5. Disorders of Male reproductive system

Question 1

Stages of pubertal maturation of male genitalia?

Answer 1

Stages 1-5
With increases pubic hair, penis and testes enlargement.
Stage 5 = Normal

Question 2

Inhibin controls…

Answer 2

FSH on Sertoli cell

Question 3

Changes in feedback in hypothalamus during puberty?

Answer 3

prepuberty: Operative and sensitive (positive feedback)
Puberty: Decreasing sensitivity
Adult: Decreased sensitivity

Question 4

Causes of hypogonadism in phenotypic males?

Answer 4

1. Temporary delay of puberty
   - Constitutional delay in puberty
   - Chronic illness e.g. malabsorption, malnutrition
   - Hormonal disturbance e.g. GH deficiency
2. Hypogonadotrophic hypogonadism (low LH and FSH, low testosterone)
   - Kallman’s syndrome (with anosmia)
   - Hypopituitarism e.g. Tumour, trauma (commonest: Prolactinoma that causes low LH and FSH)
3. Hypergonadotrophic hypogonadism (high LH and FSH, low testosterone)
   - Klinefelter’s syndrome (XXY): Atrophy of seminferous tubules
   - Anorchia
   - Orchitis e.g. mumps
   - Radiation treatment
   - Surgical or traumatic castration

Question 5

Cause of high LH and FSH in Hypergonadotrophic hypogonadism?

Answer 5

Low testosterone release from Leydig cells in testes

E.g. No testes, infections like mumps

Question 6

Presentation: Underdeveloped
Low LH and FSH, Low testosterone.
Pre-puberty, 15yrs old
Psychological impacts

Answer 6

Diagnosis: ?
Treatment: Testosterone injections monthly, for a year. Full sexual development one year one. Switches on LH and FSH production with testosterone positive feedback.

Question 7

16yr old
6 months waste loss
Dysphagia and vomiting
22kgs, 145cm

Answer 7

Malnutrition cause
FSH, LH and testosterone levels low

Investigation:
-Barium meal
Findings= Achalasia of the oesophagus
Treatment= Heller’s procedure

Result: 
Increase weight and heigh
Puberty resumed
Testosterone: Normal 
FSH is normal (controls spermatogenesis) so normal fertility

Question 8

18 yr old
Hypogonadism
Small penis and scanty pubic hair

Answer 8

Investigations: Low FSH and LH, testosterone LOW
Normal chromosomes

Diagnosis: Anomia, hypothalmic defect so low GnRH. Still low FSH so testes won’t develop

Treatment: Testosterone injection to cause penis size increase but testicles still small. Bit still infertile.

Treatment for fertility: GnRH pulsatile supplement to stimulate pituitary to secrete FSH. Causes testes development and sperm production

Question 9

14 years old boy with headache, visual stature and diabetes insipidus (low ADH). Growth stopped (lower growth hormone).

Answer 9

Diagnosis: Craniopharyngioma (low LH and FSH) explains diabetes insipidus inhibiting ADH production

Tumour removal: LH and FSH levels self correct

Question 10

60 years old male with backache. Thoracic spine x-rays show osteoporosis with vertebral collapse
Poor sexual development with hypogonadism, small penis, scanty pubic hair, gynaecomastia.

Answer 10

Chromosome analysis: Kleinfelter’s syndrome XXY
Hypergonadotrophic hypogonadism
Cause of back pain due to no testosterone feedback so testosterone LOW, and HIGH LH and FSH

Treatment:

• Surgical excision of breast tissue “mammoplasty”
• Testosterone replacement
• Supplements of bisphosphonate and calcium

Question 11

Symptoms of hypogonadism

Answer 11

Sexual dysfunction
Fatigue
Depressed mood
Osteoporosis 
Decrease in muscle mass and strength
Loss of facial and body hair

Question 12

Treatment of delayed puberty

Answer 12

Constitutional delay:

• Short term low-dose
• Sex steroid treatment

Hypergonadotrophic:
-Sex-steroid replacement

Hypogonadotrophic:

• Sex steroid replacement
• GnRH administration

Question 13

Testosterone replacement

Answer 13

Current therapies:

• IM injection every 2-3 weeks
• Oral 3-4 times daily
• SubC pellets every 4-6 months
• Transdermal
• Buccal

Question 14

What is diabetes insipidus?

Answer 14

In diabetes insipidus, AVP fails to properly regulate your body’s level of water, and allows too much urine to be produced and passed from your body.