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CLASS 22010 Endocrine > HYPOGONADISM > Flashcards

HYPOGONADISM Flashcards

1
Q

What is caused by deficient testosterone secretion by the testes or sperm production?

A

Male hypogonadism

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2
Q

What are the causes of male hypogonadism classified due to?

A
  1. insufficient gonadotropin by the pituitary (hypogonadotropic)
  2. pathology in the testes themselves (hypergonadotropic)
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3
Q

A patient with what may present with the following:

  1. fatigue
  2. decreased strength
  3. poor libido
  4. hot flashes
  5. erectile dysfunction
  6. gynecomastia
  7. infertility
  8. small testes
A

Hypogonadism

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4
Q

True or False

Hypogonadism

The general rule for total testosterone is <200ng/dL is low and >350ng/dL is normal however per societal guidelines you should use the reference ranges published with specific assay used

A

True

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5
Q

True or False

For total testosterone values between 200-350ng/dL measure it with Albumin to calculate bioavailable testosterone

A

True

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6
Q

If testosterone is low what other lab values should you obtain ?

A
  1. LH
  2. FSH
  3. Prolactin
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7
Q

High FSH/LH indicated primary testicular failure from:

A
  1. Atrophy from previous mumps orchitis
  2. autoimmune destruction
  3. previous chemo/radiation exposure
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8
Q

A high prolactin level in a patient with hypogonadism may suggest what?

A

prolactinoma

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9
Q

Low FSH/LH indicated secondary hypogonadism from:

A
  1. Hypogonadotropic hypogonadism
  2. hyperprolactinemia
  3. steroid or opiate use
  4. other hypothalamus or pituitary disorders
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10
Q

Low FSH/LH should prompt additional screening for:

A
  1. Hemochromatosis with Transferrin, Ferritin, and genotypic for HFE gene
  2. Pituitary mass with MRI of the Sella (where pituitary gland is)
  3. Anabolic steroid or supplement use
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11
Q

True or False

Treatment for hypogonadism should only be initiated with guidance from the medical officer

A

True

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12
Q

What labs must be checked before initiating treatment for hypogonadism?

A
  1. HCT
    a. pre-treatment of 55% or greater is of high risk of developing erythrocytosis
  2. PSA
    a. testosterone replacement is contraindicated in prostate cancer
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13
Q

What is the preferred method of testosterone replacement?

A 
Transdermal testosterone (AndroGel, Testim, Fortesta, Axiron) 
25-100mg daily application
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14
Q

What is the longer acting form of testosterone treatment?

A

intramuscular testosterone

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15
Q

What is the typical regimen for intramuscular testosterone?

A

100mg IM, higher doses are used to spread out injection intervals to 2-4 weeks

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16
Q

What are some alternate routes for testosterone administration?

A
  1. buccal
  2. implantable
  3. intranasal
17
Q

True or False
Side effects of alternate routes for testosterone

Hepatic metabolism and side effects including cholestatic jaundice, hepatitis, hypertension, and increased risk for cardiovascular complications limit use

A

True

18
Q

True or False
Indirect stimulation

Normal hypothalamus-pituitary-gonadal (HPG) axis is down regulated by estrogen sensing in the hypothalamus. This negative feedback mechanism can be blocked by inhibiting the hypothalamic estrogen receptors with clomiphene (clomid). This will result in increased FSH/LH secretion and increased testosterone synthesis and spermatogenesis

A

TRUE

19
Q

What is the preferable therapy if a patient is desiring fertility? (spermatogenesis is inhibited w/ direct testosterone replacement due to down-regulation of FSH)

A

Clomiphene (Clomid)

20
Q

What treatment for hypogonadism is used in an attempt to restore normal physiology before committing to life-long testosterone therapy?

A

Clomiphene (clomid)

21
Q

The typical regimen for clomiphene is 25mg for ___ months, followed by a ___ week “off period to determine if intrinsic testosterone testosterone pathway is self-sustaining.

A
  1. 3 months

2. 6 week

22
Q

The “pulse therapy” of clomiphene may be attempted up to 3 times, at which point if the intrinsic HPG axis is not corrected a patient may elect for what?

A

life-long testosterone therapy

23
Q

True or False

Therapeutic target is 0800 testosterone levels in middle of normal range (approximately 800ng/dL)

A

True

CLASS 22010 Endocrine (15 decks)

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