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Endo > Hypogonadism > Flashcards

Hypogonadism Flashcards

1
Q

Gonad Pathway

A
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2
Q

What? ET?

Male Hypogonadism

A

Testosterone deficiency
Causes: Testicular, hypothalamic, or pituitary abnormalities

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3
Q

What does Testosterone do?

A
  • sexual, cognitive, and body development
  • Fetal Stage -> sex determination
  • Prepubertal Stage -> body odor, oily skin, acne, growth, hair growth
  • Puberty -> enlarged sebaceous glands, penis enlargement, incr libido, incr muscle spasms, muscle mass, deep voice, incr height, bone maturation, loss of scalp hair, face/leg/axillary hair
  • Adults -> libido, penile erection, aggression, mental/physical energy
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4
Q

2 types of male hypogonadism

A
  • Primary (primary testicular failure)
  • Sexondary (problem with hypothalamus or pituitary gland

Hypothalamus -> GnRH -> Pituitary -> LH -> Testicle -> Testosterone

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5
Q

What structures secrete these hormones?

_____ -> GnRH -> ______ -> LH _______ -> testosterone

A

Hypothalamus -> GnRH -> Pituitary -> LH -> Testicle -> Testosterone

Within the testicle, leydig cells convert cholesterol to testosterone, then negative feedback loop

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6
Q

Within the testicle, ______ cells convert cholesterol to testosterone

A

Leydig

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7
Q

Which disorders are Primary vs Secondary Hypogonadism?

A

Primary
Klinefelters Syndrome
Undescended testicles
Mups orchitis
Hemochromatosis
Testicular Injury
Chemotherapy
Normal aging

Secondary
Kallman Syndrome

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8
Q

Primary or Secondary Hypogonadism?

Klinefelter’s Syndrome

A

Primary Gonadism
Klinefelter’s (XXY)

extra X causes abnorm testicles (low Testosterone)

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9
Q

_____ syndrome = Hypogonadism, Gynecomastia, Psychosocial problems

A

Klinefelter’s

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10
Q

Klinefelter’s Syndrome WU

A
  • Karyotype analysis on peripheral blood lymphocytes
  • XCAT-KS buccal swab test,
  • fluorescence in-situ hybridization (FISH)
  • Microarrays forpostnatal diagnostic testing
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11
Q

Klinefelter’s Syndrome Trmnt

A
  • androgen (Testosterone) replacement therapy - maintains testosterone, estradiol, FSH, LH
  • Therapy (speech, behavior, psychosocial)
  • Fertility Specialist
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12
Q

30% Men > ____ yo have below normal testosterone levels

A

75

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13
Q

_____ Syndrome = Secondary Hypogonadism due to GnRH deficiency

A
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14
Q

Most common pituitary tumor?

A

Prolactinomas

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15
Q

imaging for concern of pituitary prolactinoma

A

Brain MRI

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16
Q

Which pulm things can cause low testosterone?

A

Sarcoidosis, Histocystosis, TB

affects hypothalamus and pituitary gland

17
Q

What does opiods, spironolactone, cyproterone, cortisol, marijuana, heroin, and methadone do to testosterone levels?

A

lowers testosterone (poss hypoganadism)

18
Q

______ Score is used in Androgen Deficiency in Aging Males

A

ADAM

https://globalrph.com/medcalcs/androgen-deficiency-in-the-aging-male/
1. Do you have a decrease in libido (sex drive)?
3. Do you have a decrease in strength and/or endurance?
7. Are your erections less strong?
*Yes to question 1,3 or 7 = testosterone deficiency is likely

19
Q

Which hypogonadism syndrome presents with micropenis and hypospadias (hole on shaft of penis)

A

Kallman Syndrome

20
Q

Micropenis is defined as a stetched penile length of < _____ standard deviations (SDs) below mean for age

A

2.5

21
Q

Hypogonadism WU

A

Morning Testosterone - free and total
FSH/LH

  • hypogonadotropic: suggests a hypothalamic/pituitary process (congenital or acquired)
  • Hypergonadotropic: indicates a primary gonadal defect (congenital or acquired)
22
Q

Hypogonadism Trmnt

A
23
Q

Androgen Drug options

A
  • Patch -> Androderm
  • Gel -> Testosterone gel (generic), AndroGel, Testim, Fortesa, Vogelxo, Axiron
  • IM shot -> Cypionate, Enanthate, Undecanoate
  • PO -> Jatenzo, Tlando, Kyzatrex
  • Implantable Pellets -> Testopel
24
Q

Cons to testosterone IM shots

A
  • never levels out
  • large needle bc suspended in oil to prolong absorption
25
Q

MC SE of Androgen (Testosterone) Therapy in men

A
26
Q

Topical Testosterone side effects in women and children

A
  • enlarged genitals,
  • premature pubic hair,
  • increasedlibido,
  • aggressive behavior,
  • male-patternbaldness,
  • excessive body hair growth,
  • increased acne,
  • irregular menstrual periods, and
  • signs of male characteristics
27
Q

Complications of Testosterone Replacement

A
  • Infertility -> lots of FSH can negatively feedback suppress spermatogenesis
  • Hepatic Adverse Effects -> peliosis hepatitis (vascular hepatitis), hepatic neoplasms, cholestatic hepatitis, jaundice
  • Edema
  • Gynecomastia
  • Sleep Apnea
  • Lipids
  • Hypercalcemia contraindication
  • Decr Thyroxine-Binding Globulin -> decreased T4 binding protein
28
Q

Do testosterone labs how many hrs after administering the following Androgen therapies?

Oral AM ->
IM shot ->
Topicals/Pellets ->

A

Oral AM -> 3-5hrs
IM shot -> 72hrs
Topicals/Pellets -> 72hrs

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