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203 > Male Hypogonadism > Flashcards

Male Hypogonadism Flashcards

1
Q

Normal man produces how much testosterone each day?

A

7mg, 5% from adrenal

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2
Q

How much testosterone is free?

A

2%

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3
Q

What is testosterone bound to?

A

More than 50% Albumin SHGB about 44%

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4
Q

Sertoli cells make?

A

Inhibin B and anti mullerian hormone

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5
Q

Leydig cells make?

A

testosterone

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6
Q

Pregnenolone converted to?

A

Progesterone and DHEA

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7
Q

Aromatase coverts testosterone to?

A

Oestrogen by FSH

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8
Q

LH and FSH composed of?

A

Glycoproteins chain alpha and beta

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9
Q

Primary hypogonadism hormone level?

A

Low testosterone and high FSH and LH

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10
Q

Secondary hypogonadism hormone level?

A

Low Testosterone and low or normal FSH and LH

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11
Q

Primary hypogonadism causes?

A 
XXY Kleinfelter syndrome
Radiation 
Trauma
Torsion 
Idiopathic
Cryptorchidsm (failure of testes to descend) 
Infection mumps
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12
Q

Secondary hypogonadism?

A 
Illness
Opioids (suppress axis)
Anorexia
Pituitary disorder
GnRH analog
Congenital GnRH deficiency
Hyperprolactinaemia- interferes with secretion of gonadotropin-releasing hormone
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13
Q

Lack of testosterone in first semester?

A

Female genitalia to ambiguous to partial virilzation

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14
Q

Symptoms and signs of hypogonadism?

A 
Decrease sexual desire and spontaneous erection
Breast discomfort gene coma stria
Less body hair 
Eunuchoidism
Small testicles less 5ml
Low height 
Hot flushes
Sweat
Mild anaemia
Sleep disturbance
Increased body fat
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15
Q

Screening suggested for?

A 
Sellar mass- pituitary
If on meds Glucocorticoids, ketoconalzole, opioids
HIV associated weight loss
Moderate to severe COPD
Type 2 diabetes
Infertility
Osteoporosis
ESRD
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16
Q

Screening?

A

Initial screen , morning total testosterone

The confirmation- repeat morning total testosterone

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17
Q

What lowers SHGB?

A

Moderate obesity
Nephrotic syndrome
Hypothyroidism
Steroids

SHBG
steroids, hypothyroidism, beesity, glomerular syndrome

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18
Q

Increase SHGB caused by?

A

HAHAHE

Ageing
Hepatic cirrhosis
Hyperthyroidism
Estrogens
HIV infection
Anticonvulsants
19
Q

In secondary hypogonadism you would check for?

A

Iron (deposits in pituitary), prolactin, other pituitary hormones

MRI pituitary

20
Q

In primary hypogonadism what should you check for?

A

Karyotype

21
Q

Testosterone might aid?

A

Prostate cancer

22
Q

Gynecomastia?

A

Benign proliferation of glandular tissue of male breast

23
Q

Gynaecomastia length

A

More 0.5 cm in length

24
Q

Causes of gynaecomastia?

A 
Drugs: spirinolactone 
Idiopathic
Cirrhosis or malnutrition
Chronic renal insufficiency
(Leydig cell dysfunction)
Hypogonadism
Hyperthyroidism because of hahahe
Testicular tumour
Persistent pubertal
25
Q

Treatment for gynaecomastia?

A

Conservative, tamoxifen (early stages), surgery, treatment of cause

26
Q

Cholesterol is converted to prgenenolne by?

A

LH and p450SCC

27
Q

Testosterone is converted to dihydrotestosterone by?

A

5 alpha reductase

28
Q

Conditions with high prevalence of hypogonadism?

A 
Sellar mass- pituitary
On drugs steroids
HIV associated weight loss
COPD
End stage renal disease
Osteoporosis
T2D
Infertility
29
Q

Normal adult should have testicles volume of?

A

Between 20 and 25 ml

30
Q

Investigations for hypogonadism?

A 
Serum testosterone
LH.FSH
SHBG
LFT
Semen analysis
Karyotyping
Pituitary function
MRI pituitary
DEXA scan
31
Q

Contraindications to testosterone therapy?

A
  1. Breast/prostate cancer
  2. Severe untreated benign prostatic hyperplasia
  3. Erythrocytosis
  4. Untreated obstructive sleep apnoea
  5. Severe heart failure
  6. MI or stroke in last 6 months
32
Q

Gynecomastia is caused by what?

A

Imbalance between androgen and oestrogen

33
Q

Inhibin B inhibits?

A

FSH

34
Q

Kleinfelters testes size?

A

Lower than 5ml

35
Q

How would you give testosterone?

A

Gel
Injection
Buccaneers/patch pellet

36
Q

What does testosterone do to prostate?

A

Enlargement and acceleration of prostate cancer

37
Q

High testosterone can cause?

A

MI so monitor FBC

38
Q

What percent of boys through puberty have gynaecomastia?

A

60

39
Q

What percent of men over 50 have gynaecomastia?

A

30-70

40
Q

What does ketoconazole do?

A

Decreases testosterone levels

41
Q

What converts cholesterol to pregnenolone?

A

LH

42
Q

What should you check for?

A 
Testosterone
PSA
LFT
RBC
DEXA
MRI
DRE
43
Q

When shouldn’t you give testosterone therapy?

A 
Breast/prostate cancer
Lump hardness on prostate cancer
PSA>3ng/ml
Severe untreated benign hyperplasia
Erythrocytosis
Untreated obstructive sleep apnea
Severe heart failure
Mi or stroke
44
Q

Gynaecomastia prevalence?

A

60% in boys of puberty age

30-70% in adult men

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