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203 theme 2 > 19. Endocrine Aspects of Male Hypogonadism > Flashcards

19. Endocrine Aspects of Male Hypogonadism Flashcards

1
Q

testosterone

A 
steroid hormone 
secreted in men and women - testes, ovary, adrenals
normal men produce ~7mg per day 
largely protein bound
50% bound to albumin
44% bound to SHBG
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2
Q

testes anatomical units

A

seminiferous tubules

interstitium

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3
Q

seminiferous tubules

A

sperm are produced

anti-Müllerian hormone (AMH) and inhibit synthesised by Sertoli cells

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4
Q

interstitium

A

Leydig cells produce androgens

peritubular myoid cells

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5
Q

androgen synthesis

A

cholesterol - influenced by LH converted to pregnenolone
converted to progesterone or DHEA
both converted to testosterone
converted either to DHT or estradiol (FSH influence)

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6
Q

hypothalamic-pituitary-testicular axis

A

pulsatile secretion of GnRH
secretion of LH and FSH
LH involved with testosterone release
FSH involved in spermatogenesis and inhibin B secretion

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7
Q

testosterone mechanism of action

A

penetrates target cell
converted to 5-alpha dihydrotestosterone (DHT)
DHT can bind to receptor to exert effect - influence gene expression
alternatively, converted to oestrogens

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8
Q

actions of testosterone

A

regulation of gonadotrophin secretion by hypothalamic pituitary system
initiation and maintenance of spermatogenesis
formation of male phenotype during embryogenesis
promotion of sexual maturation at puberty + maintenance after
increase lean body mass, decrease fat mass

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9
Q

male hypogonadism

A

decrease in one or both of the 2 major functions of the testes: spermatogenesis and testosterone production

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10
Q

primary causes of male hypogonadism

A 
Klinefelter syndrome 
cryptorchidism 
infection-mump
radiation
trauma
torsion
idiopathic
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11
Q

secondary causes of male hypogonadism

A 
congenital GnRH deficiency 
hyperprolactinaemia 
GnRH analog
opioids 
illness
anorexia nervosa 
pituitary disorder
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12
Q

clinical features in first trimester

A

female genitalia, ambiguous genitalia, patrol virilisation

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13
Q

clinical features in this trimester

A

micropenis

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14
Q

clinical features pre-puberty

A

failure to undergo/complete puberty

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15
Q

clinical features in adulthood

A

may appear younger than chronological age

decreased libido, depressed mood, small genitalia, decreased muscle mass and hair, infertility

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16
Q

symptoms / signs of male hypogonadism

A 
incomplete sexual development 
decreased libido 
breast discomfort, gynaecomastia 
reduced body hair 
small/shrinking testes 
infertility 
small height 
decreased muscle bulk and strength
17
Q

less specific symptoms / signs of male hypogonadism

A 
low energy, motivation, initiative and aggressiveness 
depressed mood. dysthymia
poor concentration and memory 
sleep disturbance 
mild anaemia 
increased body fat
18
Q

conditions with high prevalence of hypogonadism

A

sellar mass, radiation to sella and other seller disease
medications affecting T production eg. glucocorticoids, opioids
his-associated weight loss
moderate-severe COPD
osteoporosis
type 2 diabetes
infertility

19
Q

relevant medical history for male hypogonadism

A 
puberty/sexual development 
past/present major illness
nutrition 
all drugs 
relationship/sexual problems 
major life event s
family history 
recent changes in body 
testicle problems 
eating disorders, excessive exercise
20
Q

examination for male hypogonadism

A 
body hair 
breast exam for enlargement/tenderness
size and consistency of testicles
size of penis
signs of severe/prolonged hypogonadism (loss of body hair, osteoporosis, reduced muscle strength and bulk)
arm span
21
Q

investigations for male hypogonadism

A 
serum testosterone 
LH/FSH
SHBG
LFT
semen analysis 
karyotyping 
pituitary function 
MRI
DEXA scan
22
Q

factors lowering SHBG

A 
moderate obesity
nephrotic syndrome 
hypothyroidism 
drugs e.g. glucocorticoids, progestins, androgens steroids 
acute illness and malnutrition
23
Q

factors raising SHBG

A 
ageing 
hepatic cirrhosis 
hyperthyroidism 
anticonvulsants 
oestrogens 
HIV infection
24
Q

testosterone administration

A

gel
injection
buccal/patch/pellet

25
Q

male hypogonadism treatment

A

testosterone

26
Q

contraindications to testosterone therapy

A 
breast or prostate cancer
lump/hardness on prostate exam 
high PSA not evaluated for prostate cancer 
severe untreated BPH 
erythrocytosis 
hyperviscosity 
untreated obstructive sleep apnoea 
severe heart failure (class III or IV)
27
Q

gynaecomastia

A

benign proliferation of glandular tissue of male breast
may be unilateral or bilateral
palpable mass of tissue at least 0.5cm in diameter
60% boys during puberty: transient
30-70% men

28
Q

gynaecomastia causes

A 
persistent pubertal gynaecomastia 
drugs 
idiopathic
cirrhosis 
hypogonadism 
testicular tumour
hyperthyroidism 
chronic renal insufficiency 
drugs, e.g. spironolactone, hCG, oestrogens, cimetidine
29
Q

gynaecomastia history

A 
duration
pain/tenderness
systemic disease
weight gain or loss
medication
chemical exposure
sexual function 
family history
30
Q

gynaecomastia examination

A 
virilisation
testicular size 
penis 
thyroid 
breast
31
Q

gynaecomastia investigations

A 
testosterone 
LH/FSH
prolactin
LFT/U&Es
TFT
oestrogen 
mammogram
32
Q

gyanecomastia treatment

A

conservative - reassurance
treat cause
tamoxifen
surgery

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