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Case 11: Male Reproductive System > Hypogonadism > Flashcards

Hypogonadism Flashcards

1
Q

What does it mean when hormones are pulsatile & examples

A

Released at different frequencies & amplitudes
GnRH, LH & testosterone

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2
Q

What is the circadian rhythm of male endocrine system

A

Increases in early a.m 4:00-8:00
Decrease in late p.m 16:00-20:00

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3
Q

What is the feedback mechanism of endocrine system

A

Negative feedback

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4
Q

What is the 2 types of testing in endocrine system

A
  1. Standard testing
  2. Dynamic testing
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5
Q

What is the hypothalamo-pituitary-gonodal axis

A

Hypothalamus release GnRH that stimulate anterior pituitary to release FSH & LH
FSH act on Sertoli cells in testicles allowing for spermatozoa @ seminiferous tubules & release inhibin to inhibit release of FSH from anterior pituitary
LH act on Leydig cells in testicles that produce testosterone from cholesterol that also stimulate Sertoli cells to produce spermatozoa or go to target tissue
Testosterone also provides negative feedback to anterior pituitary & hypothalamus

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6
Q

What is androgens

A

Sex hormones with cholesterol as precursor

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7
Q

What is the 2 male androgens

A

Testosterone
Dihydrotestosterone

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8
Q

What is the 3 functions of androgens

A
  1. Masculination of genital tract
  2. Development & maintenance of male secondary sexual characteristics
  3. Anabolic effect on muscle mass, bone density & decrease fat mass)
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9
Q

What is the pathway of testosterone biosynthesis

A
  1. Cholesterol
  2. Pregnenolone to progesterone & DHEA
  3. Progesterone to mineralocorticoids & glucocorticoid
  4. DHEA & progesterone to androstenedione
  5. Androstenedione to oestrone & testosterone
  6. Testosterone to oestrodiol via aroma taste at liver/fat cells & DHT via 5-alpha reductase
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10
Q

What 8 factors affect testosterone production

A
  1. Sex difference
  2. Age
  3. Pulsatility
  4. Diurnal rhythm
  5. SHBG concentration
  6. Health state (stress, illness, diabetes, metabolic syndrome, obesity)
  7. Hyperprolactinaemia
  8. Medication
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11
Q

What is the 2 forms of testosterone

A
  1. Free that is active & bioavailable
  2. Bound to proteins
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12
Q

To what proteins do testosterone bind

A
  1. Sex hormone binding globulin that has high affinity & low capacity
  2. Albumin that has low affinity & high capacity & bioavailable
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13
Q

What is SHBG

A

Glycoprotein produced at the liver

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14
Q

What 3 things does SHBG bind

A

Testosterone, DHT, estrogen

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15
Q

What is the function of SHBG

A

Regulate bioavailability of sex hormones to tissue

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16
Q

What is used to provide an estimate of free testosterone

A

Free androgen index

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17
Q

3 examples of increased SHBG

A

Hyperthyroidism
Aging
GH deficiency

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18
Q

3 examples of decreased SHBG

A

Obesity
Hypothyroidism
GH excess

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19
Q

What is testosterone mechanism of action

A

Testosterone is synthesized & enter the cells (lipophilic molecule) & can be converted to DHT or directly bind to androgen receptor
If converted to DHT it then binds to androgen receptor in cytoplasm
After binding it gets translocated to nucleus, gene regulation, protein synthesis & target tissue effects

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20
Q

What is androgen insensitivity syndrome

A

Mutation of androgen receptor & dysfunctional receptors
Can be complete or partial

21
Q

What is the 3 places where DHT conversion occur

A

Prostate, skin & hair follicles

22
Q

What is the 3 functions of DHT

A
  1. Development of male external genitalia
  2. Prostate growth & function
  3. Secondary sexual characteristics
23
Q

What is the important enzyme that converts testosterone to DHT

A

5-alpha reductase

24
Q

What does hypogonadism mean

A

Decreased function of testes

25
Q

What 2 things does hypogonadism affect

A

Sperm production
Testosterone production

26
Q

What 2 things does hypogonadism leads to

A

Infertility
Loss of secondary sexual characteristics

27
Q

Where does primary & secondary hypogonadism occur

A

Primary: testicular failure
Secondary: hypothalamus or pituitary failure

28
Q

What is chemical results of primary hypogonadism

A

High FSH & LH w/ low testosterone

29
Q

What is chemical results of secondary hypogonadism

A

Low or inappropriate LH & FSH w/ low testosterone

30
Q

What is another name for primary hypogonadism

A

Hypergonadotrophic hypogonadism

31
Q

What is another name for secondary hypogonadism

A

Hypogonadotrophic hypogonadism

32
Q

What is the causes of primary hypogonadism

A

Congenital: Klinefelter syndrome
Acquired: damage to testes, infection, chemotherapy/radiation

33
Q

What is causes of secondary hypogonadism

A

Congenital: Kallmann syndrome
Acquired: tumors, systemic disease, medication, obesity & metabolic syndrome

34
Q

What dynamic test is done w/ primary hypogonadism

A

HCG stimulation test

35
Q

What 2 dynamic test is done w/ secondary hypogonadism

A
  1. Clomiphene stimulation test
  2. GnRH stimulation test
36
Q

What is 3 clinical features of hypogonadism pre-natal

A

Affects primary male sex structures
Incomplete virilization
Cryptorchidism

37
Q

What is 3 clinical features of hypogonadism before puberty

A

Lack of secondary sex characteristics
Eunuchoid body proportion
Delayed puberty

38
Q

What is 6 clinical features of hypogonadism post puberty

A

Osteoporosis
Fatigue & mood change
Increased fat
Gynaecomastia
Decrease muscle
Decrease libido & erectile dysfunction
Testes atrophy & infertility

39
Q

What is 4 clinical features of hypogonadism elderly

A

Same as adult
Cognitive changes
Andropause
Insulin resistance, central obesity, increased CVS risk

40
Q

Define gynaecomastia

A

Enlargement of male breast tissue

41
Q

What is 4 causes of gynaecomastia

A

Idiopathic
Obesity
Hormonal imbalance
Liver disease

42
Q

How to test for gynaecomastia

A

Assess hormone levels
Rule out underlying pathologies

43
Q

How is total testosterone measured

A

8-10am
To confirm hypogonadism test should be repeated on separate occasion

44
Q

When to test LH & FSH

A

When confirmed low testosterone

45
Q

When is LH & FSH high & low

A

High: primary
Low/inappropriately normal: secondary

46
Q

How does HCG test work

A

Tests Leydig cells function & mimic LH response to stimulate testosterone & normally increases

47
Q

How does GnRH test work

A

Test HPG axis function by stimulating GnRH to stimulate LH/FSH release
If hypothalamic disease LH & FSH should increase but if pituitary disease LH & FSH will not increase

48
Q

How does clomiphene test work

A

Tests hypothalamic-pituitary response by inhibiting estrogen feedback & GnRH should increase in secondary but not in primary

Case 11: Male Reproductive System (9 decks)

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