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Endocrinology > Endocrine Regulation of Male Infertility > Flashcards

Endocrine Regulation of Male Infertility Flashcards

1
Q

Which cells produce testosterone?

A

Leydig cells

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2
Q

Testosterone in the blood circulates bound to which proteins?

A

Sex hormone binding globulin (SHBG)

Albumin

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3
Q

What are the effects of testosterone in the body?

A 
Growth of the sex organs, skeletal muscle, epiphyseal plates, larynx, secondary sex characteristics
Erythropoiesis
Behavioural changes
Libido
Erectile function
Spermatogenesis
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4
Q

How does hypogonadism affect a child or young adult?

A

Slow growth in teens

No pubertal growth spurt

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5
Q

What can be used to measure the size of the testes?

A

Orchidometer

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6
Q

When should testosterone levels by tested for in suspected hypogonadism?

A

Early morning testosterone

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7
Q

Why is it useful to know the LH and FSH levels in suspected hypogonadism?

A

Helps to determine if there is a possible pituitary cause

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8
Q

What is the term for hypogonadism caused by a pituitary problem?

A

Hypogonadotrophic hypogonadism

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9
Q

In hypogonadotrophic hypogonadism there is a low testosterone and low LH/FSH. What other hormones might be affected?

A 
Increased prolactin
Decreased cortisol
Decreased IGF-1/GH
Decreased TSH
Increased sodium
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10
Q

What are the possible causes of hypogonadotrophic hypogonadism?

A 
Pituitary tumours
Pituitary surgery/radiotherapy
Genetic syndromes
Cerebellar ataxia
Kallmann's syndrome
Head injury
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11
Q

What is the most common cause of isolated gonadotrophin deficiency?

A

Kallmann’s syndrome

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12
Q

What is Kallmann’s syndrome?

A

A failure of cell migration of GnRH cells to the hypothalamus from the olfactory placode.

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13
Q

Kallmann’s syndrome is associated with aplasia/hypoplasia or the olfactory lobes. What is the result of this?

A

Anosmia or hyposmia

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14
Q

As well as hypogonadism, what is Kallmann’s syndrome associated with?

A 
Aplasia/hypoplasia of the olfactory lobes leading to anosmia/hyposmia
Deafness
Renal agenesis
Cleft lip/palate
Micropenis +/- cryptorchidism
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15
Q

Kallmann’s syndrome is familial. What are the three possible modes of inheritance in this syndrome?

A 
X-linked due to absence of KAL gene (KAL1)
Autosomal dominant (KAL2)
Autosomal recessive (KAL3)
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16
Q

Other than Kallman’s syndrome what are the possible causes of inherited hypogonadotrophic hypogaondism?

A

Kisspeptin mutations

GPR54 mutations

17
Q

What are the clinical features of Kallmann’s in childhood, adolescence and adults?

A

Childhood - poor growth and undescended testes
Adolesence - poor growth, small testes, micropenis, delayed/absent puberty
Adults - slow, but adequate growth, small testes, small phallus, hypogonadal features

18
Q

What are the biochemical features of primary gonadal failure?

A

Low testosterone
Normal/high LH and FSH
Normal prolactin

19
Q

What are the possible causes of seminiferous tubule failure and adult leydig cell failure?

A

Trauma
Chemotherapy
Radiotherapy
Multi-system disorders

20
Q

What is the most common cause of male hypogonadism?

A

Klinefelter’s syndrome

21
Q

What chromosomal abnormality is seen in Klinefelter’s syndrome?

A

47XXY

22
Q

At what stage of development does Klinefelter’s syndrome manifest clinically?

A

Puberty

23
Q

What are the clinical features of Klinefelter’s syndrome?

A 
Delayed puberty
Suboptimal genital development
Reduced secondary male sexual characteristics
Persistent gynaecomastia
Azoospermia
Behavioural issues
Learning difficulties
24
Q

How is Klinefelter’s syndrome treated?

A

Androgen replacement possibly alongside psychological support and fertility counselling

25
Q

How can androgen replacement therapy for hypogonadism in men be administered?

A

Oral
IM
Topical

26
Q

What are the options for fertility treatment in men with Klinefelter’s syndrome?

A

hCG
Recombinant LH and FSH
GnRH pumps

27
Q

What are the side effects of androgen replacement treatment for male hypogonadism?

A

Mood issues (aggression/behavioural changes), libido issues, increased haematocrit, possible prostate effects, acne, sweating, gynaecomastia

Endocrinology (6 decks)

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