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05 Endo > Male Endo > Flashcards

Male Endo Flashcards

1
Q

__ acts on ___ to produce testosterone

A

LH on leydig cells

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2
Q

___ acts on ___ to regulate spermatogenesis

A

fsh on sertoli cells

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3
Q

when is high cholesterol levels allowed?

A

puberty, adults dont need that much testosterone and it poses health risks

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4
Q

highest levels of testosterone at ___

A

early morning hours

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5
Q

testosterone is bound to

A

sex hormone binding globulin and albumin

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6
Q

proportions of circulating testosterone

A

2% free form
30% bound to shbg
68% weakly bound to albumin

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7
Q

testosterone is acted on by ___ to produce DHT

A

5a-reductase

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8
Q

testosterone is acted on by ___ to produce estradiol

A

aromatase

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9
Q

effects of dht

A 
external genitalia growth
prostate growth
acne
facial/body hair growth
scalp hair loss
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10
Q

effects of estradiol

A 
hypothalamic/pituitary feedback
bone resorption
epiphyseal closure
vascular and behavioral effects
gynecomastia
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11
Q

conditions associated with decreased shbg concentration

A

moderate obesity, nephrotic syndrome, hypothyroidism, use of glucocorticoids/ progestins/ androgens, acromegaly, t2dm, familial shbg deficiency

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12
Q

conditions associated with increased shbg concentration

A

aging, hepatic cirrhosis and hepatitis, hyperthyroid, use of anticonvulsants or estrogens, hiv

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13
Q

what is oligozoospermia

A

low sperm count <15 m sperm/ml

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14
Q

what is astenozoospermia

A

reduced motility

<32% motile spermatozoa

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15
Q

what is terazoospermia

A

abnormal morphology that affects fertility

<4% normal forms

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16
Q

who reference values for sperm parameters

A 
sperm volume >1.5 ml
total sperm number >/= 39 million/ejaculate or >/= 15 million/ml
total motility >/= 40% of total sperm
normal morphology >/= 4.0%
vitality 58% alive
progressive motility 32%
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17
Q

what is male hypogonadism

A

a clinical syndrome that results from the failure of the testes to produce adequate amounts of testosterone

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18
Q

pathogenesis of fertility problems

A

testosterone production stops at an early age

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19
Q

effects of early testosterone loss

A

muscle, height, or osteoporosis problems

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20
Q

what is primary hypogonadism

A

disorder of the testis - low testosterone

body tries to compensate and produce more gnrh, lh, and fsh

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21
Q

what is secondary hypogonadism

A

secondary to disorder of pituitary or hypothalamus

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22
Q

common cause of congenital primary hypogonadism (androgen deficiency and impairment of sperm production)

A

klinefelter’s syndrome (xxy) and variants

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23
Q

causes of acquired primary hypogonadism (androgen deficiency and impairment of sperm production)

A

common: bilateral castration/trauma, drugs, ionizing radiation
uncommon: orchitis

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24
Q

causes of primary hypogonadism from systemic disorders (androgen deficiency and impairment of sperm production)

A

common: ckd, cld, aging
uncommon: malignancy (lymphoma, testicular ca), sickle cell disease, spinal cord injury, vasculitis, infiltrative disease

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25
causes of congenital primary hypogonadism (isolated)
cryptorchidism, varicocele, y chromosome microdeletions
26
causes of acquired primary hypogonadism (isolated)
orchitis, ionizing radiation, chemo, thermal trauma
27
causes of primary hypogonadism from systemic disorders (isolated)
spinal cord injury
28
most common sex chromosome abnormality and most common cauase of primary hypogonadism causing androgen deficiency
klinefelter's syndrome (xxy)
29
clinical features of klinefelter's syndrome
very small testes (4 ml), infertile, azoospermia, gynecomastia
30
pathogenesis of hypogonadism from mumps
causes permanent seminiferous tubule damage (fibrosis), impaired spermatogenesis, leydig cell failure and androgen deficiency
31
hypergonadotropic hypogonadism
primary hypogonadism
32
hypogonadotropic hypogonadism
secondary hypogonadism
33
pathophysiology of secondary hypogonadism
caused by disorder of the pituitary or hypothalamus, usually due to genetic disorders (or head trauma, tumors, radiation, or infection)
34
labs for secondary hypogonadism
low testosterone with low gonadotropin (lh and fsh)
35
congenital disorders associated with gonadotropin deficiency
kalimann syndrome (+ anosmia), prader-willi syndrome, lawrence-moon syndrome (leptin mutation)
36
acquired disorders associated with gonadotropin deficiency
severe illness, stress, malnutrition, and exercise; hemochromatosis, sellar mass lesions, hyperprolactinemia
37
common associated symptoms with male hypogonadism
decreased libido, reduced frequency of sex, erectyle dysfunction, reduced beard growth, loss of muscle mass, decreased testicular size, gynecomastia
38
focus on pe for male hypogonad
secondary sexual characteristics: hair growth and pattern, gynecomastia, testicular volume, prostate, body proportions
39
testicular volume is best assessed by ___
prader orchidometer normal: 3.5-5.5 cm in length = 12-25 ml congenital: very small testis
40
testicular length and volume for prepuberty
3-4 ml | <2 cm long
41
testicular length and volume for peripubertal
4-15 ml | <2 cm long
42
testicular length and volume for adults
20-30 ml | 4.5-6.5 cm by 2.8-3.3 cm
43
common presentation of klinefelter syndrome
small, firm testes <4 ml, hypergonadotropic male
44
common presentation for congenital hypogonatropism
small, firm testes <4 ml, hypo/normogonad male
45
common presentation for successful medical treatment of infertility
infertile men with testes < 15 cc
46
definition of eunuchoid proportions
arm span >2 cm greater than height suggest that androgen deficiency occurred before epiphyseal fusion
47
if thyroid disease is cause of infertility ___ is often present
goiter
48
examination that shows pigmentation changes that suggest hemochromatosis or cushing syndrome
skin exam
49
testicular examination (CLICK)
hypospadia, fibrosis, and varicocoele ideally measured with prader orchidometry
50
t/f if there is low testosterone check lh and fsh
true
51
if lh and fsh are low do ___
mri
52
what to test when there is low t, low or normal lh and fsh
secondary hypogonadism prolactin, iron, other pituitary hormones, mri
53
what to test when low t, high lh and fsh
primary hypogonadism karyotype
54
types of testosterone therapies
oral testosterone undecanoate 40-80 mg po with meals bid to tid parenteral testosterone undecanoate testosterone adhesive matrix patch
55
t/f short acting preparations of testosterone are preferred than long acting
true, so that adverse events are observed and discontinue early (enanthate and cypionate)
56
t/f excessive testosterone can produce cancer
false
57
treatment for secondary hypogonadism
give gnrh or beta hcg
58
golden period to give gnrh before testis will fibrose
6 months
59
treatment for patient with brain trauma resulting in low lh and fsh but normal sperm and testosterone
beta hcg, fsh, gnrh
60
t/f you give pituitary hormones at age 70
false, use testosterone
61
primary problems: ___ | secondary problems: ___
primary: testosterone secondary: beta-hcg, fsh, gnrh
62
conditions where testosterone administration has very high risk of serious averse outcomes
metastatic prostate cancer, breast cancer
63
evaluate patients every ___
3-6 months testosterone level aim for mid to normal range only
64
when to check for drug effects
enanthate and cypionate: midway through treatment to adjust | undecanoate: prior to next dose
65
check hematocrit every ___
3-6 mos, discontinue if >54%
66
measure mineral bone density when ___
1-2 years after initiation
67
indications for urologic consult
increase in psa >1.4 ng/ml within 12 months psa velocity of more than 0.4 ng/ml/year after 6 mos abnormality in digital rectal exam prostate symptoms of more then 19
68
when to look at the peak for testosterone
6th week
69
t/f testosterone increases the incidence, but not the severity of prostate ca
false, it increases severity but not incidence

05 Endo (16 decks)

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