Endocrine-2 (Male Reproductive)

Question 1

H-P-gonad axes

Answer 1

GnRH
↓
LH
↓
Testes
↓
Testosterone production
————————————
GnRH
↓
FSH
↓
Testes
↓
Sperm

Question 2

What is the percentage of testosterone in the testes?

Answer 2

95%

Question 3

What are the functions of testosterone?

Answer 3

• Male reproductive structure development
• Maintenance of libido and erectile function
• Required for sperm maturation

Question 4

Primary hypogonadism

Answer 4

Primary disease - problem is in the testes

Question 5

Hypogonadotropic hypogonadism

Answer 5

Secondary disease - lack of FSH/LH from the pituitary

Question 6

What are some presentations of primary hypogonadism?

Answer 6

• Absence of testes
• Lack of testosterone production
• Lack of functional sperm

Question 7

What are some presentations of secondary hypogonadism?

Answer 7

• Pituitary adenomas
• Hyperprolactinemia
• Hypothyroidism
• Heavy marijuana use

Question 8

What kind of drug therapy is used in primary male hypogonadism?

Answer 8

Testosterone replacement therapy

Question 9

What are some adverse drug reactions in testosterone replacement therapy?

Answer 9

• Increased BP
• Major CV events

Question 10

Does testosterone restore fertility?

Answer 10

No

Question 11

What are some ways to treat secondary hypogonadism?

Answer 11

• Give Human Chorionic Gonadotropin (hCG)
• Give a source of FSH

Question 12

What is a source of FSH that can be used to treat secondary hypogonadism?

Answer 12

Menotropins

Question 13

What is benign prostatic hyperplasia?

Answer 13

A benign enlargement of the prostate gland that occurs as men age

Question 14

What does prostate growth compress?

Answer 14

Urethra

Question 15

What is LUTS?

Answer 15

Lower urinary tract symptoms

Question 16

What are some obstructive symptoms of LUTS?

Answer 16

• Difficult in getting urinary flow started
• Weak urine stream
• Dribbling
• Bladder fullness

Question 17

What are some irritative symptoms of LUTS?

Answer 17

• Frequent urination
• Urgency
• Urinary incontinence
• Nocturia

Question 18

What are some complications of BPH?

Answer 18

• Urinary retention
• UTIs
• Irreversible impairment of bladder function
• Chronic renal failure

Question 19

What are some recommended initial tests for a basic evaluation of any man with LUTS?

Answer 19

• Urinalysis
• Physical exam
• PSA level
• Frequency/volume charts

Question 20

Is serum creatinine recommended for an initial evaluation for LUTS?

Answer 20

No

Question 21

What is the recommended non-pharmacological treatment for LUTS?

Answer 21

• Watchful Waiting
• Lifestyle modifications

Question 22

What are some forms of drug therapy for patients with LUTS?

Answer 22

Alpha-1 receptor antagonists, 5 alpha-reductase inhibitors

Question 23

What is the mechanism of action of alpha-1 receptor antagonists?

Answer 23

Relaxes smooth muscle in the bladder neck and prostate

Question 24

Is urinary flow rate increased or decreased with the use of alpha-1 receptor antagonists in patients with LUTS?

Answer 24

Increased

Question 25

What are some examples of non-selective alpha-1 receptor antagonists?

Answer 25

- Terazosin - Doxazosin

Question 26

What are some examples of selective alpha-1 receptor antagonists?

Answer 26

- Tamsulosin - Silodosin - Alfuzosin

Question 27

What is the mechanism of action of 5 alpha-reductase inhibitors?

Answer 27

Decreases conversion of testosterone to DHT

Question 28

When should you follow up with patients taking 5 alpha-reductase inhibitors?

Answer 28

3 months

Question 29

How much do 5 alpha-reductase inhibitors decrease PSA levels by?

Answer 29

50%

Question 30

How can erectile dysfunction be classified?

Answer 30

Psychogenic, drug induced, or organic

Question 31

How does an erection begin?

Answer 31

Stimulation of parasympathetic nerves

Question 32

What do phosphodiesterase (PDE) enzymes metabolize?

Answer 32

cGMP

Question 33

What is the mechanism of action of PDE-5 inhibitors?

Answer 33

Prevents the metabolism of cGMP

Question 34

When does the initial release of nitric oxide occur?

Answer 34

With foreplay

Question 35

What is a common product used to treat erectile dysfunction?

Answer 35

Tadalafil (Cialis)

Question 36

What is considered an adequate trial for drug therapy treating ED?

Answer 36

7-8 doses

Question 37

What doses is tadalafil available in?

Answer 37

5mg, 10mg, 20mg

Question 38

What are some adverse effects of oral PDE-5 inhibitors?

Answer 38

- Headache - Flushing - Nasal congestion - Cyanospia

Question 39

What is a contraindication of oral PDE-5 inhibitors?

Answer 39

Any organic nitrate - causes severe hypotension

Question 40

Priapism

Answer 40

An erection lasting > 4hrs

Question 41

What is another treatment that can be used for ED?

Answer 41

Alprostadil

Question 42

What is the mechanism of action of alprostadil?

Answer 42

Stimulates adenyl cyclase, increase cGMP

Question 43

What dosage forms do alprostadil come in?

Answer 43

- Urethral inserts - Intracavernosal injections

Question 44

Hypopituitarism

Answer 44

A clinical disorder characterized by diminished secretion of one or more of the pituitary hormones

Question 45

What is the number one cause of hypopituitarism?

Answer 45

Pituitary tumors

Question 46

What is the order in which the hormones are generally effected?

Answer 46

GH > FSH/LH > TSH > ACTH > Prl

Question 47

How is hypopituitarism typically treated?

Answer 47

Treat the underlying cause

Question 48

If hypopituitarism is not correctable, what do we do for a TSH deficit?

Answer 48

Levothyroxine

Question 49

If hypopituitarism is not correctable, what do we do for an ACTH deficit?

Answer 49

Glucocorticoid

Question 50

If hypopituitarism is not correctable, what do we do for a FSH/LH deficit?

Answer 50

Males: Testosterone Females: Combination hormonal contraceptive Fertility: Menotropins