Hypogonadism

Question 1

Which type of male hypogonadism is described below?

testicular failure

Answer 1

Primary

Question 2

Which type of male hypogonadism is described below?

pituitary failure

Answer 2

Secondary

Question 3

What are some congenital causes of primary male hypogonadism?

Answer 3

Klinefelter’s syndrome
Fetal testicular loss

Question 4

What are some acquired causes of primary male hypogonadism?

Answer 4

Medications
Severe systemic illness
Castration
Mumps orchitis
Idiopathic
trauma

Question 5

What are some congenital causes of secondary male hypogonadism?

Answer 5

Kallman’s Syndrome
Prader-Willi Syndrome

Question 6

What are some acquired causes of secondary male hypogonadism?

Answer 6

Pituitary adenoma

Inflammatory diseases – likely cytokine (IL-1) induced DMII

Alcohol or anabolic steroid abuse

Other endocrine disorders - Hyperprolactinemia, hypothyroidism

Question 7

List some sgns and symptoms associated with low testosterone

Answer 7

Loss of muscle mass and strength

Loss of libido and erectile function

Depression

Fatigue

Osteoporosis

Increased fat mass Reduced exercise endurance

Some regression of sexual characteristics

Decreased growth of body hair

Testes may be small or normal in size

Oligospermia or azoospermia

Question 8

What is the initial testing in suspected male hypogonadism?

Answer 8

Plasma total testosterone (free plus protein bound) or Plasma free testosterone (non-protein bound)

Morning sample recommended – optimal because of the circadian rhythms of testosterone (Avoid false negatives)

Question 9

A plasma total testosterone (free plus protein bound) reading of what suggests hypogonadism?

Answer 9

<300 ng/dL (10.4 nmol/L) suggests hypogonadism

Question 10

Plasma free testosterone (non-protein bound) reading of what suggests hypogonadism?

Answer 10

<50 pg/mL (173 pmol/L) suggests hypogonadims

Question 11

These lab values are useful in the evaluation of male hypogonadism to ascertain whether the cause is primary or secondary

Answer 11

LH and FSH

Question 12

This lab value is used to rule in or rule out a pituitary tumor as a cause for male hypogonadism

Answer 12

Serum prolactin (High prolactin levels may suggest presence of pituitary tumor)

Question 13

What also needs to be ordered in the event of high prolactin levels?

Answer 13

always gets MRI in high prolactin levels

Question 14

What are some goals and benefits of testosterone replacement therapy?

Answer 14

Improve libido and improve erectile dysfunction

Improve body mass and strength

Improve bone mineral density

Improve energy level

Improve mood/sense of well-being

Question 15

List some side effects/complications of testosterone replacement therapy?

Answer 15

Worsening BPH or carcinoma of the prostate

Erythrocytosis

Worsening of sleep apnea

Question 16

Testosterone therapy is contraindicated in patients with known or
suspected carcinoma of what?

Answer 16

the prostate

Question 17

A baseline value of what is recommended before initiating testosterone replacement therapy?

Answer 17

PSA

Question 18

How often should you monitor PSA levels in men receiving testosterone replacement therapy?

Answer 18

PSA levels should be determined annually in men receiving
testosterone replacement therapy