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MD2 Ambulatory Care and Emergency Medicine > Androgen Deficiency in Men > Flashcards

Androgen Deficiency in Men Flashcards

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1
Q

What is androgen deficiency?

A

Clinical syndrome with characteristic symptoms and signs
Low testosterone levels
Absence of transient/reversible causes of low testosterone levels

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2
Q

What are the symptoms of androgen deficiency?

A 
Non-specific
- Decreased sense of wellbeing
- Poor concentration
- Tiredness
- Poor stamina
- Mood change
   - Depression
   - Irritability
- Sleep disturbance
Sexual
- Reduced libido
- Erectile dysfunction rare
- Infertility
Organ specific
- Reduced muscle mass and strength
- Osteoporosis and fracture
- Increased fat mass
- Breast discomfort
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3
Q

What are the issues associated with measuring testosterone levels?

A

No age-related reference ranges
- For younger patients, aim for mid-normal range
- Can be lower for older patients
- If within normal range, do they need hormone replacement?
Lack of standardisation
Inaccuracy in low range

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4
Q

When is the risk of osteoporosis and fracture increased in relation to androgen deficiency?

A

If found in younger patients; ie, <50

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5
Q

What are the signs of androgen deficiency?

A 
Gynaecomastia
Loss of body hair
- Axillary
- Pubic
- Decreased shaving
Very small/shrinking testes - especially <5 mL
Low-zero sperm counts
Mild anaemia
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6
Q

What does the clinical presentation of male hypogonadism depend on?

A

Age of onset

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7
Q

What are the features of male hypogonadism if onset is during the first trimester?

A

Partial virilisation
Ambiguous genitalia
If complete deficiency: female external genitalia

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8
Q

What are the features of male hypogonadism if onset is during the third trimester?

A

Micropenis

Cryptochidism

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9
Q

What are the features of male hypogonadism if onset is during pre-puberty?

A 
Incomplete pubertal maturation
Testes <4 mL
Eunochoidal body habitus
Gynaecomastia
Decreased peak bone mass
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10
Q

What are the features of male hypogonadism if onset is during adulthood?

A 
Decrease in
- Libido
- Mood
- Stamina
- Muscle mass and strength
- Bone mineral density
Increased fat mass
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11
Q

When is free testosterone measured instead of total testosterone?

A

Any condition where sex hormone-binding globulin (SHBG) altered

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12
Q

What does it mean if serum total testosterone is normal?

A

Eugonadal

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13
Q

What do you do if serum total testosterone is low?

A

Repeat test > if normal > eugonadal

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14
Q

What do you do if serum total testosterone is borderline?

A

Calculated free testosterone, to rule out falsely low total testosterone

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15
Q

What may it mean if leutenising hormone (LH) is elevated?

A

Decreased testosterone secretion

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16
Q

What are LH and follicle stimulating hormone (FSH) levels in primary androgen deficiency?

A

Elevated

17
Q

What are LH and FSH levels in secondary androgen deficiency?

A

Low/(inappropriately) normal

18
Q

What are some examples of acquired primary androgen deficiencies?

A 
Testicular damage
- Trauma
- Orchitis
- Toxins
Drugs
- Spironolactone
- Ketoconazole
19
Q

What are some examples of congenital primary androgen deficiencies?

A 
Klinefelter syndrome
Cryptorchidism
Mutations in androgen biosynthesis enzymes
LF/FSH receptor mutations
Myotonic dystrophy
20
Q

What are some examples of structural secondary androgen deficiencies?

A 
Tumour
Surgery
Radiation
Trauma
Infiltration
- Iron overload
- Sarcoidosis
- Histiocytosis
21
Q

What are some examples of genetic secondary androgen deficiencies?

A

Kallmann’s syndrome
Idiopathic hypogonadotropic hypogonadism
LH/FSH beta subunit mutations

22
Q

What are some examples of functional secondary androgen deficiencies?

A

Hyperprolactinaemia
Morbid obesity
Cushing’s syndrome

23
Q

What are some examples of partial or transient androgen deficiencies?

A

Acute illness
Chronic disease
Drugs

24
Q

What effect does hyperprolactinaemia have on gonadotropins?

A

Inhibitory

25
Q

What is the genetic abnormality in Klinefelter’s syndrome?

A

90% 47, XXY

26
Q

What are the features of Klinefelter’s syndrome?

A

Testes <4 cm, firm, “pea-like”
Azoospermia > infertility
Total testosterone commonly low/normal, LH high
More rapid total testosterone decrease with ageing
Puberty triggers germ cell extinction

27
Q

What are the differential diagnoses if the testes are not palpable?

A

Anorchism

Bilateral cryptorchidism

28
Q

What are the differential diagnoses if the testes are less than 5 mL?

A

Kallmann’s syndrome
- Anosmia
Hypogonadotropic hypogonadism
Klinefelter’s syndrome

29
Q

What are the differential diagnoses if the testes are between 8 and 15 mL?

A

Germinal damage

  • Toxins
  • Idiopathic
30
Q

What are the differential diagnoses if the testes are between 15 and 20 mL?

A

Varicocele
Drugs
Idiopathic

31
Q

When are natural testosterone levels highest in the body?

A

0800-1000

32
Q

If sperm are viable in a case of androgen insufficiency, why are they harvested before androgen therapy is started?

A

Therapy decreases FSH and LH so testes stop producing sperm

33
Q

What are the different modes of delivering androgens?

A 
Tablets
- Not used, because too many side effects
Gel/patches
- More steady release
8-10 week/3 monthly injections
- Take time to peak and then wane
34
Q

When is non-classical androgen deficiency common?

A

Ageing

Chronic disease

35
Q

What are the principles of management for testosterone therapy?

A

Establish treatment goals
Achieve adequate total testosterone levels
Monitor treatment response
Monitor for adverse effects

36
Q

What are the adverse effects of testosterone therapy?

A 
Erythrocytosis
Acne and oily skin
Deranged LFTs
Enlarged prostate
Reduced sperm production and fertility
37
Q

What are the contraindications to testosterone therapy?

A 
Evidence of prostate cancer
Breast cancer
Erythrocytosis/hyperviscosity
Untreated obstructive sleep apnoea
Severe lower urinary tract symptoms
Class III/IV heart failure
Desire to have children

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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