Male Hypogonadism

Question 1

What are the features of Kallman’s syndrome?

Answer 1

• Failure of cell migration of GnRH cells to hypothalamus from Olfactory placode
• Associated with aplasia/hypoplasia of olfactory lobes - giving anosmia or hyposmia
• May be associated with deafness, renal agenesis, cleft lip/palate
• May have micropenis +/- cryptorchidism
• Familial with variable penetration
• Absence of KAL gene (KAL1 is X-linked, KAL2 is AD, KAL3 is AR)

Question 2

What are the features of Kleinfelters syndrome?

Answer 2

• Commonest genetic cause of male hypogonadism
• XXY (but other sex chromosome variations exist)
• Clinically manifests at puberty
• ↑LH & FSH – but seminiferous tubules regress and Leydig cells do not function normally
• Can cause delayed puberty, reduced secondary male characteristics, persistent gynaecomastia, azospermia and behavioural issues/learning difficulties
• Treat with androgen replacement +/- psychological support +/- fertility counselling

Question 3

What are the features of hypogonadotrophic hypogonadism?

Answer 3

• Low testosterone +/- LH +/- FSH
• May have high prolactin, low cortisol, low IGF-1/GH, low TSH and high Na

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Question 4

What are the side effects of androgen replacement?

Answer 4

• Mood issues (aggression/behavioural change)
• Libido issues
• Increased haematocrit
• Possible prostate effects
• Acne
• Sweating
• Gynaecomastia