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Endocrinology Exam 3 > Male Gonadal Disorders > Flashcards

Male Gonadal Disorders Flashcards

(42 cards)

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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 ____

18
Q

Tanner Staging

Study These Flashcards
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

Study These Flashcards
A
  • LH & FSH
  • GnRH stimulation test
20
Q

Possible DDx for delayed male puberty

Study These Flashcards
A

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

21
Q

Precocious Puberty

Study These Flashcards
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.

23
Q

Pathology of the testes causing decreased
testosterone

Study These Flashcards
A

Primary Hypogonadism
AKA Hypergonadotropic Hypogonadism

24
Q

Insufficient gonadotropin secretion by the
pituitary

Study These Flashcards
A

Secondary Hypogonadism
AKA Hypogonadotropic Hypogonadism

25
Notable Causes of Hypergonadotropic Hypogonadism
* Aging * Klinefelter syndrome (XXY) * Mumps * Chemotherapy or radiation * Testicular trauma
26
Klinefelter syndrome
Tall stature with "eunuchoid habitus” Small testes
27
Several notable causes of Hypogonadotropic Hypogonadism
* Aging * Alcohol use * Chronic illness * Hypothyroidism * Malnourishment * Obesity
28
S/S of Men with acquired hypogonadism
* Decreased libido * Erectile dysfunction * Depression * Fatigue * Weight gain * ↓ muscle mass * Infertility * Gynecomastia
29
Laboratory evaluation of Male hypogonadism
* Non-fasting, A.M. serum testosterone * Total Testosterone * Free Testosterone (calculated) * Low Testosterone suggests the diagnosis (Normal: 300-1000)
30
Treatment of Male Hypogonadism (testosterone)
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
T/F Significant weight loss can drastically improve Testosterone
T
32
Treatment Risks of Male Hypogonadism
* 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
Rx- Testosterone
* Topical gel (AndroGel®) * Transdermal patch (AndroDerm®) * Intramuscular injectable * Testosterone pellets (Testopel®) * Dissolvable PO tab (Striant®) $$$$ * Newest oral capsule (Jatenzo®, Kyzatrex, Tlando) $$$$
34
Rx- Testosterone MOA
Exogenous Testosterone replacement * Important note:Exogenous Testosterone inhibits the physiologic hormone axis and secretion of FSH and LH
35
Rx- Testosterone indications
* Male Hypogonadism * Low Libido states
36
Contraindications of Rx- Testosterone
* 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
Rx- Testosterone side effects
* Nausea, vomiting, diarrhea * Edema- Mild mineralocorticoid effect * Worsening of Benign Prostatic Hypertrophy * Acne * Skin irritation/contact dermatitis * Patch/Gel * Emotional lability
38
Rx- Testosterone Adverse effects
* Severe sleep apnea * Myocardial infarction or Stroke * Stimulation of prostate cancer growth * DVT (in first 6 months)
39
Rx- Testosterone Follow up
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
Gynecomastia
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
Gynecomastia causes
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
Diagnostic Evaluation for Gynecomastia:
* 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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