Male repro

Question 1

secondary hypogonadism in male with joint aches

Answer 1

hereditary hemochromotosis

Question 2

ddx of post-pubertal secondary hypogonadism

Answer 2

pituitary macroadenoma
hyperprolactinemia
hereditary hemochromotosis
cushing syndrome
opiates
obesity

Question 3

PROP1 gene abnormalities lead to which pituitary hormone deficiencies

Answer 3

GH
TSH
LH
FSH

Question 4

causes of elevated SHBG

Answer 4

aging
liver dz
hyperthyroidism
meds (anticonvulsants, estrogen)
HIV infection

Question 5

male with signs/symptoms of hypogonadism but normal testosterone, check these lab

Answer 5

SHBG, free testosterone

Question 6

NROB1 (formerly DAX1) mutation causes which endocrine abnormalities

Answer 6

congenital hypoadrenalism – primary AI PLUS hypogonadotropic hypogonadism (x linked recessive)

Question 7

age range for PSA screening on TRT

Answer 7

55-69

Question 8

age range for high-risk prostate cancer screening

Answer 8

start at age 40

Question 9

high risk prostate cancer categories

Answer 9

African American

1st degree relative with prostate ca

Question 10

PSA levels which should prompt urology referral

Answer 10

> 4.0 ng/dL
3.0 in high risk populations
increase of > 1.4ng/mL

Question 11

avg increase in PSA on TRT

Answer 11

< 0.5 ng/dL

Question 12

rare side effect of testosterone UNDECANOATE formulation (long-acting, 10 weeks)

Answer 12

pulmonary oil microembolism

Question 13

first step after significant increase in PSA while on TRT

Answer 13

repeat PSA to confirm

Question 14

when to measure T level on androgel

Answer 14

2-8 hours after application

there is a modest serum T peak after administration

Question 15

effect of carbamazipine, phenytoin on SHBG

Answer 15

increases SHBG

Question 16

Male with normal testosterone but gynecomastia or symptoms of hypogonadism

Answer 16

check SHBG

Question 17

elevated hct in pt on TRT, even when changed to gel. doesn’t tolerate dose decrease

Answer 17

continue TRT, phlebotomy