Male Hypogonadism Flashcards
1
Q
what is primary hypogonadism, and what is the most common cause of it?
A
- occurs when the testes fail to respond to follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
- testosterone is insufficient to inhibit production of FSH and LH; hence, FSH and LH levels are elevated
- the most common genetic cause of primary hypogonadism is klinefelter syndrome (47,XXY)
2
Q
what is klinefelter syndrome (47,XXY)?
A
- seminiferous tubule dysgenesis
- failure of spermatogenesis
- leydig cell hyperplasia
3
Q
what is secondary hypogonadism?
A
- failure of the hypothalamus to produce gonadotropin-releasing hormone (GnRH), as in idiopathic hypogonadotropic hypogonadism, or of the pituitary gland to produce enough FSH and LH
- testosterone levels are low and levels of FSH and LH are low or inappropriately normal
4
Q
what are the acquired causes of primary hypogonadism?
A
- chemotherapy/radiation therapy
- testicular infection (e.g. mumps, echovirus, flavivirus)
- trauma
- high-dose of antiandrogen (e.g. cimetidine, sprinolactone, ketoconazole)
5
Q
what are the acquired causes of secondary hypogonadism?
A
- hypopituitarism (e.g. tumour, infarction)
- hyperprolactinaemia
- haemochromatosis
- drugs (e.g. oestrogens, metoclopramide, opioids)
- cushing’s syndrome
- cirrhosis
- obesity
6
Q
what are the symptoms of hypogonadism?
A
- decreased libido
- erectile dysfunction
- cognitive (e.g. visual-spatial interpretation, sleep disturbance, depression)
- decreased lean body mass
- increased visceral fat
- testicular atrophy
- osteopenia
- gynaecomastia
7
Q
what are the investigations for hypogonadism?
A
- serum FSH
- serum LH
- serum testosterone
- IV GnRH
- serum prolactin (e.g. prolactinoma)
- transferrin saturation (e.g. haemochromatosis)
- ? karyotype
- ? semen analysis
8
Q
what is the management of hypogonadism?
A
- TRT
- gonadotropin replacement therapy (e.g. secondary hypogonadism)
