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Therapie des hypothalamisch und hypophysär bedingten Hypogonadismus

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Andrologie

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Zusammenfassung

Die Wahl der Therapie des hypothalamisch oder hypophysär bedingten Hypogonadismus richtet sich nach dem Behandlungsziel: Geht es darum, eine bis dahin ausgebliebene pubertäre Hodenreifung zu initiieren und/oder einen Kinderwunsch zu erfüllen, dann sind die unzureichend gebildeten oder unzureichend wirksamen zentralen Hormone der gonadotropen Achse zu substituieren. Wenn ausschließlich Virilisierungseffekte des männlichen Organismus initiiert oder aufrechterhalten werden sollen, ist Testosteron zu substituieren. In diesem Falle bleiben jedoch unzureichend gereifte Hoden immatur, die testikuläre Testosteronsekretion wird nicht stimuliert und die Spermatogenese bleibt aus.

Während bei hypothalamischer Ursache des hypogonadotropen Hypogonadismus (HH) die Möglichkeit besteht, alternativ den GnRH-Mangel oder die defiziente hypophysäre LH- und FSH-Sekretion durch entsprechenden Hormonersatz auszugleichen, ist bei hypophysärer Ursache des Hypogonadismsus lediglich die Gonadotropin-Substitution wirksam.

Die Dosierung der Therapie hat die bereits stattgefundene pubertäre Reife zu berücksichtigen, um unerwünschte Nebenwirkungen einer zu raschen Androgenisierung zu vermeiden.

Im Falle eines funktionellen Hypogonadismus ist die Therapie der Ursache der Beeinträchtigung der zentralen gonadotropen Achsenfunktion das Ziel der Behandlung. Gelingt dies, so ist der Hypogonadimus ohne Hormontherapie reversibel.

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  1. Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinikum Münster, Münster, Deutschland

    Julia Rohayem & Eberhard Nieschlag

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  1. Julia Rohayem
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  2. Eberhard Nieschlag
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Correspondence to Julia Rohayem .

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Editors and Affiliations

  1. Centrum für Reproduktionsmedizin und And, Universität Münster, Münster, Deutschland

    Eberhard Nieschlag

  2. Zentrum für Reproduktionsmedizin und And, Universität Halle-Wittenberg Universitätsklinikum Halle (Saale), Halle, Sachsen-Anhalt, Deutschland

    Hermann M. Behre

  3. Abt. Klinische/Operative Andrologie, Universitätsklinikum Münster, Münster, Nordrhein-Westfalen, Deutschland

    Sabine Kliesch

  4. Zentrum für Reproduktionsmedizin und And, Universitätsklinikum Münster, Münster, Deutschland

    Susan Nieschlag

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Rohayem, J., Nieschlag, E. (2022). Therapie des hypothalamisch und hypophysär bedingten Hypogonadismus. In: Nieschlag, E., Behre, H.M., Kliesch, S., Nieschlag, S. (eds) Andrologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61904-9_38-1

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