrotum size was noted.
Promotion and maintenance of sexual potency was also noted.
9. The patients with hypogonadotropic hypogonadism were treated with androgens,
HCG or HCG and HMG. However, due to the short period of therapy and follow-up, no
firm conclusions about treatment efficacy in this group can be drawn. Howeverl, the
best therapy to promote fertility should have been human chorionic gonadotropin
combined with human menopausal gonadotropin.
In conclusion, it appears that long-term treatment with androgen preparation
promotes sexual potency and improves male secondary sex characteristics in
hypergonadotropic hypogonadism.
In addition, long-term treatment with human chorionic gonadotropin combined with
human menopausal gonadotropin may provide an efficient means of treating paitients
with hypogonadotropic hypogonadism to obtain potency and fertility.
[영문]
Male hypogonadism refers to decrease in Leydig cell function, diminished or absent spermatogenesis, or both defects in tandem.
The results of clinical investigation on 29 patients with male hypogonadism seen in urology department of Severance hospital from May, 1980 to August, 1982 are reported.
The results were as follows ;
1. Physical findings varied according to whether onset occurred before or after puberty.
2. The major physical finding was delay in sexual maturation.
In addition, gynecomastia was found in 7 cases, hyposmia or anosmia in 4 cases, secondary bilateral anorchia in 4 cases, cryptorchidism in 3 cases and mental retardation in 1 case.
3. In patients with hypergonadotropic hypogonadism(eunuch group), testicular volume was 2.5 : 0.8㎖.
In patients with hypogonatotropic hypogonadism(eunuchoid group), testicular volume was 2.4 ± 1.8㎖.
4. In patients with hypergonadotropic hypogonadism, penile length was 4.4 ± 1.2cm.
In patients with hypogonadotropic hypogonadism, penile length was 2.8 ± 1.4cm.
5. In patients with hypergonadotropic hypogonadism, plasma FSH was 62.4 ± 20.5mIU/㎖, plasma LH 65.0 ± 23.6mIU/㎖, plasma testosterone 1.6 ± 1.4ng/㎖ and plasma prolactin 10.2 ± 4.2ng/㎖.
In patients with hypogonadotropic hypogonadism, plasma FSH was 3.5 ± 1.9mIU/㎖, plasma LH 5.3 ± 2.8mIU/㎖ and plasma testosterone 0.9 ± 0.6ng/㎖,
6. The cause of hypergonadotropic hypogonadism was Klinefelter's syndrome in 5 cases, prepubertal traumatic bilateral anorchisms in 2 cases, postpubertal bilateral anorchisms for seminoma or torsion in 2 cases. Testicular atrophy was found in 3 cases, 2 cases having past history of mumps orchitis and 1 case having past history of trauma. In 3 cases, no etiology could be identified.
7. The cause of hypogonadotropic hypogonadism was a Kallamnn's syndrome in 4 cases. In two other cases, a pituitary lesion was suspected but could not be confirmed due to absence of pituitary hormone reserve function test. Two cases were identified as gonadotropin deficiency with growth hormone deficiency.
8. In patients with hypergonadotropic hypogonadism, androgen replacement therapy with a testosterone preparation was performed. After the treatment, improvement of male secondary sex characteristics such as hair growth, voice change ,enlargement
of penis size and scrotum size was noted.
Promotion and maintenance of sexual potency was also noted.
9. The patients with hypogonadotropic hypogonadism were treated with androgens, HCG or HCG and HMG. However, due to the short period of therapy and follow-up, no firm conclusions about treatment efficacy in this group can be drawn. Howeverl, the
best therapy to promote fertility should have been human chorionic gonadotropin combined with human menopausal gonadotropin.
In conclusion, it appears that long-term treatment with androgen preparation promotes sexual potency and improves male secondary sex characteristics in hypergonadotropic hypogonadism.
In addition, long-term treatment with human chorionic gonadotropin combined with human menopausal gonadotropin may provide an efficient means of treating paitients with hypogonadotropic hypogonadism to obtain potency and fertility.