Gonads Flashcards
Define primary hypogonadism
Increase FSH, Lh
Decreased testosterone men, decrease 17B estradiol women and never menstruated
Define secondary hypogonadism
Decrease FSH, lh
Decrease testosterone men, decrease 17B estradiol women and had menstruated
When should testosterone be measured
Fasting (food decreases), highest at 9 am
Name different symptoms at different thresholds of testosterone (4)
< 13: decreased vitality and vigour
<11: decreased morning elections
< 8,5: erectile dysfunction
<8: decreased sexual thoughts
Name 3 best predictors of hypogonadism in men
• 3 sexual symptoms
• total test <8 -11 nmol/l
• free test < 0,22
Name 2 indications measure free testosterone in men
• Lower end test 6,9 - 13,1 n mol / L
• abnormal shbg
Name 7 conditions associated with decreased shbg and associated testosterone levels
(Decreased total test with normal or decreased free test)
• obesity
• diabetes
• use glucocorticoids, progestins, androgen steroids
• nephrotic syndrome
• hypothyroid
• acromegaly
• polymorphisms in shbg gene
Name 7 conditions associated with increased shbg and associated testosterone levels
(Normal total test but decreased free test)
• aging
. HIV,
• cirrhosis, hepatitis
• hyperthyroid
. Anticonvulsants
• use of oestrogens
• polymorphisms in shbg gene
Management symptoms hypogonadism with low (<8) morning total testosterone? (5)
• Repeat testosterone, measure lh FSH PRL (prolactin)
If high gonadotropins:
• measure hb/hct, perform Dre, confirm PSA < 4 ng/ml
• trial testosterone replacement
• monitor: testosterone level, clinical response, regular hb/ Hct, serum PSA, bone scans
If low/normal gonadotropins
• investigate pituitary and other causes: measure serum PRL, pituitary MRI, serum drug screen, ferritin.
Management symptoms hypogonadism with borderline (8-11) morning total testosterone? (3)
• Repeat testosterone, measure shbg, calculate free testosterone
• if free testosterone low (<220) - follow protocol as for low testosterone
•If normal, investigate other causes
Name 2 second line tests for male hypogonadism
• hCg stimulation test: check if hypothalamus -pituitary problem, testicular trauma, gonadal dysgenesis eg klinefelter DSD (stimulate Leydig cells,useful delayed puberty after 14 )
• semen analysis: only if infertility
What type of testosterone is better to test for in women and children
Free (men total)
Name 3 broad causes with 2 examples of hypogonadism due to ovulatory dysfunction
• Hypothalamo-pituitary suppress or disease: low BMI!, high prolactin, idiopathic
. Ovarian disease: PCOS, premature autoimmune ovarian failure
• hyperandrogenism: PCOS, congenital adrenal hyperplasia
How test for uterine cause of amenorrhaea
Progestogen challenge test (normal = withdrawal bleed)
What is the clinical exam for hirsutism and what is an abnormal score
Ferriman gallWey score >8
Name 7 diagnostics tests PCOS
•* test 2,5 -5 nmol /l diagnostic (if > 5 consider ovarian tumour)
• fasting insulin, OGTT, lipogram - metabolic syndrome
. High Framingham risk score
• high 17 - ohp in late onset CAH
• high free test, bat, free androgen index
• 25% have high DHEAS, androstenedione
• ovarian morphology >12 cysts or ovarian volume > 10ml
Name 5 lab investigations and results menopause
. Very high fsh, low to normal estradiol
• low AMH, low follicle number, low inhibin
• estriol and estrone become major estrogens (adrenal androgens)
• adverse lipid changes - low HDL, high LDL
• possible osteoporosis due to low estradiol
How determine whether secondary hypogonadism is due to pituitary or hypothalamus?
GnRH stimulation test (normal = double baseline FSH and LH)
Increased LH = problem in ovaries or testes, not secondary.
Reduced could be either
What is Kallmann syndrome?
Abnormal migration olfactory and GnRH neurons through cribriform plate
Hypogonadotrophic hypogonadism with anosmia; midline facial defects, sensorineural hearing loss, renal anomalies
Decreased GnRH, FSH, LH, testosterone
Slightly feminine physique
What is Klinefelter syndrome?
Genetic 47 XXY affect testes
Testicular dysgenesis, decreased Leydig cell and seminiferous tubules function
Tall, feminisation
High LH and FSH , low testosterone, high estrogen
Name 6 hormones tested for infertility and how they cause infertility
- prolactin: high (disrupt ovulation and menstrual function)
- LH, FSH; LH:FSH (LH should be lower than FSH. High LH = disrupted follicle development, anovulation)
- E2 (estradiol) (suboptimal follicular development)
- SHBG (low → increased unbound / free testosterone → disturb folliculogenesis)
- testosterone + free androgen index (necessary for normal ovarian function)
- dheas (indicate normal adrenal androgen production - produced in zona reticularis)
How Calculate free androgen index
Total testosterone / SHBG x 100%
