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SMALL TESTIS

How Testis Develops: In all male child testis is small. It remains small until the onset of genital development i.e. puberty which usually starts at age of 14 years. At this time L.H. & F.S.H. hormone is secreted from pituitary gland in brain. These hormone act as Germ cell & Sertoli cells in testis leading to there growth. This enlargement is size continues upto 18 years, ultimately reaching size of 12 to 25 ml. Other hormones which control testis size are growth hormone IGF-1 & others. 

Cause of small Testis: There are many causes of small testis. These are as follows :- 

1)      Hypogonadotropic Hypogonadism: Hypogonadism, Hypothyroidism, Testosterone deficiency, hyperprolactinema,  Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiency) Hypogonadotropic states: Hypothalamic – pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome , Hypothalmic deficiency, pituitary hypoplasia, Trauma, post surgical, postoradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, tuberculosis, fugal infection, hemochromatosis) Autoimmune hypophysitis, drug-induced hyperprolactinemia, Untreated endocrinopathies , Glucorticoid excess, Hypopituitarism, Cushing disease, Addison disease.
Isolated gonadotropin deficiency (non acquired) : Pituitary , Hypothalamic
Associated with multiple pituitary hormone deficiencies : Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngiomas, Rathke pouch cycts, hypothalamic tumors, pituitary adenomas), Following surgery, Following cranial irradiation, Following CNS chemotherapy, Following inflammation, Infiltrative or destructive processes (autoimmune, hemosiderosis), Associated with syndromes involving hypthalamic function, Laurence-Moon-Beidl sundrome Prader-Willi syndrome , Frohlich syndrome
Isolated gonadotropic deficiency with or without anosmia, Fertile eunuch syndrone, Idiopathic hypopituitarism, CNS disorders : tumors, infections, pituitary agenesis or hypoplasia, hydrocephalus, Septooptic dysplasia, CNS radiation for leukemia or brain tumor, Prader-Willi and Laurence-Moon-Biedly Syndrome, Thalassemia major

(2) Hyperogonadotropic hypogonadism:

testicular failure, development defect, drugs, trauma, congenital defect, congenital adrenal hyperplasia, Chromosomal defect, testosterone hormone biosynthetic defect, Mumps orchitis leading to testicular atrophy,
Primary testicular defect-disorders of testicular differentiation or inborn errors of testosterone synthesis, Klinefelter syndrome, Other X polysomies (i.e. XXXXY, XXXY)
Rainbow syndrome,
(3) Partial androgen insensitivity 
(4) Growth Hormone Deficiency 
(5) Idiopathic small Testis: In many patients all the hormone growth factor & every thing else is normal ,still they have small testis with or without small pennis i.e. genitalia. This occurs due to Decreased capacity of testicular tissue to grow.This occurs due to defective development of the testis in utero so that its growing capacity decreases later in life

(6)Vanishing Testis Syndrome

            (7) Dysmorphic Syndrome

(8)   Post Mumps Orchitis.

                                          Consequences of Small Testis :

When testis is small it denotes that testis is not fully developed thus it will not be having normal function also.

 The two functions of fully developed testis are: 
(1) Production of normal amount of semen including sperms. So people with small testis has less i.e. decreased semen amount, subnormal sperms count or may be even nil sperms called Azoospermia. This leads to infertility.

(2) The second function of testis is to produce male hormone testosterone. This hormone then acts on various organ system of body like hair of face & body leading to development of beard & moustache, development of muscular body, increase in penile size, male pattern of behavior, having genital desire & power. Thus small testis meaning underdeveloped testis leads to less beard & moustache, less muscular body, feminine behavior, soft skin, infertility, impotency. Patient may have one symptom or more of above symptoms & signs. 

Investigation & Diagnosis: For proper diagnosis of cause of small testis we do following tests. 
For diagnosis of cause of investigation following tests are required. These tests include
 complete male hormone profile. This profile includes all the male hormone tests which affects testicular development , growth & other genital organ development as well as genital functions.
Thyroid test
serum prolactin
SHBG
Semen analysis
ultrasound of testis
Growth Hormone analysis
DHT Level

Other tests depending on likelihood of other possibilities
Tests may show low testosterone. L.H. & F.S.H. may be decreased or increased may be low. Thyroid test may show low free T3 & free T4 & TSH may be increased or decreased. Similarly prolactin hormone may be low or high.
other tests which may be required depending on likelihood of the any of above causes. 
 In biochemistry liver function or kidney function tests are done. 
 Dynamic test to judge functional capacity of testis whether testis has the capacity to function normally or not. In this test we inject single injection of gonadotropin as intramuscular injection then three day later the rise in concentration of male hormone is seen to asses whether testis has capacity to function normally or not.
Chromosomal analysis is done to see the genetic structure of testis, because there are many chromosome disorders, which lead to small pennis. 
Capacity of generation of active testosterone i.e. DHT is tested. This DHT generation test is abnormal in some cases of small pennis / thin pennis /underdeveloped pennis. 
Tests to locate testis as ultrasonography or C.T. Scan abdomen is needed if testis is not palpable. 
MRI / CT SCAN head if suspecting hypogonadotropic hypogonadism. 
Serum inhibin is tested which tells that whether testis is functioning or not. 
Serum Iron, T.I.B.C. & ferritin concentration tested for hypogonadism due to hemochromatosis. Combined Pituitary hormone tests are performed when suspecting pituitary disorder. 
Molecular genetic studies done in some special cases. 
Serum estrogen increased whenever testicular function is decreased. 
Serum DHT is low in some conditions when generation of dihydrotestosterone is decreased.

Assessment of androgen receptor is done when needed, 
Dynamic tests as HCG test, response to antiestrogen & gonadotropin releasing hormone tests.
Interpretation of all above tests one need to be expert of hormone diseases with good experience. Based on above test result diagnosis of cause of small /or thin pennis is made. Once the cause is found then treatment becomes very easy with good results. 
 If needed growth hormone & some other tests.  

Treatment : After finding the cause appropriate treatment started in form hormone replacement therapy. The treatment s as follows:
1) Gonadotropin therapy is also very effective in testis enlargement. This is available as injections which has no side effects with very good results. After start of treatment testis starts enlarging in three months time. With in one year time testis enlarges to normal size. Its function also normalizes in most patients. Later testis starts producing normal level of male hormone testosterone.  Once testosterone production normalizes, erection & genital desire becomes normal. Physical weakness disappears & mentally becomes more active & alert. All other symptoms also normalizes. Bone strength recovers. Testosterone treatment is harmless if given by expert in hormone in proper doses.

2) Gonadotropin Releasing hormone therapy is effective in many cases of underdeveloped testis even when gonadotropin therapy has failed in normalizing testicular size & function.

3) Growth hormone therapy in many cases where somatrop deficiency is found.

4) Growth Factor Therapy 

5) Male Hormone Replacement: Treatment with male hormone testosterone is available as oral tablets,  skin patch, skin gels or injection is  given with very good results.

The various preparation of testosterone & route of administration are: 

1)     Oral preparation that is available in capsule form. It need to be given one to three capsule daily.

These have no side effects. 

2) Transdermal Testosterone given as testosterone gel preparations.  It need to be applied any part of skin once a day.

It is very effective & has no side effects. 

3).  Transdermal Testosterone scrotal patch are also available which are very effective even if used in small doses.  It is very effective & has no side effects.

 4) Sublingual Testosterone cyclodextrin is now available which is very fast acting & very effective is fast & bettergenital organ secondary genital character development.  It is used as one tablet daily to be kept under the tongue for few minutes. It has no side effect and it is very effective

5)  Local application of D.H.T. gel available as Andractim gel is a new preparation for male hormone replacement. 

6)  Injection Testosterone esters these includes Testosterone enanthate & testosterone cypionate given intramuscular injections every 10 to 14 days. 

7) Long acting testosterone as testosterone bucilate given once in 4 months. 

8)  Testosterones implants are now available which once injected remain effective for up to six months. 

Response: Once we start the treatment testis starts enlarging in size. After start of treatment testis starts enlarging in three months time. With in one year time testis enlarges to normal size. Its function also normalizes in most patients. 

Side Effects: As this treatment consist of replacement of defective hormones. These hormones are given in physiological replacement doses as prescribed in our scientific text books. Thus this treatment does not have any side effects.

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Absent genital Development

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We get patients from all major cities in India & Abroad . In the following cities all the facilities for investigation & treatments including medicines are available as Delhi (North, South, East, Central, West, New Delhi), Ghaziabad, Faridabad, Noida, Gurgaon, Meerut, Saharanpur, Dehradun, Ferozepur , Aurangabad, Manesar, Rewari, Pataudi, Rohtak, Bahadurgarh,Bombay,  Bhiwani, Karnal, Panipat , Ambala, Ludhiana, Amritsar, Batala, Gurdaspur, Jalandhar, Patiala, Chandigarh, Calcutta,  Ferozepur Simla, Manali, Jammu, Udhampur, Poonch, Rajouri, Srinagar, Kargil, Aligarh, Mathura, Etawah, Lucknow, Kanpur, Allahabad, Varanasi, Kashi, Faizabad, Bareilly, Moradabad, Rampur., Dehradun, Uttarkashi, Meerut, Sitapur, Mathura,  Madras, Pilibhit, Nainital, Almora, Agra, Ferozabad, Jhansi, Alwar, Jaipur, Dausa, Ajmer, Beawar, Pali, Bhilwara, Chittorgarh, Kota, Dholpur, Churu, Ratangarh, Sikar, Bikaner, Jodhpur, Jalore, Rajkot, Porbandar, Jamnagar, Dwarka, Junagadh, Surendranagar, Bhav Nagar, Ambala, Ahmedabad, Gandhi Nagar, Godhra, Vadodara, Surat, Bilmora, Navasari, Mumbai, Sonapur, Kalbadevi, Girgaon, Dadar, Mahim, Dharavi, Juhu, Andheri, Kurla, Sahar, Pune, Thane, Palghar, Panaji, Panvel, Solapur, Pandharpur, Ahmednagar, Satara, Kolhapur, Ichalkaranji, Kalyan, Nasik, Dhule, Bhir, Nagpur, Bhandara, Amraoti, Khandwa, Indore, Ujjain, Ratlam, Mandsaur, Bhopal, Vidisha, Sagar, Guna, Shivpuri, Gwalior, Jabalpur, Bhilai, Raipur, Hyderabad, Zahirabad, Suryapet, Guntakal, Chittoor, Tirupati, Tirumala, Nandyal Vijayawada, Guntur, Goa,  Tenali, Nellore, Visakhapatnam, Vellore, Bangalore, Banglore, Ulsoor, Mysore, Srirangapatna, Hassan, Mangalore, Udupi, Manipal, Davanagere, Shimoga, Dharwad, Hubli, Bellary, Hospet, Bijapur, Belgaum, Chennai, Chengalpattu, Pondicherry, Tiruvannamalai, Kumbakonam, Thanjavur, Tiruchirappalli, Palani, Madurai, Sivakasi, Tirunelveli, Ambasamudram, Tenkasi, Nagercoil, Kanchipuram, Salem, Erode, Tirupur, Coimbatore, Pollachi, Kanyakumari, Ernakulam, Trivandrum, Calicut, Kottayam, Calcutta, Howrah, Purulia, Darjeeling, Siliguri, Gangtok, Bhubaneswar, Puri, Rourkela, Guwahati, Shillong, Imphal, Kohima, Agartala, Patna, Gaya, Bokaro, Jamshedpur, Ranchi, Madhubani.

We also get patients from following major cities of the world as Aalborg, Abadan, Abidian, Abudhabi, Abuja, Acapulco, Addis,  Ababa, Adelaide, Agadir, Agana, Ahvaz, Akueryai, Al Ain, Al Khobar, Alaska, Aleppo, Alexandria,       Alexandroupolis, Algiers, AlicanteAll, Areas, All Parts, All parts, Alma-Ata, Almada, AlofiAmatitlan, Ambato, Amman, Amsterdam, Andorra, Andrup, Ankara, AntanarivoAntigua, Antwerp, Apia, Aqaba, Areqioca, Arusha, Ashghabat, Asmara, Assab, Assuncion, Atbara, Athens, Auckland, Augra  Do Heroism Bacolod, Badalona, Baghdad, Baku, Bamako, Bander seribegaw, Bangkok, Barcelona, Barranquilla, Basseterre, Bedzin, Beijing, Belfast, Belgrade, Belize, Bengui, Benha, Benina, Bergen, Berlin, Bern, Bethlehem, Bhutan, Bimini, Birmingham, Bisho, Bissau, Bizerta, Bobo Dioulasso, Bogra, Bonaire, Bonn, Boras, Brasilia, Bratislava, Brazov, Brazzavila, Bremen, Bridgetown, Brisbane, Bristol, charest, Budape  st Buenos Aires, Bujumbura, Bulawayo, Bundung, Burgas, Buzau, Caacupe, Cairo, Cali, Canberra, Cap Haitien, Cape Town, Carecas, Castries, Cebu, Chengdu, Chicago, Chiclayo, chittagong, Christchurch, Christmas Island, CocosKeeling Island, Cologne, Colombu, Conakry, Conception, Contonou, Copenhagen Cordaba,  Cork, Coroval, Corprivertion, Craiova, Cuenca, Cumana, Curacao, Dacca, Dakar, Damascus, Damman, Dangregia, Dar Es Salaam, Defeera, Derbrecen, Dewaniya, Diego Suarez, Diriamba, Djibouti, Doha, Dramman, Dubai, Dublin, Durban, Dushanbe, Dusseldort, El Salvador, Entebbe, Erevan, Equitorial Guinea, Fade N'Gorma, Falun, Faroe Islands, Fes, Franarantsoa, Frankfurt, Freeport, Freetown, French Guiana, Frunze.Ft de France, Fujairah,  Gaborone, Garbrovo, Genda, Geneva, George Town, Georgetown, Ghent, Gibraltar, Glasgow, Gonaives, Gondomar, Granada Grand Beirut, Graz,Guadalajara, Guautemala City, Guayaquil, Gyongyas, Hajja, Hamar, Hamburg, Hamilton, Havana, Halsinki, Ho Chi Milk City, Hodeidah, Homs, HongKong, Honiara, Honolulu, Houston, Hyvinkaa, Ibadan, Ikeja, Incheon, Industira, Invercargill, Isfahan, Islamabad, Island tuvalu, Istanbul, Jakarta, Janawa, Jeddah, Jerusalam, Jimma, Jinia, Johannesburg, Jaba, Kaduna, Kampala, Kaoshiung, Karachi, Karor, Kathmandu, Khartoum, Khon Kean, Khulna, Kiev, Kigalibad, Kingston, Kingstown, Kismayo, kitwe, Kobe, Kolding, Kosice, Koudougou, Kowloon, Kristianstav, Kula Belait, Kuala Lumpur, Kuantan, Kumasi, Kuwait, Kyoto, La Paz, Lady Ville, Lea, Lagos, Lahore, Lahti, Larissa, Las Palmas, Lattaquieh, Leeds, Leipzig, Librevilla, Lima, Limassol, Linden, Lisbon, Liverpool, Ljubl-iana, Lome, London, Los Angeles, Luanda, Lubumbashi, Lugazi, Lungi, Lusaka, Luxembourg, Macao, Madani, Madrid, Majuro, Maldonado, Male, Malmo, Managua, Manama, Mancheter, Manila, Mansoure, Manta, Maputo, Maracay, Marrakech, Maseru, Mashad, Mayotte, Mbabane, Mbale, Medan, Medlin, Melbourne, Mendoza, Mexico city, Miami, Micronesia, Milano, Misrata, Mmabatho, Mogadiscio, Mombassa, Monrovia, MonteCarlo, Monterrey, Monte-video, Montreal, Moscow, Mosule, Mulanje, Mumbai, Muscat, Mutare, Mwanza, Nabeul, Naestved, Nagozi, Nairobi, Najat, Nanjing, Nassau, Nastriya, Nazareth, Ndjamena, New Amsterdam, New-York, Niamey, Nicosia, Norrkoping, Nottingham, Nouakehott, Noumea, Nukualofa, Oklahoma City, Omdurman, Oradea, Orodtheab, Oruro, Osaka, Oslo, Ostrava, Ottawa, Ouagadougu, Oulu, Panama-City, Paralimni, Paramaribo, Paris, Paysandu, Perth, peshawar, Philadelphia, Pingtung, Piraeus, Piura, Pl Villa, Plazen, Plovdiv, Plymouth, Poneloya, Port Au Prince, PortSaid, Port-Sudan, Potosi, Prague, Praia, Pretoria, Pt Lousi, Pt of Spain, Pt.Stanley, Pte Apitre, Pusan, pyongyang, Rabat, Ramalla, Rarstonga, Rawalpindi, Reykyavik, Riga,Rio De Janeiro, Riyadh, Road Town, Rodriquez Islands, Rome, Rosario, Roseau, Rota, Rotterdam, Rzeszow, Saba, Sabh, Sailburg, Salta, Samoa-American, San Francisco, San Jose, San Marcos, San Marino, San pablo, Sandnes, San-Jaun, Sanna, Senta Cruz(Graciosa), Santa Cruz, Santiago, Santo Doming, Sao Paulo, SaoTome Island, Semarang, Seoul, Serrekunda, Sert, Sfax, Shangai, Shariah, Singapore, Skopie, Sofia, Sopot, ST.Denis, St.Georges, St.Helena, St.Johns, St.Pitterbuze, Stockholm, Strydom Airport, Stuttgart, Suphanburi, Suva, Sydney, Szekesfehervar, Taegu, Taichung, Tainan, Taipei, Taiz, Tallinn, Tamatave, Tampere, Tanga, Tashkent, Tavira, Tbilisi, Tegucigalpa, Tehran, Tel-Aviv, Tema, Temburong, Teneriffe, The Hague, The Valley, Thessaloniki, Thohoyandou, Thomwood, Thonbiri, Thyolo, Timisoara, Tirane, Titograde, Tokyo, Toronto, Tripoli, Tsumeb, Tunisi, Turks Caicos, Tutong, Ulan-Batar, Vaduz, Valetta, Valparasio, Vancouver, Vatican City, Victoria, Victoria Falls, Vienna, Vientiana, Vigo, VilaDOporto, Villa Nueva, Villarica, Vilua, Vina Del Mar, Volgagrad, W.Berlin, Wallis & Futuna Island, Warsaw, Washington Dc, Wellington, Windhoele, Yaounde, Yaren, Yokohama, Yundum, Zagreb, Zahle, Zurich.

 At these places all the facilities for investigation & treatments are available.

At our center / centre / clinic / clinics / hospital / hospitals doctors are dedicated for latest & scientific treatment of these diseases.

Antibodies-AtAb(Microsomal & thyrogtobulin Abs)  720, tTG-Tissue Transglutaminase Antibody-lgA, 1200, Collagen markers: • ANA - Anti Nuclear Antibody, serum by EIA 480, ANA-Anti Nuclear Antibody, serum by IFA 480, ANA profile 4480, ANCA-MPO (p-ANCA) serum 550

ANCA-PRS(c-ANCA), serum 550 ANCA-Anti Neutrophil Cytoplasmic Antibody (MPO&PR3both) **, Arthritis panel 1350, Centromere Antibody, serum 700, CCP-Ab to cyclic citrulinated Peptide 600, CIC-IgM antibodies to circulating immune complex 550, DNA (Double Strand) Antibody, serum 630, ENA(Extractable Nuclear Antigen) profile 3360, Histone antibody 1050, IBD profile, serum (Inflammatory Bowel Disease) 2300, Jo-1 antibody, serum 700, La Antibody SSB (Soluble substance B) 700, RNP-Sm Antibody, serum 700, Ro Antibody SSA (Soluble Substance A), serum 700, Sderoderma panel (Antibody to SCI-70 and Centromere) 1120, Scl-70 antibody, serum 700, SLE profile 1680, Sm (Smith antigen), serum 700, SSA-Ro (Soluble Substance A) Antibody, serum 700, SSB-La (Soluble Substance B) Antibody, serum 700, U1-snRNP (68 KDa), serum 700 Cancer markers: • Breast Marker Profile (CA 15.3, CEA) 900, BTA-Bladder tumour associated analytes 2000

Different Hospitals in india are: Moolchand Health Care, St. Stephen’s Hospital, Dr. Ram Manohar Lohia Hospital, G.B Pant Hospital, Lok Nayak Hospital, RG Stone Urological Reasarch Institue, Sir Ganga Ram Hospital, Jeevan Hospital, Deen Dayal Upadhyaya Hospital, Orthonova Hospital, Batra Hospital, Sahi Hospital, Indraprastha Apollo Hospitals, Holy Faimly Hospital, Jeevan Mala Hospital, Jaipur Golden Hospital, Lady Harding Hospital, Smt. Sucheta Kriplani Hospital, Mata Chanan Devi Hospital, Safdarjung Hospital, Mohindra Hospital, M.P Heart centre Hospital, Bara Hospital, Hindu Rao Hospital, Holy Angels Hospital, Shankar Hospital, Holy Family Hospital, Chopra Hospital, Escorts Hospital St. Stephen's Hospital, Vardaan Hospital, Visitech Eye Hospital, Vardhman Mahavir Medical College, Safdarjung Hospital, Lok Nayak Jai Prakash (LNJP) Hospital, Private Hospital, Guru Teg Bahadur Hospital, Kalra Hospital,  Bangalore Baptist Hospital, Bowring Hospital, B W Lions Eye Hospital, Bangalore Hospital, Bangalore Children's Hospital, Genesis Hospital, Lakeside Hospital, M G A Hospital, Mallya Hospital, Manipal Hospital, Sindhi Charitable Hospital, Yellamma Dasappa Hospital,  Sir Harkisandas Narottamdas Hospital, Prince Alikhan Hospital, Saifee Hospital, Breach Candy Hospital, Jaslok Hospital, Habib Ismail Hosptal, Kalajyot Hospital, Motiben Dalvi Hospital, Bombay Hospital, Corwest Jain Clinic Group of Hospitals, D.S. Kothari Hospital, Lotus Hospital, Elizabeth Hospital, Bhatia Hospital, The Bomanji Dinshaw Petit Parsee Hospital, Cumbala Hill Hospital, Noor Hospital, K.B. Haji Bachoali Charitable Ophthalmic & ENT Hospital, Bai Jerbai Wadia Hspital, Nawroji Wadia Maternity Hospital, Wadia Hospital, Yerla Medical Trust Hospital, Tarachand Bappa Hospital, Dhanwantari Hospital, Shri Samasta Parajiya Suvarna Hospital, Smt.B.C.J. General Hospital, Smt.B.C.J. General Hospital, Holi Spirit Hospital, Lilavati Hospital, The Bandra Holy Family Hospital, Raheja Hospital, Gurunanak Memorial Hospital, Ramakrishna Mission Hospital, Radhibai Watumull Global Hospital, BSES Hospital, Sushrut Hospital, LH Hiranandani Hospital, Maganlal Popatlal & Sarvoday Hospital, Rajawadi Municipal General Hospital, Shatabdi Hospital, KBB Hospital, V.N. Hospital, Dr.K.B. Babha Hospital, Cooper Hospital, Bhagwati Hospital, Sion Hospital, K.E.M. Hospital Nayar Hospital, Kama Hospital, G.T. Hospital, J.J. Hospital, Sr.George Hospital, Aliganj Hospital, Blue Cross Hospital, Getwell Hospital, Krishna Lok Hospital, Lucknow Hospital, Medwin Hospital and Health Centre, Vivekanand Hospital, G.M.Associate Hospital, Dufferin Hospital, Civil Hospital, Communicable/Infectious Diseases Hospital Lifeline Hospital and Heart Centre, Lucknow Hospital, Shalimar Hospital, Rajendranagar Hospital Tuberculosis Hospital, Lucknow Rajpoot Hospital, Nishat Hospital, Z A Chartable Hospital, Indira Gandhi Eye Hospital, Sitapur Eye Hospital, Awadh Hospital and Heart Centre, Balrampur Hospital, Cantonment General Hospital, Civil Hospital, Dr.Shyama Prasad Mukherjie Hospital, Fatima Hospital, G.M.Associate Hospital, K.K.Hospital, Veerangana Jhalkari Bai Female Hospital, Shekhar Hospital, Queen Mary Hospital, Osmania General Hospital, Gandhi Hospital, Government Maternity Hospital, Nilofar Hospital, Cancer Hospital, T.B. Hospital, Hospital for Mental Diseases, Sarojini Devi Hospital, Sundram Medical Foundation, Chennai. MIOT Hospital, Chennai. Apollo Hospital, Madras. Malar Hospital Limited, Gandhi Nagar Adyar, Chenni. Calcutta Medical College Hospital. N.R.S. Medical College & Hospital, Calcutta. R.G. Kar Medical College & Hospital, Calcutta. Calcutta National Medical College & Hospital, Instt. of Postgraduate Med. Education & Research, Calcutta Seth S.K.M. Hospital, Calcutta. Sambhu Nath Pandit Hospital, Calcutta. Lady Dufferinvictoria Hospital, Calcutta. Howrah General Hospital, Howrah, Hoogly Sadar Hospital, Hoogly, Chittaranjan Seva Sadan & Chittaranjan Cancer Hospital,  Ramakrishna Mission Seva Pratishthan General Hospital, Calcutta.Civil Hospital, Imphal, Manipur.

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Absent genital Development

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disorders with, ocular effects , osteoporosis , permanent, primary, amenorrhea with, causes , gonadotropins , micropennis ,  secondary, combined,  pseudohypoparathyroidism type 1a, respiratory effects , secondary,  primary, combined, tertiary, testicular, anemia , treatment ,  trypanosomiasis, vitamin A , Hypogonadotropic eunuchoidism.   Kallmann syndrome Hypogonadotropic hypogonadism.  Hypogonadim, hypogonadtropic Hypokalemia alcohol intake ,  aldsterone secretion,  Cushing syndrome,  diabetic ketoacidosis management, diuretics ,  ectopic ACTHsyndrome,  ,  hyperaldosternism,  hyperparathyroidism, hyperreninemia , hyponatremic, magnesium deficiency ,  mineralocorticoid excess,.   Alkalosis, hypokalemic prerenal  sources , differentiation ,  pseudoaldosteronism,  pseudohypoaldosteronism type I,  renal tubular acidosis, renin-producing tumors ,  renovascular hypertension, with VIPoma, Hypokalemic periodic paralysis, acute, epidemiology , hereditary versus acquired,  hyperthyroidism, Hypomagnesemia.   Magnesium, deficiency  alcohold intake ,  critical illness,  , inhypertyyroidism, hypocalcemia , intestinal, primary, mental symptoms , neonatal, with hypocalcemia, clinical management neuromuscular manifestations , renal, primary with VIPoma, Hypomania  bipolar disorder,  hypothyroidis, inanorexia nervosa, Hyponatremia  adrenal insufficiency,  adrenal insufficiency,  adrenocortical insufficiency,  adrenocorticotorpic hormone deficiency, aldosterone secretion ,  “beer potomanin,”  critical illness, prognostic significance , definition , demylination , diuretic-induced, drug-induced, with effective solute other than sodium,  elderly, encephalopathy , euvolemic,  HIV-infected(AIDS) patients, evaluation ,  , with hyperglycemia, hypokalemia with,  hypopituitarism,  hypothyroidism, hypovolemic,  , iatrogenic (hospital-acquired), with myedema coma, neurologic complications , not reflecting hypoosmolality, postoperative,  pseudohypoaldosteronism, type I,  SIADH, management , spontaneous correction , treatment , tumoral,  tumor-associated SIAD, urinary kallikreins , Hyponatremic hypertensive syndrome  massive protteinuria, Hypoosmalality extracellular fluid (ECF) volume , hyponatremia not reflecting management , plasma sodium level ,  renal failure,  SAID, Hypoosmolar states, central nervous system symptoms I, serum sodium , clinical manifestations , definition , depletion-induced, treatment , differential diagnosis , dilution-induced, treatment , diuretic-induced, euvolemi, treatment evaluation , frequency , frequency , incidence , morbidity  mortality , nauseas  vomiting , pathogenesis , plasma endocrine response  prevalence , significance , treatment , acute, long-term, Hypoosmotic swelling test, Hypoparathyroidism, adrenal insufficiency,  mucocutaneous candidiasis (HAM), after thyroidectomy, alcohol-induced, autoimmune, nonendocrine organ-specific disorders associated with,  autoimmune adrenal failure,  autoimmune polyglandular (hypofunction) syndrome, autosomal dominant, biochemical characteristics , calcification , cardiovascular effects ,  cataract formation, cerebral effects , chronin acquired, chronic genetic, clinical findings , cutaneous manifestations , dental/orfacial abnormalities , familial isolated, autosomal dominant, autosomal recessive, PTH gene mutations , familial X-linked, functional, (AIDS) patients, hyperhosphatemia , idiopathic,.   Hypoparathyroidism, familial isolated familial isolated, PTH infusion , urinary response  nephrogenous aCMP , transient, neonatal, with neonatal hypocalcemia, treated, magnesium metabolism ,  type 1 polyglandular syndrome, vitamin D status , Hypoparathyroidism-deafness-renal dysplasia, Hypophosphatasia, adult, childhood, dental/orofacial abnormalities , infantile, ocular manifestations , osteomalacia , ostoporosis , otolaryngologic considerations , perinatal, prenatal, prenatal diagnosis , radiographaic findings ,  retinitis pigmentosa, co-occurrence , treatment , Hypophosphatemia,.   Hereditary hypohosphatemic rickets with hypercalciuria; Rickets, hypophosphatemic; X-linked hypophosphatemic rickets  acute phase response syndrome, alcohol intake ,  alkalosis,  anorexia nervosa,  autosomal-dominant hypophosphatemic rickets/ostomalacia, burn injury , causes , central nervous system symptoms , combined mechanism resulting ,  critical illness, indiabetic detoacidosis, with disturbance  phosphate intake/gastrointestinal absorption, familial, dental/orofacial abnormalities ,  Fanconi syndrome, fasting,  hypophoshatemic rickets,  gastrointestinal malabsorption, glucose administration   hereditary hypophosphatemic rickets with hypercalciuria, homeostatic response , hypercalcemia with, treatment ,  hyperparathyroidism,  infections disease,  MaCune-Albright syndrome, muscle weakness with,  neuromuscular manifestations ,   nutritiona recovery syndrome,  osteodystrophy   alcoholism, peripheral symptoms ,  phosphate deprivation, phosphorus repletion , with renal phosphate loss,  renal transplant recipient, respiratory effects , signs  symptoms ,  toxic shock syndrome, with transcellular shift  phosphorus, treatment ,  tumor-induced osteomalacia,  vitamin D-dependent rickets type I, vitamin D metabolism ,  X-linked hypopphosphatemic rickets/osteomlacia, Hypophyseal fossa.  Pituitary fossa; Sella turcica, Hypophsectormy  breast cancer treatment, continuedspermatogenesis after, partial, indications ,  prostate cancer, total, indication , Hypophysial artery (ies), Hypopysial stalk,.   Pituitary stalk atrophy , gliomas , granular cell tumors , interruption , mononuclear cell infiltration , squamous cell nests , Hypophysiotropic hormones(s),.   Corticotropin-releasing hormone; Gonadotropin-releasing hormone; Growht hormone-releasing hormone; Growth hormone-releasing hormone; Prelatic release-inhibiting hormone; Prelatic-releasing factor; Somatostatin, Thyrotropin-releasing hormone action ,  pituitary tumorigenesis, Hypopysis metastases , phyryngeal, Hypophysitis autoimmune, animal model , lymphocytic, ACTH deficiency with, nonendocrine organ-specific disorders associated with, organ-specific autoimmune disease associated with, postpartum,  pregnancy, cytokines , infectious, lymphocytic,  children, postpartum, T cells , subclinical,  Addison disease, association , Hypopigmentation.   Vitiligo endocrine/metabolic causes , Hypopituitarism, acquired prenatal, traumatic, adrenal insufficiency , after postpartum hemorrhase, anemia ,  anovulation, autoimmune, with basal encephalocele, cerebral effects , clinical presentation , conditions mimicking, congenital, dental/orofacial abnormalities , with diabetes insipidus, diagnosis ,  elderly, hormone therapy discontinuation , hypogonadotropic hypogonadism secondary , hypothalamic, rheumatic involvement , idiopathic, imaging ,  infants  children, acquired, differential diagnosis , treatment , infection , infiltrative processes ,  intercurrent illness, clinical management , intermitternt illnesses , isolated, definition ,  Kallmann syndrome.  Kallmann syndrome laboratory assessment , long-term follow-up , lungs , mental symptoms , mortality , with nonfunctional pituitary adenoma, acular manifestations , partial definition , radiation-related, pathogenesis , physical findings , postoperative, prognosis , postoperative, prognosis , postoperative, prognosis , postpartum, pathophysiology ,  pregnancy, prevalence  radiation-induced, renal effects , radiation-induced, renal effects , secondary (central) conditions caused  by, selective, definition , signs  symptoms , with suprasellar dysgerminoma, target gland hormonal assays , false-negative, causes , false-positive, causes , treatment , endocrine replacement therapy , glucocorticoid replacement , growth hormone therapy , maintenance therapy , glucocorticoid replacement , growth hormone therapy , maintenance medications , thyroid hormone replacement ,  trypanosomiasis, Hypoprolactinemia,  hypogonadism, Hyporeflexia  adrenal insufficiency,  adrenal insufficiency,  hypomagnesemia,  malnourished infants  children, Hypospadias, associated anomalies, classification , coronal,  cryptorchidism, definition , distal shaft, etiology , glakndular,  3Beta-hydroxysteroid dehydrogenase deficiency, midsshaft, penoscrotal, perineal, physical examination , scrotal, treatment , without other defects, Hypotelorism, endocrine/metabolic causes , Hypotension.   Orthostatic hypotension  adrenal insufficiency, bromocriptine-related,  critical illness,  hypermagnesemia,  mastocytosis, platelet-activation factor , postoperative, with pheochromocytoma removal, postprandial, aging , postural, againg ,  sepsis  thirst, Hypothalamic acromegaly, Hypothalamic nuclei anatomic raltionship , by zones, anterior, arcuate (infundibular),  appetite regulation, functional significance , GnRH from, catecholamine innervation , dorsomedial,  appetite regulation, functional significance , identification , lateral tuberal, functional significance , identification , lateral tuberal, functional significance, , magnocellular, paraventricular,  appetite regulation, atrophy , catecholamine input  chemically significance , immunihistochemical staining , pathways , afferent, efferent, posterior, genitally dimorphic (intermediate), funetional significance , suprachiasmatic,  circadian rhythms, functional significance , topography , tuberomillary, functional significance , ventromedial, functional significance , Hypothalamic obesity, Hypothalamic pathways afferent classic, efferent, Hypothalamic-pituitary-adrenal axis abnormalities ,  exercise-associated amenorrhea, activation ,  critical illness,  alcoholism,  critical illness, cytokines , decreased activity , disorders associated with,  depression,  diffuse neuroendocrine system, disrupted activity , disorders associated with, dysfunction  CRH-receptor type I antagonists ,  critical illness, dysregulation , disorders associated with,  eating disorders, fetal,  parturition,  HIV-infected(AIDS) patients, IL-6 ,  inflammantion, interactions with immune system, leptin , neural control ,  parturition,  sepsis, setpoint ,  renal failure, stress , thymic effects , Hypothalamic-pituitary-adrenocortical axis alternate-day glucocorticoid therapy , assessment   craniopharyngioma patient,  glucocoticoid-treated therapy , assessment   craniopharyngioma patient,  glucocorticoid-treated patients, corticotrophin ,  cortisol secretion,  critical illness,  acute versus chronic phase, dynamic tests , evaluation , after radiation exposure  hypopituitarism, feebback , function , assement , IL-6 , leptin ,  low birth weight infants neuroendocrien regulation , reserve, tests , suppression , glucocorticoid-related, assessment , development , recovery from, treatment , Hypothalamic-pituitary axis cytokines , dysfunction cancer treatment-related, prevention , treatment ,   exercise-associated amenorrhea, vs. polycystic ovarian syndrome, fetal, function , testing,  elderly, hormone secretion into,  men with renal failure, nonthyroidal illness ,  obesity,  ovulation control  psychogenic amenorrhea, substance p , Hypothalamic/pituitary disease, acquired  primary amenorrhea, primary amenorrhea, primary amenorrhea , Hypothalamic-pituitary feedback sensitivity, aging , Hypothalamic-pituitary-gonadal axis, alcohol ,  alcoholism, androgen deprivation , cytokines ,  depression, development , childhood period, fetal period, neonatal period, pubertal period, dynamic tests , dysfunction , mental symptoms causes by,  eating disorders,  ,  lover, puberty , thymic effects , Hypothalamic/pituitary insufficiency,  primary, hypogonadotropic hypogonadism , secondary, hypogonadotropic hypogonadism, , Hypothalamic-pituitary-lactotrope axis, dynamic tests , Hypothalamic-pituitary-ovarian axis,  abnormal bleeding,  premenstrual syndrome, Hypothalamic-pituitary-somatotrope axis inhibitory dynamic tests , stimulatory dynamic tests , Hypothalamc-pituitary-somatotropic function  eating disorders, Hypothalamic-pituitary-testicular axis,  testicular descent, Hypothalamic-pituitary-thyroid axis, abnormalities ,  exercise-associated amenorrhea, alcoholism ,  bulimia,  children,  critical illness,  acute versus chronic phase, ccytokines ,  depression, drugs affection,  eating disorders, evaluation  after radiations exposure,  hypopituitarism, fetal, functional evaluation , functiona , factors affecting,  HIV-infected (AIDS)patients, sepsis , stimulatory dynamic tests , Hypothalamic-posterior pituitary axis, stimulatory dynamic tests , Hypothalamic Hypothalamic zone(s), coronal, ma mamillary level , supraoptic level , tuberal level  , lateral, longitudinal, medial, midline, Hypothalamo-neurohypophysial system, Hypothalamus, againg , anatomy ,  appetite regulation, arteriovenous malformation ,  autonomic functions,  biologic rhythms, blood supply ,  body temperature regulation,  cardiovascular system, catechol estrogen levels , chemical neuroanatormy , chasmatic (preoptic) region ,  chronic fatigue syndrome, circadian pacemaker , computer tomographic anatomy , cytokines , diabetes , diabetes , disorders ,  anorexia nervosa, cerebral effects , gastrointestinal manifestations ,  male hypogonadism, otolaryngologic effects , respiratory effects , rheumatic manifestations , embryology ,  emotion,  bibromyalgia,  food intake regulation, functional neureoanatomy , functions , brain regions affecting,  gastrointestinal function, gliomas ,.   Diencephalic syndrome radiation therapy ,  growth hormone secretion, harmartoblastoma , harmartoma , gonadotropin-dependent precocious puberty , imaging ,  ,  homogenitalmales, hormones   breast milk, psychiatric effects , transport , imaging , infections ,  male hypogonadism,  Langerhands cell histocytosis, lateral (LH), , appetite regulation, lesions   delayed puberty, posttraumatic, THS deficiency with,  libido, magnetic resonance imaging , magnocellular neurons , mamillary complex ,  memory,  memory,  menopausal hot flushes metastatic disease , imaging , morphology , neural connections , thalamic nuclei, pathways  neuronal harmatoma , nonendocrine, functions , opioids , parvicellular neurons , pathology , pathophysiology , periventricualar stratum , physiology ,  pituitary tumorigenesis,  pregnancy, radiation effects , regulations  energy balance ,  respiration,  sarcoidosis,  septo-potic dysplasia, , sleep-wake cycles, stimulatory dynamic tests ,  stress response, testicular androgen production , thymic effects ,  thyroid hormone regulation, toxins , tumors   amenorrhea,  appetite regulation, neurosurgical management ,  radiation therapy , ventromedial (VMH),  appetile regulation, Hypothermia cyclic, hypothalamic injury , paroxysmal, Hypothroidism, acquired, clinical presentation , diagnosis , etiology , growth curve with, prognosis , treatment , adrenocorticla involvement , after subacute thyroiditis, after treatment  Graves disease, agoitrous,  Albright hereditary osteodystrophy, amiodarone-induced, diagnosis  management , anemia , respiratory effects ,  anorexia nervosa, ascites , asymptomatic autoimmune, T cell , basal metabolic rate (BMR) , bone  biopsy , bone , cancer treatment-related, cardiovascular effects , treatment , central,  critical illness, isolated,  prolonged critical illness, THR-stimulation test , cerebral effects , “chemical,” clinical presentation , congenital,  amenorrhea, cutaneous manifestations , definition , etiology , neonatal screening , acular effects , otolaryngologic considerations , treatment , cortisol secretion , cutaneous appendages , cutaneous appendages , cutaneous manifestations , definition , denta/orofacial abnormalities , depression , diagnosis , drug-induced, drug metabolism  drug sensitivity ,  elderly, clinical manifestations , diagnosis , laboratory diagnosis , treatment , adverseeffects , electrocardiographic findings ,  end-stage renal disease.

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