低ゴナドトロピン性性腺不全症の臨床的検討

Abstract

低ゴナドトロピン性性腺不全症8例について以下の成績をえた.1)思春期前発症のものが5例, プロラクチン産生下垂体腫瘍により思春期後に発症したものが3例であった.2)主訴については, 前者はいずれも外性器発育不全, 後者は性欲低下2例, 不妊1例であった.3)睾丸容積は前者が平均7.8 ml, 後者のそれは平均20 mlであった.4)血中LHおよびFSH値は, 正常下限～低値を示し, 思春期前発症例と思春期後発症例で差をみなかった.後者の血中プロラクチン値は92～1070 ng/mlであった.血中テストステロン値は全例低値で平均0.8 ng/mlであった.5) LH-RH試験, hCG試験はいずれも比較的反応良好なものが多かった.なお思春期前発症例のうち治療により精液中に精子の出現をみた例では, 両試験とも他例に比し, 良好な反応がみられた.6)思春期前発症例にはhCGないしhMGの投与をおこなったが, 造精機能の導入をみたのは1例のみであった.プロラクチン産生下垂体腫瘍によるものでは, 腫瘍摘除術ないしブロモクリプチン投与, 一部の例にはゴナドトロピン投与もおこない, いずれもほぼ正常の精液所見がえられ予後良好といえた

Clinical study of eight cases of hypogonadotropic hypogonadism was performed. These cases consisted of five prepubertal cases and three postpubertal cases induced by prolactin-producing hypophyseal tumor. The former five cases had the chief complaints of incomplete development of their external genitalia. The chief complaints in three postpubertal cases were decreased libido in two and infertility in one. The average testicular volumes were 7.8 ml and 20 ml in prepubertal and postpubertal cases, respectively. The basal levels of luteinizing hormone (LH) were within the normal limit in most cases and follicle stimulating hormone (FSH) were low in most cases. There were no differences between the levels of these hormones in prepubertal cases and those in postpubertal cases. The range of basal level of prolactin in blood was 92 mg/ml to 1, 070 ng/ml in the postpubertal cases. The basal level of testosterone in blood was low in all cases. Most cases had rather good responses of LH and FSH after the administration of luteinizing hormone releasing hormone. The plasma level of testosterone was elevated after the administration of human chorionic gonadotropin (hCG) in most cases. The appearance of sperm in the semen was observed after the hCG therapy in only one of the prepubertal cases. On the other hand, all the postpubertal cases showed almost normal findings in semen analysis after hormone therapy.