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     Abnormal hypophysis gland or hypothalamus GnRH secretions lead to gonadotrophic deficit. Patients with hypogonadotrophic hypogonadism also suffer from androgenic deficit. Their seric levels of testosterone are decreased while their seric LH level remains normal, though there are cases where it can also be low.
     Congenital hypogonadotrophic hypogonadism is usually diagnosed in boys who fail to enter puberty. Phenotypically they are men because their maternal hCG stimulates fetal cells to produce testosterone thus developing a masculine genital system. But their organism produces few or no GnRH, then LH secretion fails to increase and testicular function remains prepubertal. Approximately 50% of these patients also suffer from Anosmia, and this condition is also known as Kallmann syndrome.
     There was scientifically proven that for this condition it is responsible an abnormal genetic encoder of the gene which stimulates, during fetal development, neuronal migration, and stops the normal GnRH migration towards the hypothalamus.
     Some of the men with congenital eunuchoidism consult the doctor late, for subnormal testicular growth, partial pubertal evolution and decreased testosterone level. Some of them also have reduced LH secretory pulsatile frequency. This version of the above condition has been called: the fertile eunuch syndrome. Also, hypogonadotrophic hypogonadism can emerge due to other hypophysis deficiencies.
     Acquired hypogonadotrophic hypogonadism can be caused by any lesion, infiltrative process or traumatism which affects the hypothalamus-hypophysis axis and interferes with the gonadotropins secretion. Tumors can be either functional- acromegalia, or nonfunctional- Craniopharyngioma.
     Patients with sellar and suprasellar tumors can also have headaches and poor vision. Gonadotropine secretion can also be altered by other hormones. Men with prolactin-secretor tumors have delayed puberty, reduced androgyny, impotence and infertility. In addition to the effect of compression of the prolactinomas which surround the hypophysis gland, LH pulsatile secretion is also affected and possibly GnRH secretions too.
     These effects can be stopped by bromocriptine treatment. Gonadotropin deficit observed in Cushing syndrome patients, probably caused by a cortisol hypersecretion, is treated with glucocorticoid antagonists, which restores the seric testosterone levels to normal. Patients with congenital adrenal hyperplasia, inadequately treated, can have both gonadotropine secretions derangements and infertility although the exact physiologic process is not very well known.
     Testicular function is also affected in men with chronic or acute systemic diseases, in those cases there are many other factors which should be taken into consideration like the patient’s life style, brusque weight loss, and malnutrition, stress, alcohol, cigarettes or drug abuse. Among the chronicle diseases which affect fertility are: hepatic diseases, gonadal dysfunction, HIV, hypogonadism, tyreotoxicosis, complete androgenic insensitivity, weight loss, old age etc.

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