Another clinical sign of CHH, more specifically Kallmann syndrome, is a lack of a sense of smell due to the altered migration of GnRH neurons on the olfactory placode. Kallmann syndrome can also be shown through MRI imaging with irregular morphology or aplasia of the olfactory bulb and olfactory sulci. Anterior pituitary function must be normal for all other axes in CHH as it is an isolated disorder. Testing anterior pituitary function is helpful to identify if the HH is due to hyperprolactinemia. Management
The goal for HH therapy is to induce pubertal development, sexual function, fertility, bone health, and psychological wellbeing. Testosterone therapy for males and estradiol therapy for females is used to improve genital development, develop secondary sexual characteristics, allow for the growth and closure of the epiphyseal plate, as well as improving sexual function. This therapy does not restore fertility as gonadotropins are required for spermatogenesis and folliculogenesis. If fertility is desired, pulsatile GnRH therapy or gonadotropin therapy is necessary.Gonadotropin therapy involves the use of human chorionic gonadotropin (hCG) and FSH. In the male, hCG stimulates Leydig cells to produce testosterone so that plasma and testicular levels increase. With the increased levels of testosterone, sexual activity, libido and overall wellbeing should improve. Administration of FSH is required to induce spermatogenesis by acting on Sertoli cells. FSH is required for maintaining the production of high numbers of good quality sperm.
: 152  Tapering from the inner to the outermost surface, they have a diameter of 2.5 μm near the pulp, 1.2 μm in the middle of the dentin, and 0.9 μm at the dentino-enamel junction. Their density is 59,000 to 76,000 per square millimeter near the pulp, whereas the density is only half as much near the enamel. Within the tubules, there is an odontoblast process, which is an extension of an odontoblast, and dentinal fluid, which contains a mixture of albumin, transferrin, tenascin and proteoglycans. In addition, there are branching canalicular systems that connect to each other. These branches have been categorized by size, with major being 500-1000 nm in diameter, fine being 300-700 nm, and micro being less than 300 nm. : 155  The major branches are the terminal ends of the tubules. About every 1-2 μm, there are fine branches diverging from dentinal tubules at 45 degree angles. The microtubules diverge at 90 degree angles. The dentinal tubules contain the cytoplasmic extensions of odontoblasts that once formed the dentin and maintain it. The cell bodies of the odontoblasts are aligned along the inner aspect of dentin against a layer of predentin where they also form the peripheral boundary of the dental pulp Because of dentinal tubules, dentin has a degree of permeability, which can increase the sensation of pain and the rate of tooth decay.