Disorders of Male Reproductive System

Question 1

Stages of Pubertal Maturation of Male Genitalia

Answer 1

• Stage 1 - no pubic hair, no enlargement of penis or testes.
• Stage 2 - testicular enlargement to >2.5cm, start to grow pubic hair
• Stage 3 - Penal enlargement, enlarging testicles, more pubic hair
• Stage 4 - Further enlargement of scrotum and testes, and darkening of pubic hair
• Stage 5 - Adult genital appearance

Question 2

Changing Sensitivity of Hypothalamic Pulse throughout life

Answer 2

• Prepuberty - low gonadal steroids, operative and sensitive feedback, low gonadotrophins.
• Initiation of Puberty - unchanged gonadal steroids, decreasing sensitivity to feedback, rising gonadotrophins.
• Adult - Adult level gonadal steroids, decreased to adult level of sensitivity to feedback, adult level of gonadotrophins.

Question 3

Causes of Hypogonadism in Phenotypic Males

Answer 3

• Temporary Delay of Puberty - constitutional delay of puberty (familial, sporadic), chronic illness e.g. malabsorption, malnutrition, malignancy, hormonal disturbance e.g. Growth Hormone Deficiency, Hypothyroidism.
• Hypogonadotrophic Hypogonadism - Kallman’s Syndrome (with anosmia) and Hypopituitarism e.g. tumour or trauma.
• Hypergonadotrophic Hypogonadism - Klinefelter’s Syndrome (XXY), Anorchia, Orchitis (e.g. mumps), radiation treatment and/or cytoxic chemotherapy (e.g. leukaemia), surgical or traumatic castration.

Question 4

Symptoms/Consequences of Male Hypogonadism

Answer 4

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

Question 5

Treatment of Delayed Puberty

Answer 5

• Constitutional Delay - short-term low-dose sex steroid treatment
• Hypergonadotrophic - sex steroid replacement
• Hypogonadotrophic - sex steroid replacement and GnRH administration.

Question 6

Testosterone Replacement

Answer 6

• Intramuscular Injection - every 2-3 weeks
• Oral - 3/4 times a day
• Subcutaneous Pellets - every 4-6 months
• Transdermal
• Buccal

Question 7

Kallman’s Syndrome

Answer 7

Kallmann syndrome is a condition characterized by delayed or absent puberty and an impaired sense of smell. This disorder is a form of hypogonadotropic hypogonadism, which is a condition resulting from a lack of production of certain hormones that direct sexual development. These hormones are normally made in a part of the brain called the hypothalamus. Males born with hypogonadotropic hypogonadism often have an unusually small penis (micropenis) and undescended testes (cryptorchidism). At puberty, most affected individuals do not develop secondary sex characteristics.

Question 8

Anorchia

Answer 8

Anorchia (also called anorchidism or anorchism) is a disorder of sex development in which a person with XY karyotype, which usually corresponds to male sex, is born without testes.