| Objective(s): Clinical index risk factors were analyzed in patients with idiopathic hypogonadotropic hypogonadism(IHH).Follow-up to observe the treatment effect of IHH patients after adopting different treatment methods,standardize the clinical diagnosis and treatment of IHH,and improve the reproductive function and quality of life of IHH patients.Methods: A total of 120 IHH patients(82 males and 38 females,Among them,15 Kalman syndrome(14 males and 1 female))were diagnosed with idiopathic hypogonadotropic hypogonadism(IHH)in the Department of Endocrinology and Metabolism,the First People’s Hospital of Yunnan Province,the case group was selected retrospectively from January 2008 to December 2021,aged 22.43 ± 6.08years;95 healthy patients with normal gonadal function(75 males and 20 females),and 21.47±2.67 years were selected as the control group.General clinical data of case and control groups were collected,eliminate some patients with missing data;Analysis of Gn RH test,Gn RH treatment for three days and HCG test in case groups;Analyze whether the clinical indicators of the case group and the control group were statistically different,and perform multivariate analysis on the statistically significant indicators.In the case group,a total of 48 BMD results were collected from IHH patients(31 patients were included in the reduced BMD group(22 males,9females),the patients in the normal BMD group included 17 patients(6 males and 11females);Examine the potential causes that increase the likelihood of patients with IHH experiencing atypical BMD.A total of 88 patients with different treatment modalities completed follow-up,follow-up observation of patients with three different treatments(Gn RH pump,HCG,oral medication),sex hormone levels were recorded at the 3 months,6 months,and 1 year of treatment,testicular volume and semen analysis in men,female uterine size and pregnancy status.Statistical analysis of any statistical differences in the sex hormone changes of patients treated with different the available treatment time node include a three-month,six-month and one-year course of treatment,changes in testicular volume and spermatogenesis in men,and female pregnancy status.Results: A total of 43 patients had Gn RH excitation testing,the 37(86%)IHH patients showed a delayed response,3(7%)IHH patients had no significant response,3(7%)patients had no response;A total of 65 patients underwent a 3-day trial of Gn RH treatment,58(89%)IHH patients had delayed response,2(3%)IHH patients had no significant response and(8%)5 patients had no response.Serum FSH and(or)LH levels were>=1 m IU / m L after 3 days of Gn RH treatment.A total of 49 patients underwent HCG excitation test,and 34(69%)Testo increased more than 2 times higher than basal level after stimulation,indicating normal function of testicular stromal cell reserve;15(31%)showed no significant increase than basal level after stimulation,indicating a decrease of testicular reserve function.The difference was statistically significant in age,weight,E2,Testo,LH,FSH,CHOL,and blood glucose between cases and controls(P<0.05),There was no notable difference between the height,TSH,T3,T4,FT3,FT4,TG,HDL-C,and LDL-C in terms of statistical significance(P>0.05);Unordered binary Logistic regression analysis showed that E2 and Testo were the protective factors for IHH(P<0.05).Comparison of BMD reduction and normal BMD group in IHH patients: gender and age were statistically different(P<0.05),E2,Prog,Testo,PRL,LH,FSHwere not statistically significant(P>0.05);Disordered binary Logistic regression analysis showed that age was the risk factor for BMD reduction in IHH patients and sex was the protective factor for BMD reduction in IHH patients(P<0.05).IHH Male patients: FSH and LH were significantly increased in the Gn RH pump treatment group until 3 months(P<0.05).higher T levels in the Gn RH pump treatment group than in the HCG treatment and oral drug treatment group(P<0.05).IHH female patients:Treatment up to 3 months,FSH and LH were significantly increased in the Gn RH pump treatment group(P<0.05).The E2 levels were higher in the Gn RH pump treatment group than in the oral medication treatment group(P<0.05).The initial testicular volume of IHH patients was small,mostly 1-3ml.With the extension of Gn RH pump treatment time,the testicular volume increased to varying degrees.By 1 year of treatment,the testicular volume was>3ml(P<0.05),18 patients had increased total amount and concentration of sperm from 6 months to 1 year;15 female patients treated with Gn RH pump,4 patients pregnancy after 1 year of treatment,2 patients pregnancy after 6 months of treatment,1 patient pregnancy after 3 months of treatment,the pregnancy rate is 47%.Conclusion(s): A single Gn RH test not be able to fully assess pituitary reserve function,poor response patients with a period of continuous stimulation effect of the reevaluation is obvious;HCG excitation test can assess testicular reserve function,some reserve function decline,also evaluated after a period of stimulation.IHH will lead to the decrease of GLU,blood lipid and BMD in patients,E2 and Testo are the protective factors for IHH in patients,age is the risk factor for decreased bone mineral density in IHH patients,and gender is the protective factor.Follow-up observation found that the three treatments could increase Sex hormone levels.For the male patients,the therapeutic effect of Gn RH pump is obviously better than that of HCG and Oral medicine.Gn RH pump has obvious effect on spermatogenesis,which increases the testicular volume and significantly increases the pregnancy rate of female patients. |
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