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Endocrinology > Clinical Approach to Male Reproductive Endocrine Disorders > Flashcards

Clinical Approach to Male Reproductive Endocrine Disorders Flashcards

1
Q 
59 y/o male with fatigue and ED. Has gained 7lbs in 2 months. No longer exercises. Gets headaches. Hx of HTN, T2DM, and hyperlipidemia. Takes amlodipine, metfomrin, and simvastatin.
BP: 138/82
HR: 72
RR: 16
BMI: 30 (obese)
- mono-gynecomastia 
- normal prostate exam 
- HbA1c= 7.2
- TSH= 1.2 (normal) 
- free T4= 0.6 (low) 
- cortisol= 7.1
- total testosterone= 120
- free testosterone= 2.4
- LH= 1.2 (low)
- FSH= 1.6 (low)
- prolactin= 74 (HIGH)
What should we do?
A
  • MRI to look at the pituitary for a prolactinoma
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2
Q

What are some contributing factors to androgen deficiency (hypogonadism) in men?

A
  • Klinefelter’s or Kallmann’s syndrome
  • testicular injury
  • mumps
  • orchiectomy
  • pituitary tumors
  • pelvic or head irradiation
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3
Q

Does male testosterone decrease as we age?

A
  • YES
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4
Q

What symptoms will you see with low testosterone?

A
  • decreased libido
  • sexual dysfunction
  • fatigue
  • decreased muscle strength and mass
  • depression
  • breast discomfort or gynecomastia
  • loss of body hair
  • shrinking testes
  • height loss
  • inability to father children
  • hot flashes
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5
Q

When should you draw testosterone levels?

A
  • in the morning when they are highest.
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6
Q

What is the normal range of testosterone?

A
  • 300-1200 mg/dL

* tightly bound to sex hormone-binding globulin

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7
Q

What percent of testosterone is free?

A
  • 2%

* so FREE testosterone is a VERY IMPORTANT TEST.

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8
Q

What will LH and FSH levels help us to distinguish?

A
  • between primary (high LH and FSH) and secondary (low LH and FSH) gonadal failure
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9
Q

How will the testes look in Klinefelter’s (XXY)?

A
  • small firm testes
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10
Q

What is the most common cause of organic impotence (inability to achieve or to maintain a penile erection)?

A
  • DM
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11
Q

How do pts with Klinefelter’s present? (PICMONIC)

A
  • azoospermia
  • gynecomastia
  • mental abnormalities
  • elevated LH and FSH
  • chromatin-positive smear
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12
Q

How do we treat Klinefelter’s?

A
  • correct androgen deficiency
  • treat the gynecomastia
  • psychiatric care
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13
Q

What is myotonic dystrophy? (PICMONIC)

A
  • chronically progressive disease due to tri-nucleotide repeats.
  • lenticular opacities (aka cataracts confined to the lens)
  • small testes
  • normal puberty development
  • leads to gonadal failure
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14
Q

Should you do a testicular biopsy in a pts with myotonic dystrophy?

A
  • YES

* however in most cases of low testosterone, we do NOT do biopsies.

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15
Q

Should we treat myotonic dystrophy with androgen therapy?

A
  • NO
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16
Q

What is important to know about seminiferous tubular failure?

A
  • common cause of adult infertility
17
Q

What is Noonan’s syndrome?

A
  • the male version of Turner’s syndrome causing primary gonadal failure.
18
Q

What are the clinical features of Noonan’s syndrome?

A
  • cubitus valgus
  • short stature
  • webbe neck
  • low set ears
  • shieldlike chest
  • ptosis
  • pulmonic stenosis
19
Q

*** What are the obesity-hypogonadism syndromes?

A
  • Laurence-Moon-Biedl syndrom retinitis pigmentosas polydactylyl, mental retardation.
  • Alstrom syndrome= retinitis pigmentosa, nerve deafness, DM, primary gonadal failure.
  • Prader-Willi syndrome= hypotonia and mental retardation.
20
Q

What is cryptorchidism?

A
  • undescended testes

* treat with HCG or orchiopexy

21
Q

What will you see with hypgonadotropic (Kallman’s) syndrome? (PICMONIC)

A
  • anosmia (loss of sense of smell)
  • hyposmia (reduced ability to smell)
  • tall stature
  • caused by failure to start or complete puberty due to defective migration of GnRH releasing neurons to the hypothalamus
22
Q

How do we treat Kallmans?

A
  • HCG

- Testosterone

23
Q

What are the types of testosterone formulations?

A
  • T enanthate
  • scrotal patch
  • nongenital transdermal system (most common)
  • T gel (buccal)
  • injectable in oil
  • subcutaneous pellets
24
Q

What are the side effects of testosterone?

A
  • can reduce sperm count and testicular volume
  • aggressiveness
  • gynecomastia
  • increased prostate size
  • hepatotoxicity (peliosis hepatitis) with oral testosterone
25
Q

What drugs can lead to gynecomastia?

A
  • cyclophosphamide
  • melphalan
  • cimetidine
  • SPIRONOLACTONE
  • DIGOXIN
  • diethylstilbestrol for prostate carcinoma
26
Q

*** What is Reifenstein’s syndrome (androgen insensitivity syndrome)?

A
  • condition that results in the partial or complete inability to respond to androgens.
  • leads to hypogonadism and gynecomastia
  • phenotypically looks like a female, but is genetically a male.

Endocrinology (18 decks)

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