Male Hypogonadism

Question 1

Normal man produces how much testosterone each day?

Answer 1

7mg, 5% from adrenal

Question 2

How much testosterone is free?

Answer 2

2%

Question 3

What is testosterone bound to?

Answer 3

More than 50% Albumin SHGB about 44%

Question 4

Sertoli cells make?

Answer 4

Inhibin B and anti mullerian hormone

Question 5

Leydig cells make?

Answer 5

testosterone

Question 6

Pregnenolone converted to?

Answer 6

Progesterone and DHEA

Question 7

Aromatase coverts testosterone to?

Answer 7

Oestrogen by FSH

Question 8

LH and FSH composed of?

Answer 8

Glycoproteins chain alpha and beta

Question 9

Primary hypogonadism hormone level?

Answer 9

Low testosterone and high FSH and LH

Question 10

Secondary hypogonadism hormone level?

Answer 10

Low Testosterone and low or normal FSH and LH

Question 11

Primary hypogonadism causes?

Answer 11

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

Question 12

Secondary hypogonadism?

Answer 12

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

Question 13

Lack of testosterone in first semester?

Answer 13

Female genitalia to ambiguous to partial virilzation

Question 14

Symptoms and signs of hypogonadism?

Answer 14

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

Question 15

Screening suggested for?

Answer 15

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

Question 16

Screening?

Answer 16

Initial screen , morning total testosterone

The confirmation- repeat morning total testosterone

Question 17

What lowers SHGB?

Answer 17

Moderate obesity
Nephrotic syndrome
Hypothyroidism
Steroids

SHBG
steroids, hypothyroidism, beesity, glomerular syndrome

Question 18

Increase SHGB caused by?

Answer 18

HAHAHE

Ageing
Hepatic cirrhosis
Hyperthyroidism
Estrogens
HIV infection
Anticonvulsants

Question 19

In secondary hypogonadism you would check for?

Answer 19

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

MRI pituitary

Question 20

In primary hypogonadism what should you check for?

Answer 20

Karyotype

Question 21

Testosterone might aid?

Answer 21

Prostate cancer

Question 22

Gynecomastia?

Answer 22

Benign proliferation of glandular tissue of male breast

Question 23

Gynaecomastia length

Answer 23

More 0.5 cm in length

Question 24

Causes of gynaecomastia?

Answer 24

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

Question 25

Treatment for gynaecomastia?

Answer 25

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

Question 26

Cholesterol is converted to prgenenolne by?

Answer 26

LH and p450SCC

Question 27

Testosterone is converted to dihydrotestosterone by?

Answer 27

5 alpha reductase

Question 28

Conditions with high prevalence of hypogonadism?

Answer 28

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

Question 29

Normal adult should have testicles volume of?

Answer 29

Between 20 and 25 ml

Question 30

Investigations for hypogonadism?

Answer 30

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

Question 31

Contraindications to testosterone therapy?

Answer 31

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

Question 32

Gynecomastia is caused by what?

Answer 32

Imbalance between androgen and oestrogen

Question 33

Inhibin B inhibits?

Answer 33

FSH

Question 34

Kleinfelters testes size?

Answer 34

Lower than 5ml

Question 35

How would you give testosterone?

Answer 35

Gel Injection Buccaneers/patch pellet

Question 36

What does testosterone do to prostate?

Answer 36

Enlargement and acceleration of prostate cancer

Question 37

High testosterone can cause?

Answer 37

MI so monitor FBC

Question 38

What percent of boys through puberty have gynaecomastia?

Answer 38

60

Question 39

What percent of men over 50 have gynaecomastia?

Answer 39

30-70

Question 40

What does ketoconazole do?

Answer 40

Decreases testosterone levels

Question 41

What converts cholesterol to pregnenolone?

Answer 41

LH

Question 42

What should you check for?

Answer 42

``` Testosterone PSA LFT RBC DEXA MRI DRE ```

Question 43

When shouldn’t you give testosterone therapy?

Answer 43

``` 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 ```

Question 44

Gynaecomastia prevalence?

Answer 44

60% in boys of puberty age | 30-70% in adult men