Hypogonadism

Question 1

Define it?

Answer 1

Impaired function of the gonads (ovaries or testes), leading to reduced sex hormone levels.

Question 2

Primary MALE hypogonadism:

What may cause this? - think about what may cause testicular failure

Why does renal failure, CLD and alcohol excess cause testicular failure?

Answer 2

Local trauma
Torsion
Chemotherapy 
Irradiation
Post-orchitis (e.g. mumps, HIV) 

They are toxic to Leydig cells of the testes

Question 3

Primary MALE hypogonadism:

Klinefelter’s syndrome:

• What type of disease is this?
• What features of hypogonadism do they have?

Cryptorchidism:
- What is it?

Answer 3

Chromosomal disease - due to mutation

Small testes
Gynaecomastia
Infertility
Reduced facial hair - look at capsule to see a case

Undescended testes

Question 4

Primary FEMALE hypogonadism:

Turner’s syndrome:

• What stature do they have?
• What happens to their neck, chest?
• What about their ears?
• What happens to their ovaries leading to infertility?
• How do their kidneys form?
• What happens to their aortic arch?

Answer 4

Short stature

Webbed-neck

Broad chest

Low-set ears

Underdeveloped ‘streak’ ovaries

Horseshoe kidney

Aortic coarctation and dissection

Question 5

Secondary hypogonadism:

Thinking about the hypo-pit axis, what may go wrong?

How does hyperprolactinaemia cause infertility in:

• Men
• Women

Kallmann syndrome:

• This causes IHH. What does this stand for and what is it?
• What 2 other key symptoms accompanies this?

What gynae condition may also cause infertility?

Answer 5

Prolactin may cause infertility in several different ways. First, prolactin may stop a woman from ovulating. If this occurs, a woman’s menstrual cycles will stop. In less severe cases, high prolactin levels may only disrupt ovulation once in a while.

Hypopituitarism

In men, high prolactin levels can cause:

• galactorrhea
• impotence (inability to have an erection during sex)
• reduced desire for sex
• infertility.

A man with untreated hyperprolactinemia may make less sperm or no sperm at all.

Idiopathic hypogonadotropic hypogonadism

Hypothalamic GnRH failure

PCOS

Question 6

S+S:

General:

• Sexual symptoms - 3
• Psychological - 2
• Why could they get osteoporosis?

Answer 6

Sub-fertility
Low libido
Small gonads

Depression and fatigue

The incidence of osteoporosis in men is indirectly correlated to the reduction in circulating testosterone. Because androgens may promote the proliferation and differentiation of osteoblasts, as well as inhibit osteoclast activity (recruitment and signaling), decreased bone density may ensue.

Question 7

S+S:

In females - 6 signs

Answer 7

Amenorrhoea
Vaginal dryness
Acne 
Hirsutism 
Small breasts

Question 8

S+S:

In males - 2 signs

Why do they get gynecomastia?

Answer 8

Erectile dysfunction
Low sperm count

Gynaecomastia - due to raised oestrogen/test ratio

Question 9

What investigations can be done? - 3

Answer 9

Men - 2 serum testosterone samples
Females - Serum estradiol

Serum gonadotropins (LH/FSH)

Question 10

How is it managed?

Answer 10

Hormone replacement

Testosterone or oestrogen