Male Hypogonadism

Question 1

Defintion

Answer 1

Failure of the testes to produce testosterone, sperm or both

Question 2

Primary hypogonadism causes

Answer 2

• Local trauma (radiation)
• Post-orchitis (mumps)
• Cryptorchidism
• Seminiferous tubule failure
• Klinefelters syndrome
• Adult leydig cell failure

Question 3

Secondary hypogonadism

Answer 3

• Hypopituitarism
• Prloactinoma
• Kallmans syndrome – isolated LH &FSH
• Systemic illness

Question 4

Blood results for Primary gonadal disease

Answer 4

• Low testosterone
• Normal/high LH/FSH
• Normal prolactin

Question 5

Commenst cause of primary gonadal disease

Answer 5

Klinefeltors syndrome

Question 6

Klinefeltors syndrome chromosomes

Answer 6

• Commonest genetic cause of male hypogonadism (1 in 500 male births)
• 47 XXY (but other sex chromosome variations exist)
• Clinically manifests at puberty

Question 7

Clinical features of klinefeltors syndrome

Answer 7

• Tall individuals
• Continue to grow but grow slowly
• Wide clinical variation in phenotype due to hormonal response to LH surges
  a. Delayed puberty
  b. Suboptimal genital development
  c. Reduced 2° male sexual characteristics
  d. Persistent gynaecomastia
  e. Azospermia
  f. Behavioural issues/learning difficulties

Question 8

Commest cause of secondary gonadal disease

Answer 8

Kallmanns syndrome

Question 9

Kallmanns syndrome definition

Answer 9

• Commonest form of isolated gonadotrophin deficiency

- Failure of cell migration of GnRH cells to hypothalamus from Olfactory placode

Question 10

Clincial features of kallmanns syndrome

Answer 10

• Associated with aplasia/hypoplasia of olfactory lobes – giviing anosmia or hyposmia
• Also may be assoc. with deafness, renal agenesis, cleft lip/palate
• May have micropenis ± cryptorchidism

Question 11

Genetics of Kallmanns syndrome

Answer 11

• Familial with variable penetration
• X-linked – Absence of KAL gene (KAL1)
• Autosomal Dominant (KAL2)
• Autosomal Recessive (KAL3)
• Other genetic causes of IHH exist (e.g Kisspeptin/GPR54 mutations)

Question 12

Symptoms of male hypogonadism in children/young adults

Answer 12

• Slow growth in teens

- No pubertal growth spurt

Question 13

Signs of male hypogonadism in children/young adults

Answer 13

• Small testes & phallus

Question 14

Symptoms of male hypogonadism in adults

Answer 14

• Depression/low mood
• Poor libido
• Erectile problems
• Poor muscle bulk/power
• Poor energy

Question 15

Signs of male hypogonadism in adult

Answer 15

• Sparse body/fcial hair
• Gynaecomastia
• Gynoid weight gain (across breast)
• Great head hair (androgen dependent)
• Short phallus
• Small testes- abn consistency

Question 16

History of male hypogonadism

Answer 16

• Height
• Weight
• History
  a. Growth
  b. Family
  c. Sexual
  d. Drug
  e. Social

Question 17

Examination tool in male hypogonadism

Answer 17

• Orchidometer – medical instrument used to measure the volume of the testes
  a. 4-6mm = early puberty
  b. 6-10mm= mid puberty
  c. 12-15mm = late puberty
  d. 20-25mm= adult testitcular volume

Question 18

Investigations in male hypogonadism

Answer 18

Sex steroid deficiency 
-	Testosterone 
a.	Early morning 
b.	Free testosterone >200 
c.	Total testosterone >16 
d.	SHBG 
-	LH and FSH 
a.	Help determine possible pituitary cause 
Fertility 
-	Semen analysis 
a.	1-3 days after last ejaculation 
b.	2-5ml volume 
c.	20 x 106 sperm/ml 
d.	50% prpgressive motility 
e.	>30% normal morphology

Question 19

Treatments for male hypogonadism

Answer 19

• Androgen replacement therapy
  a. Oral
  b. IM
  c. Topical
• Fertility treatment
  a. HCG
  b. Recombinant LH & FSH
  c. GnRH pumps

Question 20

Side effects of testosterone therapy replacement

Answer 20

a. Side Effects
b. Mood issues (aggression/behaviour change)
c. Libido issues
d. Increased haematocrit
e. Possible prostate effects
f. Acne, sweating
g. Gynaecomastia