Male Endocrine Disorders

Question 1

virilization

Answer 1

female develops male sex characteristics, or newborn boy has increased male characteristics at birth

Question 2

Compare/contrast Hyper and Hypogonadotrophic hypogonadism

Answer 2

Both have small gonads due to low testosterone levels

hyper = high LH and FSH; testicular dysfunction (primary)

hypo = low to normal LH and FSH; gonadotropin deficiency (secondary)

Question 3

Premature gonadal failure

Answer 3

inadequate testosterone and sperm when levels should be normal (20-40)

Question 4

Andropause

Answer 4

Normal age-related decline in testosterone

~ menopause in women

Question 5

Etiology of testicular dysfunction (primary hypogonadism)

Answer 5

Klinefelter’s syndrome (47,XXY)
Cryptorchidism 
Trauma/Torsion
Infectious orchitis (Mumps) 
Radiation

Question 6

Etiology of gonadal deficiency (secondary hypogonadism)

Answer 6

Illness - HIV, Liver/Kidney disease, COPD, Cancer, Hemochromatosis

Obesity - testosterone to estradiol in adipose tissue

Normal Aging

Drugs - Spironolactone, ketoconazole, Anabolic Steroids, ETOH, THC, Opioids

Pituitary tumor/lesion

Question 7

Clinical findings of hypogonadism if congenital or acquired before puberty

Answer 7

failure to develop secondary sex characteristics

feminine features

Question 8

Diagnostic testing to eval hypogonadism

Answer 8

Total testosterone
LH & FSH
GnRH stimulation test
Semen analysis
Testicular biopsy

Question 9

Diagnostic testing for hypogonadism should be restricted to which men?

Answer 9

men with symptoms or physical features of androgen deficiency

Question 10

How to differentiate primary vs secondary causes of hypogonadism?

Answer 10

LH and FSH levels

high = primary
low = secondary

Question 11

When during day is total testosterone highest?

Answer 11

8 AM

Question 12

Guidelines for when to treat hypogonadism

Answer 12

testosterone < 300 ng/mL and at least 3 symptoms

Question 13

Hypogonadism treatment

Answer 13

Testosterone or gonadotropin replacement

Question 14

When is testosterone replacement contraindicated?

Answer 14

Baseline hematocrit >/= 50%

severe untreated sleep apnea

recent MI or unstable angina

poorly controlled CHF

Hx of prostate cancer, BPH, CHF

Question 15

Benefits of testosterone replacement

Answer 15

• Improved mood and sense of well-being
• Improved libido and decreased ED
• Increased muscle strength and endurance
• Decrease mortality

Question 16

How and what to monitor for hypogonadism treatment?

Answer 16

3-6 mon after initiation, then annually

Monitor testosterone, hematocrit, and PSA

Question 17

When should testosterone therapy be stopped?

Answer 17

hematocrit > 54%

PSA > 1.4

Question 18

Hypogonadism, hypospadias, cryptorchidism, and gynecomastia

Normal testosterone and LH levels

Answer 18

Androgen insensitivity

Question 19

incomplete descent of one or both testes from abdomen

Answer 19

cryptorchidism

Question 20

Treatment of choice for cryptorchidism

Answer 20

orchioplexy

Question 21

Complications of cryptorchidism

Answer 21

infertility

testicular cancer

Question 22

Development of secondary sex characteristics before 9 years

Answer 22

precocious puberty

Question 23

precocious puberty treatment

Answer 23

Spironalactone (androgen agonist)

Ketaconazole (inhibits androgen synthesis)

Question 24

failure to develop secondary sex characteristics by 14 yrs old

Answer 24

delayed puberty

Question 25

presence of glandular breast tissue in males

Answer 25

gynecomastia

Question 26

Gynecomastia treatment

Answer 26

• Remove suspected drugs
• Treat when severe psychological and/or cosmetic problems present
• Anti-estrogen drugs (tamoxifen)
• Aromatase Inhibitors (reduces amount of estradiol synthesized from testosterone)
• Surgery

Question 27

> 90% of male infertility due to what?

Answer 27

sperm problems