Male Hypogonadism Lecture Powerpoint

Question 1

Clinical features of male hypogonadism

Answer 1

• Decreased spermatogenesis

- Impaired testosterone secretion

Question 2

First, third, adolescence, and adult consequences of impaired testosterone secretion

Answer 2

1st trimester - female external genitalia, partial virilization
3rd trimester - micropenis
Adolescence - incomplete puberty
Adult - energy, libido, decreased hair, loss of muscle mass, severe osteoporosis

Question 3

Kallmann’s syndrome

Answer 3

Male individuals who have lifelong hypogonadism and also have anosmia due to deficient secretion of GnRH

Question 4

Klinefelter’s syndrome

Answer 4

Genetic abnormality of two x chromosomes on a male patient resulting in infertility and hypogonadism

Question 5

Eunuchoid proportions

Answer 5

Measured when floor to pubis are measured as 2cm longer than pubis to crown of a patient indicative of male hypogonadism

Question 6

Lab tests for male hypogonadism (4)

Answer 6

• Serum total testosterone (most important test avoid when hospitalized or on steroid therapy)
• LH and FSH
• serum free testosterone (binding protein abnormality suspected)
• Prolactin levels

Question 7

Diurnal fluctuation of testosterone

Answer 7

Highest in the morning, lowest in the evening

Question 8

Testosterone low with LH and FSH high is ___ hypogonadism, while low testosterone with low FSH and LH is ___ hypogonadism

Answer 8

Primary, secondary

Question 9

Primary hypogonadism causes (4)

Answer 9

• Congenital abnormalities such as klinefelters
• Bilateral cryptorchidism (undescended testes)
• varicocele
• Infection such as mumps

Question 10

Secondary hypogonadism causes (4)

Answer 10

• Kallmann’s syndrome (deficient secretion of GnRH)
• isolated hypogonadotropic hypogonadism
• systemic illness and long term steroid treatments
• chronic opiate administration

Question 11

General principle of male hypogonadism testosterone treatment

Answer 11

Only treat those who are actually hypogonadal, goal to restore testosterone level to normal range

Question 12

Issue with oral preparations of testosterone

Answer 12

Almost impossible to maintain normal levels with them, also liver toxic due to first pass effect

Question 13

Male hypogonadism testosterone treatment options (2)

Answer 13

• Injectable Tetosterone 100mg weekly or 300 every 3 weeks (fluctuations occur)
• transdermal patch or gel

Question 14

Undesirable effects of testosterone treatment (5)

Answer 14

• acne
• gynecomastia over first few months (body converts to estrogen initially)
• physically aggressive behavior
• PSA level increases but should remain in normal range (BPH isn’t a problem)
• 2ndary polycythemia vera

Question 15

Gynecomastia

Answer 15

Benign proliferation of glandular tissue of the male breast, differs from fatty deposition in breast (pseudogynecomastia)

Question 16

Occurrence of gyneocomastia by age

Answer 16

Infancy - transient in 60-90% that regresses over 2-3 weeks from influence of mom's estrogen
Adolescence (puberty) - normal to see rise in estrogen before testosterone
Older men (50-80) - due to testosterone decrease with age

Question 17

Gynecomastia pathogenesis

Answer 17

• Decreased androgen production

- Increased estrogen production

Question 18

Drug causes of gynecomastia (4)

Answer 18

• alcohol
• tricyclic antidepressants
• amiodarone
• spironolactone

Question 19

Testicular germ cell tumor and gynecomastia indicates…

Answer 19

….poor prognosis, patient has very high hCG levels that convert androgens to estrogen via aromatase

Question 20

Gynecomastia treatment (4)

Answer 20

• most of the time self limiting
• surgery
• androgen therapy to hypogonadal
• avoidance of triggering drugs

Question 21

Testosterone variation with age

Answer 21

100 ng/dl DECREASE from age 20-80 especially in free testosterone, will see symptoms comparable to hypogonadism

Question 22

Serum testosterone level recommendation for therapy

Answer 22

• Treat if less than 200 ng/dL or free T 10% below lower normal limit AND have clinically important symptoms of androgen deficiency should be evaluated forwith LH, prolactin, etc.
• Treatment is conc. of 300-400 ng/dl in adults and 500-600 ng/dl in children

Question 23

FDA warning regarding potential harmful effects of testosterone therapy

Answer 23

-warns against increased CV risk in patients –> despite decrease in HDL has NOT been found to be true