Classification of Andrological Disorders
Infertility and hypogonadism are symptoms of a wide range of disorders to be dealt with in the following chapters. It is the physician's task to recognize the subtle nuances of these symptoms and to use appropriate ancillary techniques in order to arrive
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Classification of Andrological Disorders Frank Tüttelmann and Eberhard Nieschlag
Contents 4.1 Classification Based on Localization and Cause ....
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4.2 Classification According to Therapeutic Possibilities .................................................................
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References ...........................................................................
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4.1 Classification Based on Localization and Cause Infertility and hypogonadism are symptoms of a wide range of disorders to be dealt with in the following chapters. It is the physician’s task to recognize the subtle nuances of these symptoms and to use appropriate ancillary techniques in order to arrive at the appropriate diagnosis. In andrology, as in all areas of medicine, a diagnosis as exact as possible is the prerequisite for optimal therapeutic direction. Correct therapy requires knowledge of the pathological basis of the underlying disorder. The causes of male infertility and hypogonadism are located at various levels of the organism. The testes themselves may be affected; the causes for infertility may lie in the excurrent seminal ducts or in the accessory sex glands; there may be a disturbance of semen deposition, but also central structures such as the hypothalamus and the pituitary or the androgen target organs may be afflicted. The first principle in classifying disorders of male infertility and hypogonadism is therefore the topographic localization of the cause. The nature of the cause may serve as a second principle of classification, e.g., endocrine, genetic, inflammatory etc.
F. Tüttelmann ( ) Institute of Human Genetics of the University, Vesaliusweg 12–14, D-48149 Münster, Germany e-mail: [email protected]
Such a classification is used in this volume. An overview is shown in Table 4.1, which also indicates whether an individual disorder is associated with signs of androgen deficiency, infertility or both symptoms. Comparable classifications are also used in other andrological textbooks/chapters, giving a rough division into hormonal, testicular and post-testicular origins (de Kretser et al. 2006; Bhasin 2007).
E. Nieschlag et al. (eds.), Andrology, DOI: 10.1007/978-3-540-78355-8_4, © Springer-Verlag Berlin Heidelberg 2010
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F. Tüttelmann and E. Nieschlag
Table 4.1 Classification of disorders of testicular function based on localization of cause Localization Disorder ICD-10 Cause of disorder Hypothalamus/ pituitary
Testes
Kallmann syndrome, idiopathic hypogonadotropic hypogonadism
E23.0
Prader-Labhart-Willi syndrome Constitutionally delayed puberty Secondary disturbance of GnRH secretion
Q87.1
Hypopituitarism
E23.0
Pasqualini syndrome Hyperprolactinemia Congenital anorchia Acquired anorchia
E23.0 E22.1 (D35.2) Q55.0 E89.5
Maldescended testes
Q53.9
Varicocele Orchitis
I86.1 N45.-
Sertoli-cell-only syndrome Spermatogenic arrest Globozoospermia Immotile cilia syndrome DSD (Disorders of sexual development) Klinefelter syndrome, 47,XXY 46,XX male syndrome
N46 N46 N46 N46
Gonadal dysgenesis Persist
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