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Endocrinology Exam 3 > Male Gonadal Disorders > Flashcards

Male Gonadal Disorders Flashcards

1
Q

Seminiferous tubules (ST) lead
to ______

A

rete testis

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2
Q

Rete testis lead to _____

A

epididymis

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3
Q

The smooth muscular duct, vas deferens propels
spermatozoa via peristalsis to the ejaculatory ducts, terminating in the _____

A

prostatic urethra

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4
Q

In 1st several weeks of development, the
embryo cannot be morphologically
identified as male or female, Gonadal tissues are _____

A

“Bipotential”

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5
Q

~6 weeks gestation, bipotential tissues
change depending on the presence or
absence of this protein:

A

The Sex-determining Region on the Y
chromosome is called the SRY Gene
Encodes for the SRY protein
* AKA Testis-determining Factor

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6
Q

Testicular development _____
require Testosterone

A

DOES NOT

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7
Q

Leydig cells produce _____

A

testosterone

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8
Q

Sertoli cells produce _____

A

Müllerian inhibiting factor (MIF)

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9
Q

Müllerian inhibiting factor (MIF)

A

MIF levels are elevated in males
* Prevents female reproductive organ development*
* MIF → regression of Müllerian ducts
Remaining Wolffian ducts form Vas deferens, epididymis, & seminal vesicles
* Requires testosterone

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10
Q

External male genitalia is regulated by
_____

A

Dihydrotestosterone (DHT)

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11
Q

Testosterone stimulates the development of:

A
  • Wolffian ducts
  • Penis
  • Prostate
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12
Q

Gonadal maturation and reproduction are
controlled by the _____

A

Hypothalamic-Pituitary complex

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13
Q

____ controls secretion of the
Gonadotropins from the Anterior Pituitary
gland.

A

GnRH - Gonadotropin-Releasing Hormone

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14
Q

From birth to puberty, GnRH is not secreted in
large amounts due to what?

A

highly sensitive feedback inhibition by testosterone and/or estrogen.
* Testosterone & estrogen don’t rise high
enough to induce puberty
* Hypothalamic sensitivity eventually decreases,
and GnRH secretion is no longer inhibited

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15
Q

In puberty, GnRH is secreted in a ____ pattern

A

pulsatile

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16
Q

Puberty is considered precocious (early) if
before age___ in boys

A

9

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17
Q

Puberty is considered “late” if there is lack
of sexual development by the age of ____

A

14

18
Q

Tanner Staging

A

Assesses pubertal stages of testes, scrotum and penis size that is appropriate for age as well as the development of pubic hair, skin texture, etc.

19
Q

Initial workup for delayed Male puberty

A
  • LH & FSH
  • GnRH stimulation test
20
Q

Possible DDx for delayed male puberty

A

Hypergonadotropic hypogonadism
* High LH and FSH
Hypogonadotropic hypogonadism
* Low LH and FSH

21
Q

Precocious Puberty

A
  • Any sign of secondary sexual maturation before age 9 in boys
  • Premature activation of hypothalamic-pituitary-gonadal
    axis.
  • May be due to hypothalamic structural abnormality or lesion, or simply a variant of normal.
22
Q

_____ is caused by deficiency in
Testosterone secretion by the testes.

A

Hypogonadism

23
Q

Pathology of the testes causing decreased
testosterone

A

Primary Hypogonadism
AKA Hypergonadotropic Hypogonadism

24
Q

Insufficient gonadotropin secretion by the
pituitary

A

Secondary Hypogonadism
AKA Hypogonadotropic Hypogonadism

25
Q

Notable Causes of Hypergonadotropic Hypogonadism

A
  • Aging
  • Klinefelter syndrome (XXY)
  • Mumps
  • Chemotherapy or radiation
  • Testicular trauma
26
Q

Klinefelter syndrome

A

Tall stature with “eunuchoid
habitus”
Small testes

27
Q

Several notable causes of Hypogonadotropic Hypogonadism

A
  • Aging
  • Alcohol use
  • Chronic illness
  • Hypothyroidism
  • Malnourishment
  • Obesity
28
Q

S/S of Men with acquired hypogonadism

A
  • Decreased libido
  • Erectile dysfunction
  • Depression
  • Fatigue
  • Weight gain
  • ↓ muscle mass
  • Infertility
  • Gynecomastia
29
Q

Laboratory evaluation of Male hypogonadism

A
  • Non-fasting, A.M. serum
    testosterone
  • Total Testosterone
  • Free Testosterone (calculated)
  • Low Testosterone suggests the
    diagnosis (Normal: 300-1000)
30
Q

Treatment of Male Hypogonadism (testosterone)

A

Most hormone clinics will treat at:
* Free <10 ng/dl
* Total Testosterone <350 ng/dl
Tesosterone forms available:
* Topical gel – Preferred
* Transdermal patch
* Injection
* Buccal or oral dissolvable tabs
* Subcutaneous pellets

31
Q

T/F Significant weight loss can
drastically improve Testosterone

A

T

32
Q

Treatment Risks of Male Hypogonadism

A
  • Possible ↑risk of CV events in men 65+ yo
  • Erythrocytosis directly ↑ risk of venous
    thromboembolic diseas
  • Benign Prostatic Hypertrophy
    is a testosterone-dependent disease
33
Q

Rx- Testosterone

A
  • Topical gel (AndroGel®)
  • Transdermal patch (AndroDerm®)
  • Intramuscular injectable
  • Testosterone pellets (Testopel®)
  • Dissolvable PO tab (Striant®) $$$$
  • Newest oral capsule (Jatenzo®, Kyzatrex, Tlando) $$$$
34
Q

Rx- Testosterone MOA

A

Exogenous Testosterone replacement
* Important note:Exogenous Testosterone
inhibits the physiologic
hormone axis and secretion
of FSH and LH

35
Q

Rx- Testosterone indications

A
  • Male Hypogonadism
  • Low Libido states
36
Q

Contraindications of Rx- Testosterone

A
  • Prostate Cancer
  • Androgens can stimulate growth of the
    prostate gland, & will stimulate tumor growth.
  • Men with Breast Cancer
  • Pregnancy, Breastfeeding
  • Significant caution with CAD, CHF, or
    OSA.
37
Q

Rx- Testosterone side effects

A
  • Nausea, vomiting, diarrhea
  • Edema- Mild mineralocorticoid effect
  • Worsening of Benign Prostatic Hypertrophy
  • Acne
  • Skin irritation/contact dermatitis
  • Patch/Gel
  • Emotional lability
38
Q

Rx- Testosterone Adverse effects

A
  • Severe sleep apnea
  • Myocardial infarction or Stroke
  • Stimulation of prostate cancer growth
  • DVT (in first 6 months)
39
Q

Rx- Testosterone Follow up

A

Pregnancy Category X and unsafe with Lactation.
* Digital rectal exam and serum PSA should be checked before starting Testosterone therapy in men over 40.
* Check PSA yearly while on the medication.
* Check H&H (hemoglobin and hematocrit) at baseline, 3-6 months after starting treatment, and then yearly.

40
Q

Gynecomastia

A

Abnormal enlargement of male breast tissue
* May be asymmetric or unilateral
* Gynecomastia during teenage puberty is
common and usually spontaneously
subsides within 1 year of onset.
* Especially common in overweight teenage
boys
* Gynecomastia is a very common finding in
Klinefelter’s (XXY)

41
Q

Gynecomastia causes

A

Idiopathic
* Puberty and obesity
* Hyperprolactinemia, Hypogonadism,
Hyperthyroidism
* Chronic liver disease or kidney disease
* Breast cancer, testicular tumors,
Bronchogenic cancer
* Alcohol, Cimetidine, Isoniazid,
Ketoconazole, Marijuana, etc.

42
Q

Diagnostic Evaluation for Gynecomastia:

A
  • Testosterone and FSH/LH: See hypogonadism
  • Prolactin Level: Rules out prolactinoma
  • Beta-hCG: Detectable levels of beta-hCG implicate
    a testicular tumor
  • TSH and Free T3 and Free T4: Rules out hyperthyroidism

Endocrinology Exam 3 (6 decks)

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