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Endocrine > male hypogonadism > Flashcards

male hypogonadism Flashcards

1
Q

what does FSH do in males?

A
  • act on Sertoli cells for spermatogenesis

- Sertoli cells release inhibin for negative feedback (turn off FSH)

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2
Q

what does LH do in males?

A
  • LH works on Leydig cells to secrete testosterone

- Leydig cells produce free testosterone which works for negative feedback

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3
Q

what produces testosterone?

A

Leydig cells

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4
Q

what is the majority of testosterone bound to?

A

SHBG

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5
Q

what is testosterone converted into?

A

dihydrotestosterone and oestradiol

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6
Q

what is male hypogonadism?

A

a clinical syndrome compromising of signs, symptoms and biochemical evidence of testosterone deficiency

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7
Q

who is male hypogonadism more common in?

A

men aged 40-79

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8
Q

what is primary hypogonadism?

A

-hypogonadism caused by the testes being primarily affected

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9
Q

what occurs to testosterone and negative feedback in primary hypogonadism?

A
  • decreased testosterone

- decreased negative feedback

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10
Q

what occurs to FSH levels and LH levels in primary hypogonadism and why?

A

-decreased testosterone production so decreased negative feedback and so higher amounts of FSH and LH

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11
Q

what is hypergonadotrophic hypogonadism?

A

primary hypogonadism

its when the testes aren’t working well so there is decreased testosterone but there are increased amounts of LH and FSH

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12
Q

how does primary hypogonadism tend to affect testosterone production and spermatogenesis?

A

spermatogenesis is more affected than testosterone production

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13
Q

what is secondary hypogonadism?

A

-the hypothalamus/pituitary is affected but the testes can still function normally

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14
Q

what are the testosterone, FSH and LH levels like in secondary hypogonadism?

A

LH/FSH levels are low/ inappropriately normal (should be high)
testosterone is low

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15
Q

what is hypogonadotrophic hypogonadism?

A

secondary hypogonadism

  • testosterone low
  • FSHLH low or inappropriately normal
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16
Q

how does secondary hypogonadism tend to affect testosterone production and spermatogenesis?

A

they seem to be equally effected

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17
Q

what are some congenital causes of primary hypogonadism?

A

Klinefelter’s syndrome
Cryptorchidism
Y-chromosome micro deletions

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18
Q

what are some acquired causes of primary hypogonadism?

A
  • testicular trauma/torsion
  • chemotherapy/radiation
  • varicocele
  • orchitis (mumps infection)
  • infiltrative disease (e.g. haemochromatosis)
  • medications (glucocorticoids, ketoconazole)
19
Q

what is the most common genetic cause of hypogonadism?

A

Klinefelter’s syndrome

20
Q

what causes Klinefelter’s syndrome?

A
  • genetic

- not inherited caused by nondisjunction

21
Q

How is Klinefelter’s syndrome diagnosed?

A

by Karyotyping

22
Q

how does Klinefelter’s syndrome present in men?

A
  • affected men are typically infertile due to tubular damage and have small, firm testes
  • wide hips
  • long arms and legs
  • female type pubic hair pattern
  • breast development
  • tendancy to grow fewer chest hairs
  • narrow shoulders
  • poor beard growth
  • absent frontal baldness
  • learning difficulties
  • psychosocial issues
  • cryptochordism
23
Q

what does Klinefelter’s syndrome increase your chances of developing?

A
  • breast cancer

- non Hodgkin lymphoma

24
Q

what are some congenital causes secondary hypogonadism?

A
  • Kallmann’s syndrome (isolated hypogonadotrophic hypogonadism)
  • Prader Willi syndrome
25
Q

what are some acquired causes of secondary hypogonadism?

A
  • pituitary disease (tumours, infiltrative disease, infection, apoplexy, head trauma)
  • hyperprolactinaemia
  • obesity
  • diabetes
  • medication (steroids, opiates)
  • acute systemic illness
  • eating disorders, excessive exercise
26
Q

what is Kallmann’s syndrome?

A

-genetic disorder characterised by isolated GnRH deficiency and hyposmia or anosmia

27
Q

what is isolated GnRH deficiency associated with?

A
  • unilateral renal agenesis (missing kidney)
  • red green colour blindness
  • cleft lip/palate
  • bimanual synkenesis
28
Q

who does Kallmanns syndrome tend to affect?

A

males but less commonly can affect females

29
Q

what are some pre pubertal onset signs/symptoms of hypogonadism?

A

Pre pubertal onset:

  • small male sexual organs, penis and prostate
  • decreased body hair, low libido, high pitched voice
  • gynaecomasyia
  • tall, slim, long arms and legs
  • decreased bone mass and muscle mass

+/- symptoms due to cause

30
Q

what are some post pubertal signs/symptoms of hypogonadism?

A
  • normal skeletal proportion, penis/prostate size and voice
  • decreased libido, decreased spontaneous erections
  • decreased pubic/axillary hair, reduced shaving frequency
  • decreased testicular volume
  • gynaecomastia
  • decreased muscle and bone mass
  • decreased energy and motivation

+/- symptoms due to cause

31
Q

how is hypogonadism diagnosed?

A
  • signs/symptoms of low testosterone
  • measure AM testosterone
  • if low repeat AM testosterone test
  • measure LH/FSH
  • if elevated could be primary hypogonadism (hypergonadrotrophic hypogonadism) so do karyotypic and iron studies
  • if FSH or LH decreased/inappropriately normal then it could be secondary hypogonadism (hypogonadotrophic hypogonadism) so exclude medications, measure prolactin and pituitary hormones, MRI and iron studies
32
Q

what type of testosterone is active?

A

free testosterone

33
Q

what can increase SHBG (sex hormone binding globulin)?

A
  • ageing
  • hyperthyroidism
  • hyperoestrogenaemia
  • liver disease
  • HIV
  • use of anticonvulsants
34
Q

what are some advantages of testogel?

A
  • fast onset
  • convenient
  • mimics circadian rhythm
35
Q

what are some disadvantages of testogel?

A
  • skin irritation is possible
  • interpersonal transfer
  • non compliance long term
36
Q

what are some advantages of testosterone undecanoate (oral testosterone)?

A

-conveniant

37
Q

what are some disadvantages of testosterone undecanoate (oral testosterone)?

A
  • variable testosterone levels
  • daily or twice daily commitment
  • many people experience nausea
38
Q

what are advantages of testosterone undecanoate e.g. Nebido (intra-muscular injection)?

A
  • steady testosterone levels
  • conveniant
  • lower frequency administration improves complicance
39
Q

what are the disadvantages of testosterone undecanoate e.g. Nebiso (intra muscular injection)?

A
  • difficult to withdraw if side effects experiecnes
  • local pain at injection side
  • coughing following injection
  • contraindicated in blood disorders
40
Q

what are some advantages of testosterone enanthate/proprionate.cipionate e.g. sustain (intra muscular injection)?

A
  • easy to withdraw if side effects experienced

- can be self administered

41
Q

what are some disadvantages of testosterone enanthate/proprionate.cipionate e.g. sustain (intra muscular injection)?

A
  • variable testosterone levels
  • coughing following injection
  • local pain at injection site
  • contraindicated if bleeding disorders
42
Q

what are contraindications for testosterone replacement therapy?

A
  • confirmed hormone responsive cancer (e.g. prostate/ breast)
  • possible prostate cancer (e.g. raised PSA, suspicious prostate on DRE)
  • Haematocrit >50%
  • severe sleep apnoea/heart failure
43
Q

what is done to monitor testosterone replacement therapy?

A

3-6 monthly whilst starting treatment, annually thereafter

  • general health and testosterone concentration
  • DRE and PSA
  • Haematocrit
  • symptoms of sleep apnoea

Endocrine (53 decks)

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