Male Endo Flashcards
__ acts on ___ to produce testosterone
LH on leydig cells
___ acts on ___ to regulate spermatogenesis
fsh on sertoli cells
when is high cholesterol levels allowed?
puberty, adults dont need that much testosterone and it poses health risks
highest levels of testosterone at ___
early morning hours
testosterone is bound to
sex hormone binding globulin and albumin
proportions of circulating testosterone
2% free form
30% bound to shbg
68% weakly bound to albumin
testosterone is acted on by ___ to produce DHT
5a-reductase
testosterone is acted on by ___ to produce estradiol
aromatase
effects of dht
external genitalia growth prostate growth acne facial/body hair growth scalp hair loss
effects of estradiol
hypothalamic/pituitary feedback bone resorption epiphyseal closure vascular and behavioral effects gynecomastia
conditions associated with decreased shbg concentration
moderate obesity, nephrotic syndrome, hypothyroidism, use of glucocorticoids/ progestins/ androgens, acromegaly, t2dm, familial shbg deficiency
conditions associated with increased shbg concentration
aging, hepatic cirrhosis and hepatitis, hyperthyroid, use of anticonvulsants or estrogens, hiv
what is oligozoospermia
low sperm count <15 m sperm/ml
what is astenozoospermia
reduced motility
<32% motile spermatozoa
what is terazoospermia
abnormal morphology that affects fertility
<4% normal forms
who reference values for sperm parameters
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%
what is male hypogonadism
a clinical syndrome that results from the failure of the testes to produce adequate amounts of testosterone
pathogenesis of fertility problems
testosterone production stops at an early age
effects of early testosterone loss
muscle, height, or osteoporosis problems
what is primary hypogonadism
disorder of the testis - low testosterone
body tries to compensate and produce more gnrh, lh, and fsh
what is secondary hypogonadism
secondary to disorder of pituitary or hypothalamus
common cause of congenital primary hypogonadism (androgen deficiency and impairment of sperm production)
klinefelter’s syndrome (xxy) and variants
causes of acquired primary hypogonadism (androgen deficiency and impairment of sperm production)
common: bilateral castration/trauma, drugs, ionizing radiation
uncommon: orchitis
causes of primary hypogonadism from systemic disorders (androgen deficiency and impairment of sperm production)
common: ckd, cld, aging
uncommon: malignancy (lymphoma, testicular ca), sickle cell disease, spinal cord injury, vasculitis, infiltrative disease
causes of congenital primary hypogonadism (isolated)
cryptorchidism, varicocele, y chromosome microdeletions
causes of acquired primary hypogonadism (isolated)
orchitis, ionizing radiation, chemo, thermal trauma
causes of primary hypogonadism from systemic disorders (isolated)
spinal cord injury
most common sex chromosome abnormality and most common cauase of primary hypogonadism causing androgen deficiency
klinefelter’s syndrome (xxy)
clinical features of klinefelter’s syndrome
very small testes (4 ml), infertile, azoospermia, gynecomastia
pathogenesis of hypogonadism from mumps
causes permanent seminiferous tubule damage (fibrosis), impaired spermatogenesis, leydig cell failure and androgen deficiency
hypergonadotropic hypogonadism
primary hypogonadism
hypogonadotropic hypogonadism
secondary hypogonadism
pathophysiology of secondary hypogonadism
caused by disorder of the pituitary or hypothalamus, usually due to genetic disorders (or head trauma, tumors, radiation, or infection)
labs for secondary hypogonadism
low testosterone with low gonadotropin (lh and fsh)
congenital disorders associated with gonadotropin deficiency
kalimann syndrome (+ anosmia), prader-willi syndrome, lawrence-moon syndrome (leptin mutation)
acquired disorders associated with gonadotropin deficiency
severe illness, stress, malnutrition, and exercise; hemochromatosis, sellar mass lesions, hyperprolactinemia
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
focus on pe for male hypogonad
secondary sexual characteristics: hair growth and pattern, gynecomastia, testicular volume, prostate, body proportions
testicular volume is best assessed by ___
prader orchidometer
normal: 3.5-5.5 cm in length = 12-25 ml
congenital: very small testis
testicular length and volume for prepuberty
3-4 ml
<2 cm long
testicular length and volume for peripubertal
4-15 ml
<2 cm long
testicular length and volume for adults
20-30 ml
4.5-6.5 cm by 2.8-3.3 cm
common presentation of klinefelter syndrome
small, firm testes <4 ml, hypergonadotropic male
common presentation for congenital hypogonatropism
small, firm testes <4 ml, hypo/normogonad male
common presentation for successful medical treatment of infertility
infertile men with testes < 15 cc
definition of eunuchoid proportions
arm span >2 cm greater than height
suggest that androgen deficiency occurred before epiphyseal fusion
if thyroid disease is cause of infertility ___ is often present
goiter
examination that shows pigmentation changes that suggest hemochromatosis or cushing syndrome
skin exam
testicular examination (CLICK)
hypospadia, fibrosis, and varicocoele ideally measured with prader orchidometry
t/f if there is low testosterone check lh and fsh
true
if lh and fsh are low do ___
mri
what to test when there is low t, low or normal lh and fsh
secondary hypogonadism
prolactin, iron, other pituitary hormones, mri
what to test when low t, high lh and fsh
primary hypogonadism
karyotype
types of testosterone therapies
oral testosterone undecanoate 40-80 mg po with meals bid to tid
parenteral testosterone undecanoate
testosterone adhesive matrix patch
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)
t/f excessive testosterone can produce cancer
false
treatment for secondary hypogonadism
give gnrh or beta hcg
golden period to give gnrh before testis will fibrose
6 months
treatment for patient with brain trauma resulting in low lh and fsh but normal sperm and testosterone
beta hcg, fsh, gnrh
t/f you give pituitary hormones at age 70
false, use testosterone
primary problems: ___
secondary problems: ___
primary: testosterone
secondary: beta-hcg, fsh, gnrh
conditions where testosterone administration has very high risk of serious averse outcomes
metastatic prostate cancer, breast cancer
evaluate patients every ___
3-6 months testosterone level
aim for mid to normal range only
when to check for drug effects
enanthate and cypionate: midway through treatment to adjust
undecanoate: prior to next dose
check hematocrit every ___
3-6 mos, discontinue if >54%
measure mineral bone density when ___
1-2 years after initiation
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
when to look at the peak for testosterone
6th week
t/f testosterone increases the incidence, but not the severity of prostate ca
false, it increases severity but not incidence
