Androgen Deficiency Flashcards
What are some features of androgen deficiency
1) Incomplete sexual development
2) Decreased libido
3) Decreased spontaneous erections
4) Gynaecomastia
5) Decreased muscle bulk and strength
6) Loss of body and pubic hair
7) Very small/ shrinking testes
8) Tiredness + poor stamina
9) Depression, irritability
3 main causes of androgen deficiency
1) Transient
2) Primary
3) Secondary
2 classes of 1’ androgen deficiency
1) Congenital
2) Acquired
What hormonal pattern do you see in 1’ androgen deficiency
High LH/FSH
What is the main cause of congenital 1’ androgen deficiency
1) Klinefelters dyndrome
What are the main causes of acquired 1’ androgen deficiency
1) Testicular damage (trauma, orchitis, toxins, infection- mumps, radioRx and chemo)
2) Drugs (spironolactone)
3) Undescended testes
What are 3 classes of 2’ androgen deficiency?
1) Genetic
2) Structural
3) Functional
What hormonal pattern do you see in 2’ androgen deficiency
Problem is in hypothalamus/ pituitary (low/ normal FSH/LH)
What is the main cause of genetic 2’ androgen deficiency
1) Kallman syndrome (GnRH deficiency)
What are the main causes of structural 2’ androgen deficiency
1) Tumour (pituitary adenoma)
2) Radiation
3) Surgery
4) Infiltration: iron overload or sarcoid
What are the main causes of functional 2’ androgen deficiency
1) hyperprolactinaemia
2) Cushing’s
3) Morbid obesity
What must be taken into account when measuring testosterone levels
1) Testosterone levels exhibit diurnal variation (highest in morning, lowest in evening). Should be measured at 8am
2) Total testosterone includes free testosterone, albumin bound testosterone and SHBG-testosterone- conditions a/w altering levels of SHBG may affect total testosterone readings (age, obesity, DM, drugs etc).
3) If there is a low reading, a repeat level is required to confirm
List some Ix you could do if the individual had low TT
1) LH/FSH (to see if this was 1’ or 2’ hypogonadism)
2) Karyotype- rule out Klinfelters syndrome (47XXY)
3) Prolactin- increased in hyperprolactinemia (prolactin causes galactorrhoea but also suppresion of gonadotrophs LH and FSH- 2’ hypogonadism)
4) Iron- haemachromatosis can cause infiltration of pituitary and 2’ hypogonadism
5) MRI brain- to help detect pituitary abnormalities- esp if pt presents with headaches, visual changes etc
Give 3 examples of testosterone replacement therapy
1) IM testosterone undecanoate- once every 3 months. Stable levels in blood
2) Transdermal patches- daily application, may cause site irriatation
3) Testosterone gel- daily application, less site irritation
Potential SE of testosterone replacement
1) Prostate Ca, BPH
2) Sleep apnoea
3) Acne
4) Reduced fertility
5) Polycythaemia
6) Breast Ca
7) Gynaecomastia
8) Mood fluctuations
