Parents were concerned about their 16-year-old son for the following reasons: he

Question

Parents were concerned about their 16-year-old son for the following reasons: he had no deepening of his voice, scanty pubic and axillary hair growth, absence of beard and mustache growth, small penis, poor muscular development, and psychosocial immaturity.

Laboratory evaluation indicated the following:

Sperm testosterone= 100 ng/dl and sperm count of 10 million/ml of semen

The following tests were performed:

Clomiphene (a nonsteroidal, weak estrogen agonist that stimulates the release of gonadotropins) 100 mg/day for seven days: 0% increase in LH (50% is normal)

Gn-RH (100 µg I.V.): 0% increase in LH in twenty minutes (300% is normal)

HCG (5000 I.U., I.V.): 50% increase in plasma testosterone one to three days after injection

This person was subsequently treated with FSH at 25-75 U three times/week and HCG as described above. Sperm count and testosterone levels were both near normal after two months of treatment, and primary and secondary sex characteristics appeared.

1. What is the endocrine disorder in this individual?

2. Is this a primary or secondary disorder? Why?

3. Why is hCG used in the treatment?

4. Why would both FSH and hCG be needed in the treatment?

Explanation / Answer

1.The endocrine disorder in this individual is hypogonadism in which testosterone is produced in low quantities in males.In this disorder the testicles are not stimulated by the pituitary gland to produce testosterone in adequate quantities.

2.This is a secondary disorder.This is because the sex organs are not directly affected as in primary disorders.The characters mentioned appear at the time of puberty and sexual maturity and are therefore secondary characters.

3.hCG is used in the treatment because it stimulates the testes to produce more testosterone as it mimicks the role of LH. hCG hormone also stimulates the androgen receptors to become more responsive so that the other sexual dysfunctions can be treated well.

4.Both FSH and hCG are needed for the treatment because FSH stimulates the testicular growth and also increases the production of androgen receptors by sertoli cells so that sperm cells mature.hCG hormone stimulates the production of testosterone from leydig cells of testes.Thus both hormones together help to maintain the secondary sexual characters by maintaining the testosterone levels.

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