误诊为隐睾的低促性腺激素性性腺功能减退一例分析及文献复习

A case report of hypogonadotropic hypogonadism misdiagnosed as cryptorchidism and literatures review

低促性腺激素性性腺功能减退(IHH)与隐睾在临床诊断中容易混淆,应该做好鉴别诊断,以免误诊误治。我们报道一例22岁男性,因发育不良伴肥胖(BMI 30.61kg/m^2)求治,经过查体双侧阴囊内空虚,并经B超诊断为双侧隐睾,拟进行睾丸牵引固定术收入院,经过系统查体和生殖激素分析获得完整资料。嘱患者增加腹压并仔细查体,可在阴囊内高位触及发育极差的睾丸(容积约0.5ml),结合FSH、LH及睾酮均显著低下,初诊为IHH。采用HCG(2 000U肌肉注射,每周2次)联合十一酸睾酮胶丸(80mg,每天2次口服)治疗2个月,患者自觉睾丸增大且已下降,检查阴囊内可触及明确的睾丸,容积约2.0ml。诊断性治疗结果表明,HCG联合睾酮能够有效治疗IHH患者的睾丸发育不良,并进一步明确了诊断。通过对本例误诊为隐睾的IHH病例诊治过程的分析并复习文献,探索了误诊原因及其危害,并制定出有效的治疗方案。

Idiopathic hypogon us differentiated diagnosis should adotropic hyp dism（IHH）can be confused with cryptorchidism, be confirmed to avoid misdiagnosis and unproper treatment in daily （BMI 30.61 kg/m^2） . Bilateral scrotum empty was found by physical examination and bilateral cryptorchidism was diagnosed by type B ultrasound detection. The patient was admitted to hospital and proposed to process the testicular traction and fixation technique. The complete clinical data were obtained careful physical examination, bilateral testes could be touched in the high position of the scrotum （the was about 0.5 ml）. The level of FSH, LH and testosterone were all significantly lower. The patient was finally diagnosis with IHH. The patients were treated with HCG（2000 U,im. twice a week） combined with testosterone undecanoate（80 mg,bid. ）for two months. Two months later, the volume of testes increased and dropped into scrotum position. Testicular volume in the scrotum was about 2 ml,and the diagnosis results were further confirmed. Through the analysis of the diagnosis and treatment process of the patient with IHH who was misdiagnosed as cryptorchidism, and reviewing the literature,the causes of misdiagnosis and its harm were explored,and an effective treatment protocol was developed.