male hypogonadism Flashcards

1
Q

what stimulates the hypothalamus to release GnRH

A

kisspeptin

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2
Q

what stimulates the anterior pituitary to release LH and FSH

A

GnRH

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3
Q

which cells produce testosterone

A

Leydig cells under control of LH

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4
Q

what is the majority of testosterone bound to

A

SHBG and albumin

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5
Q

what is testosterone converted to

A

dihydrotestosterone and oestradiol

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6
Q

what is male hypogonadism

A

testosterone deficiency

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7
Q

what does primary hypogonadism mean

A

testes primarily affected

  • decreased testosterone means decreased negative feedback
  • anterior pituitary secretes higher amounts of LH/FSH
  • hypergonadotrophic hypogonadism
  • spermatogenesis is affected more tan testosterone production
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8
Q

what is secondary hypogonadism

A

hypothalamus/pituitary affected, testes capable of normal function

  • LH/FSH low despite low testosterone
  • hypogonadotrophic hypogonadism
  • spermatogensis and testosterone production are equally affected
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9
Q

congenital causes of primary hypogonadism

A
  • klinefelter’s syndrome
  • cryptorchidism
  • Y-chromosome microdeletions
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10
Q

acquired causes of primary hypogonadism

A
  • testicular trauma
  • chemotherapy
  • radiation
  • varicocele
  • orchitis
  • infiltrative disease
  • medications
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11
Q

what is Klinefelter’s syndrome caused by

A

nondisjunction

-47 XXY

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12
Q

symptoms of male hypogonadism

A
  • poor beard growth
  • small testicles
  • female pubic hair pattern
  • long arms and legs
  • wide hips
  • breast development
  • narrow shoulders
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13
Q

congenital causes of secondary hypogonadism

A
  • kallmann’s syndrome

- prader-Willi syndrome

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14
Q

acquired causes of secondary hypogonadism

A
  • pituitary damage (trauma, tumours, infiltrative disease etc)
  • hyperprolactinaemia
  • obesity, diabetes
  • medications
  • acute systemic illness
  • eating disorders
  • excessive exercise
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15
Q

what is kallmann’s syndrome

A

genetic disorder characterised by isolated GnRH deficiency and hyposmia or anosmia

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16
Q

pre-pubertal symptoms of hypogonadism

A
  • small sex organs
  • decreased body hair
  • high pitched voice
  • low libido
  • gynaecomastia
  • tall, slim, long arms and legs
  • decreased bone and muscle mass
17
Q

post-pubertal symptoms of hypogonadism

A
  • normal skeletal proportions
  • normal penis/prostate size
  • normal voice
  • decreased libido and erections
  • decreased pubic hair
  • decreased testicular volume
  • gynaecomastia
  • decreased muscle and bone mass
  • decreased energy and motivation
18
Q

how to diagnose hypogonadism

A
  • measure AM testosterone
  • repeat if low
  • if still low then measure LH/FSH
  • these should be elevated if primary
  • then karyotyping or iron studies
  • if LH/FSH normal then exclude meds, MRI, iron studies, look at prolactin and pituitary hormones
19
Q

why can total testosterone be misleading

A

-only free portion is biologically active

20
Q

treatment for hypogonadism

A

testosterone replacement therapy

  • testogel
  • testosterone undecanoate oral capsules
  • testosterone undecanoate intra-muscular injection (Nebido)
  • testosterone enanthate/propionate/cipionate intramuscular injection (Sustanon)
21
Q

contraindications for testosterone replacement therapy

A
  • confirmed hormone responsive cancer
  • possible prostate cancer
  • haematocrit
  • severe sleep apnoea/heart failure
22
Q

how often is testosterone replacement monitored

A

3-6 monthly while starting treatment, annually thereafter