Testicular Dysfunction in Systemic Diseases
Men value highly their reproductive health as part of a full life. Consequently its preservation is an essential consideration in medical care and dissatisfaction can be anticipated should the focus on the presenting disease and its treatment neglect the
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Testicular Dysfunction in Systemic Diseases Gideon A. Sartorius and David J. Handelsman
Contents
18.1 Background
18.1
Background ........................................................... 339
18.2
Mechanisms of Reproductive Disruption by Systemic Diseases ............................................. 339 18.2.1 18.2.2
18.3
Specific Diseases and Disorders ........................... 341 18.3.1 18.3.2 18.3.3 18.3.4 18.3.5 18.3.6 18.3.7 18.3.8 18.3.9 18.3.10 18.3.11 18.3.12 18.3.13
18.4
Onset of Hypogonadism ......................... 340 Level of Disruption in the Male Reproductive Axis................................... 340
Renal Disease.......................................... Liver Disease .......................................... Respiratory Diseases ............................... Malignant Disease .................................. Neurological Diseases ............................ Gastrointestinal Diseases ........................ Hematological Diseases .......................... Endocrine and Metabolic Diseases ......... Immune Diseases .................................... Infectious Diseases ................................. Cardiovascular Diseases ......................... Dermatological Diseases ........................ Other Chronic Diseases ..........................
341 342 344 345 346 349 349 350 351 352 353 354 354
Therapeutic Implications ..................................... 355
References ........................................................................... 356
Systemic non-testicular illness has major effects on the testis although these have not always been sufficiently recognized. The clinical management of any medical disorder should include careful consideration of the effects of illness and its treatment on male reproductive health (including fertility, androgenic status and sexual function). Men value highly their reproductive health as part of a full life. Consequently its preservation is an essential consideration in medical care and dissatisfaction can be anticipated should the focus on the presenting disease and its treatment neglect the often unstated, but nevertheless deeply felt, men’s expectations that they retain full reproductive functions. This chapter will highlight the impact of systemic, non-testicular disease on testicular function. In a first part, pathophysiological mechanisms for testicular dysfunction are considered, while the second part highlights specific diseases and their treatment by organ system. Sexual dysfunction and testosterone deficiency or its treatment are covered in other chapters (Chaps. 16, 21, 26) while drug effects on testicular function, a field still remarkably understudied, is covered only in connection with specific diseases for which they are prescribed.
18.2 Mechanisms of Reproductive Disruption by Systemic Diseases G. A. Sartorius () University Women’s Hospital Basel, Spitalstrasse 21 Ch-4031 Basel, Switzerland e-mail: [email protected]
The clinical reproductive effects of non-testicular illnesses depend on the epoch of
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