误诊为隐睾的低促性腺激素性性腺功能减退一例分析及文献复习
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摘要
低促性腺激素性性腺功能减退(IHH)与隐睾在临床诊断中容易混淆,应该做好鉴别诊断,以免误诊误治。我们报道一例22岁男性,因发育不良伴肥胖(BMI 30.61kg/m~2)求治,经过查体双侧阴囊内空虚,并经B超诊断为双侧隐睾,拟进行睾丸牵引固定术收入院,经过系统查体和生殖激素分析获得完整资料。嘱患者增加腹压并仔细查体,可在阴囊内高位触及发育极差的睾丸(容积约0.5ml),结合FSH、LH及睾酮均显著低下,初诊为IHH。采用HCG(2 000U肌肉注射,每周2次)联合十一酸睾酮胶丸(80mg,每天2次口服)治疗2个月,患者自觉睾丸增大且已下降,检查阴囊内可触及明确的睾丸,容积约2.0ml。诊断性治疗结果表明,HCG联合睾酮能够有效治疗IHH患者的睾丸发育不良,并进一步明确了诊断。通过对本例误诊为隐睾的IHH病例诊治过程的分析并复习文献,探索了误诊原因及其危害,并制定出有效的治疗方案。
Idiopathic hypogonadotropic hypogonadism(IHH)can be confused with cryptorchidism,thus differentiated diagnosis should be confirmed to avoid misdiagnosis and unproper treatment in daily clinical practice.This paper reported a 22 year old man went to hospital due to penile dysplasia and obesity(BMI 30.61 kg/m~2).Bilateral scrotum empty was found by physical examination and bilateral cryptorchidism was diagnosed by type B ultrasound detection.The patient was admitted to hospital and proposed to process the testicular traction and fixation technique.The complete clinical data were obtained through physical examination and reproductive hormone analysis.After increased abdominal pressure and careful physical examination,bilateral testes could be touched in the high position of the scrotum(the volume was about 0.5 ml).The level of FSH,LH and testosterone were all significantly lower.The patient was finally diagnosis with IHH.The patients were treated with HCG(2000 U,im.twice a week)combined with testosterone undecanoate(80 mg,bid.)for two months.Two months later,the volume of testes increased and dropped into scrotum position.Testicular volume in the scrotum was about 2 ml,and the diagnosis results were further confirmed.Through the analysis of the diagnosis and treatment process of the patient with IHH who was misdiagnosed as cryptorchidism,and reviewing the literature,the causes of misdiagnosis and its harm were explored,and an effective treatment protocol was developed.
Idiopathic hypogonadotropic hypogonadism(IHH)can be confused with cryptorchidism,thus differentiated diagnosis should be confirmed to avoid misdiagnosis and unproper treatment in daily clinical practice.This paper reported a 22 year old man went to hospital due to penile dysplasia and obesity(BMI 30.61 kg/m~2).Bilateral scrotum empty was found by physical examination and bilateral cryptorchidism was diagnosed by type B ultrasound detection.The patient was admitted to hospital and proposed to process the testicular traction and fixation technique.The complete clinical data were obtained through physical examination and reproductive hormone analysis.After increased abdominal pressure and careful physical examination,bilateral testes could be touched in the high position of the scrotum(the volume was about 0.5 ml).The level of FSH,LH and testosterone were all significantly lower.The patient was finally diagnosis with IHH.The patients were treated with HCG(2000 U,im.twice a week)combined with testosterone undecanoate(80 mg,bid.)for two months.Two months later,the volume of testes increased and dropped into scrotum position.Testicular volume in the scrotum was about 2 ml,and the diagnosis results were further confirmed.Through the analysis of the diagnosis and treatment process of the patient with IHH who was misdiagnosed as cryptorchidism,and reviewing the literature,the causes of misdiagnosis and its harm were explored,and an effective treatment protocol was developed.
引文
[1]赵芳雅,陈海冰.男性低促性腺激素性性腺功能减退症的诊治[J].中华内分泌代谢杂志,2013.29:998-1001.
[2]杨志林,徐万华,赵为广.隐睾患儿血清性激素水平的研究[J].现代诊断与治疗,2015,26:2703-2704.
[3]王海,李宏军.特发性低促性腺激素性性腺功能减退症的药物治疗[J].生殖医学杂志,2016,25:1035-1039.
[4]McBride JA,Carson CC,Coward RM.Diagnosis and management of testosterone deficiency[J].Asian J Androl,2015,17:177-186.
[5]李宏军.应关注男性不育的药物治疗:睾酮,用还是不用[J].中国性科学,2014,23:106-110.
[6]Nieschlag E.Current topics in testosterone replacement of hypogonadal men[J].Best Pract Res Clin Endocrinol Metab,2015,29:77-90.
[7]茅江峰,窦京涛,伍学焱.特发性低促性腺激素性性腺功能减退症诊治专家共识解读[J].中国实用内科杂志,2016,36:204-207.
[8]徐洪丽,伍学焱.男性低促性腺激素性性腺功能减退症替代治疗[J].中国实用内科杂志,2013,33:513-515.
[9]Pitteloud N,Dwyer A.Hormonal control of spermatogenesis in men:therapeutic aspects in hypogonadotropic hypogonadism[J].Ann Endocrinol(Paris),2014,75:98-100.
[10]杨晓玉,刘金勇,舒黎,等.41例男性特发性低促性腺激素性性腺功能减退症的临床分析[J].国际生殖健康/计划生育杂志,2014,33:418-422.
[11]朱通,李彦锋,廖良功,等.促性腺激素释放激素泵治疗成年男性特发性低促性腺激素性性腺功能减退症的临床疗效与安全性观察[J].中华生殖与避孕杂志,2017,37:261-267.
[12]孙首悦,王卫庆,蒋怡然,等.微量泵脉冲输注戈那瑞林治疗特发性低促性腺激素性性腺功能减退症[J].中华内分泌代谢杂志,2011,27:654-658.
[13]黄炳昆,茅江峰,徐洪丽,等.GnRH脉冲输注与HCG/HMG联合肌注对男性IHH患者生精治疗效果比较[J].中华医学杂志,2015,95:1568-1571.
[14]Dwyer AA,RaivioT,Pitteloud N,et al.Gonadotrophin replacement for induction of fertility in hypogonadal men[J].Best Pract Res Clin Endocrinol Metab,2015,29:91-103.
[15]Matsumoto AM,Snyder PJ,Bhasin S,et al.Stimulation of spermatogenesis with recombinant human follicle-stimulating hormone(follitropin alfa;GONAL-f):long-term treatment in azoospermic men with hypogonadotropic hypogonadism[J].Fertil Steril,2009,92:979-990.
[2]杨志林,徐万华,赵为广.隐睾患儿血清性激素水平的研究[J].现代诊断与治疗,2015,26:2703-2704.
[3]王海,李宏军.特发性低促性腺激素性性腺功能减退症的药物治疗[J].生殖医学杂志,2016,25:1035-1039.
[4]McBride JA,Carson CC,Coward RM.Diagnosis and management of testosterone deficiency[J].Asian J Androl,2015,17:177-186.
[5]李宏军.应关注男性不育的药物治疗:睾酮,用还是不用[J].中国性科学,2014,23:106-110.
[6]Nieschlag E.Current topics in testosterone replacement of hypogonadal men[J].Best Pract Res Clin Endocrinol Metab,2015,29:77-90.
[7]茅江峰,窦京涛,伍学焱.特发性低促性腺激素性性腺功能减退症诊治专家共识解读[J].中国实用内科杂志,2016,36:204-207.
[8]徐洪丽,伍学焱.男性低促性腺激素性性腺功能减退症替代治疗[J].中国实用内科杂志,2013,33:513-515.
[9]Pitteloud N,Dwyer A.Hormonal control of spermatogenesis in men:therapeutic aspects in hypogonadotropic hypogonadism[J].Ann Endocrinol(Paris),2014,75:98-100.
[10]杨晓玉,刘金勇,舒黎,等.41例男性特发性低促性腺激素性性腺功能减退症的临床分析[J].国际生殖健康/计划生育杂志,2014,33:418-422.
[11]朱通,李彦锋,廖良功,等.促性腺激素释放激素泵治疗成年男性特发性低促性腺激素性性腺功能减退症的临床疗效与安全性观察[J].中华生殖与避孕杂志,2017,37:261-267.
[12]孙首悦,王卫庆,蒋怡然,等.微量泵脉冲输注戈那瑞林治疗特发性低促性腺激素性性腺功能减退症[J].中华内分泌代谢杂志,2011,27:654-658.
[13]黄炳昆,茅江峰,徐洪丽,等.GnRH脉冲输注与HCG/HMG联合肌注对男性IHH患者生精治疗效果比较[J].中华医学杂志,2015,95:1568-1571.
[14]Dwyer AA,RaivioT,Pitteloud N,et al.Gonadotrophin replacement for induction of fertility in hypogonadal men[J].Best Pract Res Clin Endocrinol Metab,2015,29:91-103.
[15]Matsumoto AM,Snyder PJ,Bhasin S,et al.Stimulation of spermatogenesis with recombinant human follicle-stimulating hormone(follitropin alfa;GONAL-f):long-term treatment in azoospermic men with hypogonadotropic hypogonadism[J].Fertil Steril,2009,92:979-990.