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Theme 1 - 203 > Male Hypogonadism > Flashcards

Male Hypogonadism Flashcards

1
Q

Where is testosterone secreted from?

A
  • Testes
  • Ovaries
  • Adrenal glands
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2
Q

How much testosterone do males secrete daily and what proportion is secreted from the adrenal glands?

A

7mg daily

5% secreted from adrenal glands

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3
Q

What percentage of testosterone is free in the blood (not bound to protein)?

A

2%

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4
Q

How much testosterone is bound to albumin?

A

Approx 50%

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5
Q

How much testosterone is bound to SHBG?

A

44%

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6
Q

Do pre-pubertal boys and hypogonadal men have more or less SHBG than normal men?

A

More

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7
Q

Who has more SHBG between men and women

A

Women

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8
Q

What are the two anatomical regions of the testes?

A

Seminiferous tubules which synthesis inhibin B and AMH via Sertoli cells. It is also where sperm is produced.

Interstitium which contains Leydig cells that produce androgens and peritubular myoid cells (smooth muscle that surround the seminiferous tubules)

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9
Q

What does Inhibin B do?

A

Controls FSH via negative feedback

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10
Q

What does Anti-Mullerian Hormone do?

A

Prevents the development of the Mullerian ducts into the uterus (in male embryo), allowing for the development of the male reproductive system.

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11
Q

How is testosterone produced from cholesterol?

A

1) Cholesterol ——> Pregnenolone

2) Pregnenolone ———–> Progesterone or Dehydroepiandrosterone (DHEA)
Also, Progesterone ——> DHEA

3) Progesterone ——–> Testosterone
Also, DHEA ——–> Testosterone

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12
Q

What enzyme converts Testosterone into Dihydrotestosterone (DHT)?

A

5a-reductase

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13
Q

What enzyme converts Testosterone into Oestradiol?

A

Aromatase

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14
Q

How does the Hypothalamic-Pituitary-Testicular axis work?

A

1) Pulsatile release of GnRH leads to the secretion of LH and FSH (both are composed of two glycoprotein chains)
2) LH is involved in the release of testosterone
3) FSH is involved in spermatogenesis and Inhibin B secretion

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15
Q

How does testosterone act on target cells

A

Enters target cells and then gets converted into 5a-dihydrotestosterone before it binds to androgen receptors.

Alternatively, testosterone can get aromatised into oestrogens

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16
Q

What does testosterone do to lean body mass and fat mass?

A

Increases lean body mass

Decreases fat mass

17
Q

What can male hypogonadism lead to?

A

Decrease in testosterone and sperm production

18
Q

What are the two types of male hypogonadism?

A

Primary: Disease of the testes
Secondary: Disease if the hypothalamus or pituitary

19
Q

What happens in primary hypogonadism?

A

Testosterone levels are low but FSH and LH levels are normal-high

20
Q

What happens in secondary hypogonadism?

A

Testosterone levels are low but FSH and LH levels are normal-low

21
Q

What are some causes of primary hypogonadism?

A
  • Klinefelter syndrome (XXY)
  • Cryptorchidism (when one/both testes fails to descend from abdomen into scrotum)
  • Radiation
  • Trauma
  • Torsion (twisting of the spermatic cord)
22
Q

What are some causes of secondary hypogonadism?

A
  • Congenital GnRH deficiency
  • Hyperprolactinaemia
  • Opioids
  • Anorexia
  • Pituitary disorder
23
Q

What are some signs/symptoms of hypogonadism?

A
  • Eunuchoidism (incomplete sexual development, can lead to lower sex drive and less spontaneous erections)
  • Gynecomastia
  • Decrease in body hair
  • Small/shrinking body hair
  • Infertility
24
Q

How do you examine for hypogonadism?

A
  • Amount of body hair
  • Breast exam for enlargement/tenderness
  • Size and consistency of testicles
  • Size of penis
  • Arm span
25
Q

What is investigated when investigating hypogonadism?

A
  • Serum testosterone
  • LH/FSH
  • SHBG
  • Semen analysis
  • Pituitary function test
26
Q

What scan can be done to investigate for hypogonadism?

A

MRI

27
Q

What can lower SHBG levels?

A
  • Obesity
  • Nephrotic syndrome
  • Hypothyroidism
  • Glucocorticoids
28
Q

What can increase SHBG levels?

A
  • Ageing
  • Hepatic cirrhosis
  • Hyperthyroidism
  • Oestrogens
  • Anticonvulsants
  • HIV
29
Q

What can hypogonadism be treated with?

A

Testosterone

30
Q

How can testosterone be given?

A
  • Gel
  • Injection
  • Buccal
31
Q

What is gynecomastia?

A

Benign proliferation of the glandular tissue of the male breast.

32
Q

What are the two types of gynecomastia?

A

Unilateral and Bilateral

33
Q

How is gynecomastia diagnosed?

A

On examination the mass of tissue will be at least 0.5cm in diameter

34
Q

What causes gynecomastia?

A

An imbalance of androgens and oestrogens and it occurs to 60% of boys during puberty

35
Q

What illnesses/diseases can cause gynecomastia?

A
  • Cirrhosis
  • Hyperthyroidism
  • Testicular tumour
  • Leydig cell dysfunction
  • Hypogonadism

Theme 1 - 203 (6 decks)

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