According to Klein et al. (2019), two pertinent types of amenorrhea occur in women. Primary amenorrhea is a lifelong absence of menses that requires evaluation if menarche has not occurred by 15 years of age or three years post-thelarche (Klein et al., 2019). Secondary amenorrhea is a cessation of previously regular menses for three months or previously irregular menses for six months, which certainly requires evaluation (Klein et al., 2019). In addition, infertility is a biological inability to conceive after one year of actively attempting to have children (Dlugasch & Story, 2021).
Neuroendocrine activity that occurs during puberty stimulates the secretion of gonadotropins from the pituitary gland that help transition the body from childhood to adulthood (Bozzola et al., 2018). This is considered delayed when the signs of sexual maturation are more than 2-2.5 standard deviation values greater than the average population (Bozzola et al., 2018). In this case study, this 16 year old male is exhibiting signs of hypogonadism.
Discuss male hypogonadism
Hypogonadism can be categorized into two groups: primary and secondary hypogonadism. In the primary type, there is a dysfunction in the testicles that leads to an impaired response of the gonads to GnRH or LH stimuli (Hackney, 2020). In secondary hypogonadism, the hypothalamus or pituitary gland fails to signal the testicles to produce testosterone, meaning that GnRH or LH are not adequately produced (Hackney, 2020). This is referred to as hypogonadotropic hypogonadism and leads to low testosterone levels and decreased sperm production (Dlugasch & Story, 2021).
Explain hormone administration
In hypogonadism, there is a lack of production of LH despite exogenous hormone administration (Lee & Ramasamy, 2018). The use of human chorionic gonadotropin (hCG) can help to recover endogenous testosterone production in patients who cannot produce their own or an amount that is insufficient (Lee & Ramasamy, 2018). Exogenous testosterone can improve some aspects of physical sexual development but can actually impair spermatogenesis when used independently, as it can promote a negative feedback pattern on the hypothalamus and pituitary (Lee & Ramasamy, 2018). By bypassing the production of LH, the intratesticular testosterone levels can remain low (Lee & Ramasamy, 2018). hCG therapy, however, preserves spermatogenesis in patients receiving testosterone replacement therapy.
Is there a problem with the hypothalamus? Why or why not?
The activation of the hypothalamus-pituitary-gonadal axis stimulates the gonads in males to produce testosterone (Bozzola et al., 2018). Luteinizing hormone or LH, is produced by the anterior pituitary gland after the secretion of gonadotropic releasing hormone, which originates from the hypothalamus (Lee & Ramasamy, 2018). the dysfunction in this patient originates in the hypothalamus and has a cascading effect on the production of sex hormones in the individual and the progression through puberty.
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