Hypogonadism

Hypogonadism wuxuu dhacaa marka qanjidhada galmada ee jirka ay soo saaraan hormoonno yar ama aan lahayn. Ragga, qanjidhadaas (gonads) waa xiniinyaha. Haweenka, qanjidhadaasi waa ugxansidaha.

Sababta hypogonadism waxay noqon kartaa mid asaasi ah (tijaabooyin ama ugxan sidayayaal) ama mid labaad (dhibaato xagga pituitary ama hypothalamus). Marka loo eego hypogonadism-ka aasaasiga ah, ugxan sidaha ama tijaabooyinka laftoodu si sax ah uma shaqeeyaan. Sababaha keena hypogonadism-ka aasaasiga ah waxaa ka mid ah:

• Ciladaha jirka qaarkood
• Cilladaha hidaha iyo koritaanka
• Caabuq
• Beerka iyo kalyaha
• Shucaac (gonads)
• Qalliinka
• Murugo
  

Cilladaha ugu badan ee hidde-wadayaasha keena hypogonadism-ka asaasiga ah waa Turner syndrome (haweenka) iyo Klinefelter syndrome (ragga).

Haddii aad horeyba u qabtey xanuuno kale oo isdifaaca jirka ah waxaad halis sare ugu jirtaa waxyeelada isdifaaca jirka ee gonads. Kuwaas waxaa ka mid noqon kara xanuunno saameeya beerka, qanjidhada adrenal, iyo qanjidhada tayroodhka, iyo sidoo kale nooca macaanka ee 1aad.

Hypogonadism-ka dhexe, xarumaha maskaxda kujira ee xukuma gonads (hypothalamus iyo pituitary) si sax ah uma shaqeeyaan. Sababaha keena hypogonadism-ka dhexe waxaa ka mid ah:

• Anorexia nervosa
• Dhiigbax aagga pituitary
• Qaadashada daawooyinka, sida glucocorticoids iyo opiates
• Joojinta steroids dhiska
• Dhibaatooyinka hiddo-wadaha
• Caabuqyada
• Ciladaha nafaqada
• Xad dhaafka birta (hemochromatosis)
• Shucaac (pituitary ama hypothalamus)
• Degdeg, miisaan lumis weyn (oo ay ku jiraan miisaanka oo yaraada qalliinka bariatric)
• Qalliinka (qalliinka salka dhakada ee ku dhow pituitary)
• Murugo
• Burooyinka

Sababta hidde ee hypogonadism-ka dhexe waa Kallmann syndrome. Dad badan oo qaba xaaladdan sidoo kale waxay leeyihiin dareen ur oo yaraaday.

Menopause waa sababta ugu badan ee loo yaqaan 'hypogonadism'. Waa caadi dumarka oo dhan waxayna ku dhacdaa celcelis ahaan illaa da'da 50. Heerarka testosterone waxay hoos u dhacaan ragga markay gaboobaan, sidoo kale. Kala duwanaanshaha testosterone caadiga ah ee dhiiga aad ayuu uga hooseeyaa nin 50 ilaa 60 sano jir ah marka loo eego kan 20 ilaa 30 jirka.

Gabdhaha qabo hypogonadism ma bilaabi doonaan caadada. Hypogonadism wuxuu saameyn ku yeelan karaa horumarka naasaha iyo dhererkiisa. Haddii hypogonadism ay dhacdo qaan-gaarnimada ka dib, astaamaha haweenka waxaa ka mid ah:

• Ololayaal kulul
• Tamarta iyo niyadda ayaa is beddela
• Caadada caadadu waxay noqota mid aan caadi ahayn ama joogsata

Wiilasha, hypogonadism wuxuu saameeyaa muruqyada, gadhka, xubnaha taranka iyo codka. Waxay sidoo kale u horseedaa dhibaatooyinka koritaanka. Ragga calaamadaha waa:

• Ballaarinta naasaha
• Murqaha oo lumay
• Dhimista xiisaha galmada (libido yar)

Haddii pituitary ama buro kale oo maskaxeed ay jirto (hypogonadism central), waxaa jiri kara:

• Madax xanuun ama arag la'aan
• Dheecaan caano ah (oo ka yimaada prolactinoma)
• Calaamadaha cilladaha hormoonnada kale (sida hypothyroidism)

Burooyinka ugu caansan ee saameeya pituitary waa craniopharyngioma ee carruurta iyo prolactinoma adenomas ee dadka waaweyn.

Waxaad u baahan kartaa baaritaanno si aad u hubiso:

• Heerka Estrogen (haweenka)
• Hormone-kiciyaha follicle (heerka FSH) iyo heerka luteinizing hormone (LH)
• Heerka testosterone (ragga) - tarjumaadda tijaabadan ragga waaweyn iyo ragga buuran way adkaan kartaa sidaa darteed natiijooyinka waa in lagala hadlaa takhasus hoormoon (endocrinologist)
• Qiyaasaha kale ee shaqada pituitary

Tijaabooyinka kale waxaa ka mid noqon kara:

• Dhiig yaraanta iyo birta
• Tijaabooyinka hidda sidayaasha oo ay ku jiraan karyotype si loo hubiyo qaab dhismeedka koromosoomyada
• Heerka Prolactin (hoormoonka caanaha)
• Tirada manida
• Tijaabooyinka qanjirka 'thyroid'

Mararka qaarkood baaritaanno sawir ah ayaa loo baahan yahay, sida sonogram ugxansidaha. Haddii cudurka pituitary laga shakiyo, MRI ama CT scan maskaxda ayaa la samayn karaa.

Waxaa laga yaabaa inaad u baahato inaad qaadato daawooyinka ku saleysan hoormoonka. Estrogen iyo progesterone waxaa loo isticmaalaa gabdhaha iyo haweenka. Daawooyinka waxay ku yimaadaan qaab kiniin ah ama maqaarka maqaarka ah. Testosterone waxaa loo isticmaalaa wiilasha iyo ragga. Daawada waxaa loo bixin karaa sida balastar maqaarka ah, jel maqaarka ah, xal lagu marinayo kilkilaha, balastar lagu marinayo ciridka sare, ama cirbad ahaan.

Haweenka aan ilma galeenkooda laga saarin, daaweynta isku dhafan ee estrogen iyo progesterone waxay yareyn kartaa fursada ay ugu dhici karto kansarka endometrial. Haweenka qaba hypogonadism ee leh galmada oo hooseysa ayaa sidoo kale loo qori karaa testosterone hooseeya ama hormoon kale oo lab ah oo loo yaqaan 'dehydroepiandrosterone' (DHEA).

Haweenka qaarkood, cirbado ama kaniiniyada ayaa loo isticmaali karaa si loo kiciyo ugxansidaha. Cirbadaha hoormoonka pituitary ayaa loo isticmaali karaa in lagu caawiyo ragga inay soo saaraan shahwada. Dadka kale waxay u baahan karaan qalliin iyo daaweyn shucaac ah haddii uu jiro cudur ku dhaca cilladda pituitary ama hypothalamic.

Noocyo badan oo ka mid ah hypogonadism waa la daaweyn karaa waxayna leeyihiin aragti wanaagsan.

Haweenka, hypogonadism wuxuu sababi karaa madhalaysnimo. Menopause waa nooc ka mid ah hypogonadism-ka oo ku dhaca si dabiici ah. Waxay sababi kartaa olollo kulul, qallayl siilka ah, iyo xanaaq maadaama heerarka estrogen ay hoos u dhacaan. Khatarta lafa-beelka iyo cudurka wadnaha ayaa sii kordha dhalmada kadib.

Haweenka qaarkood ee qaba hypogonadism-ka waxay qaataan daaweynta estrogen, badiyaa kuwa qaata caadada joojinta hore. Laakiin isticmaalka muddada-dheer ee daaweynta hoormoonka ayaa kordhin kara halista kansarka naasaha, xinjirowga dhiigga iyo cudurka wadnaha (gaar ahaan dumarka da'da weyn). Haweenku waa inay kala hadlaan daryeel caafimaad bixiyahooda khataraha iyo faa'iidooyinka daaweynta hormoonka menopausal.

Ragga, hypogonadism wuxuu keenaa luminta waditaanka galmada wuxuuna sababi karaa:

• Awood daro
• Madhalaysnimo
• Cudurka Osteoporosis
• Tabar darrida

Ragga caadiyan waxay leeyihiin testosterone ka hooseeya markay gaboobaan. Si kastaba ha noqotee, hoos u dhaca heerarka hoormoonku uma eka sidii haweenka oo kale.

La hadal adeeg bixiyahaaga haddii aad ogaato:

• Dheecaanka naaska
• Ballaarinta naasaha (ragga)
• Nalalka kulul (haweenka)
• Awood daro
• Timaha jidhka oo luma
• Luminta caadada
• Dhibaatooyinka uurka
• Dhibaatooyinka xagga galmada
• Tabar darrida

Ragga iyo haweenkaba waa inay wacaan adeeg bixiyahooda haddii ay qabaan madax xanuun ama dhibaato xagga aragtida ah.

Joogtaynta jirdhiska, culeyska jirka ee caadiga ah iyo caadooyinka cunida caafimaadka leh ayaa mararka qaarkood kaa caawin kara. Sababaha kale lagama yaabo in laga hortago.

Yaraanshaha Gonadal; Xiniinyaha oo xumaada; Fowdada ugxaanta; Hormoonkaas - hypogonadism

• Gonadotropins

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Bhasin S, Brito JP, Cunningham GR, iyo al. Tijaabinta testosterone ee ragga qaba hypogonadism: tilmaamaha ku-takhasuska daaweynta bulshada ee Endocrine Society. J Clin Endocrinol Metab. 2018; 103 (5): 1715-1744. PMID: 29562364 pubmed.ncbi.nlm.nih.gov/29562364/.

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van den Beld AW, Lamberts SWJ. Endocrinology iyo gabowga. Gudaha: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Buugga Buugga Endocrinology. 14aad. Philadelphia, PA: Elsevier; 2020: cutubka 28.