patho - hypogonadism Flashcards
know the hypophyseal - pituitary - testicular axis
slide 3 - he said to know it
primary hypogonadism
- congenital: Kleinfelter’s
- other: exposure to chemo, torision, orchitis, trauma
Kleinfelter’s syndrome
- 47XXY (diagnostic)
- may fail to reach puberty or may occur after puberty w/ azoospermia
secondary hypogonadism
- typically a result of insufficent GnRH by hypothalamus or deficient LH/FSH by pituitary
- congenital: Kallmann
- Acquired: iatrogenic, hyperprolactinemia, chronic opiod use, steroids, obesity, hemochromotosis, sleep apnea
Kallmann syndrome
idiopathic hypogonadotropic hypogonadism w/ anosmia
androgen deficiency in the aging male
- natural aging causes slow decrease in T production in testes
- it’s highly variable
- “low T” is a popular vernacular but be cautious, it’s actually rare
evaluation of male hypogonadism
- complete H and P
- complete sleep hx
what are the most specific sx of male hypogonadism
-lack of morning erections
-gynocomastia
-loss of testicular volume
(diagnosis based on hx is not recommended)
*Measurement of T is not advised if pt is getting morning erections
diagnosis of T deficiency
-2 early morning serum T measurements
normal T levels
300-1200 nl/dl
Lab med 240-950 (use this value for exam per Letassy)
when to do T measurements
- after several days of no strenuous activity in healthy men
- b/c illness and activity can decrease levels
what is the gold standard of testing T deficiency
Free testosterone by equilibrium dialysis
next steps after low T has been established
- investigate if its primary or secondary
- measure: LH, FHS, prolactin, and TSH
primary T deficiency
- elevated LH, FSH w/ low T
- hypergonadotropic hypogonadism
- measure ferritin to r/o hemochromatosis
secondary T deficiency
- low LH, FSH w/ low T
- hypogonadotropic hypogonadism
- perform MRI to look for hypothalmic or pituitary masses
T replacement tx
- benefits are controversial but include:
- increased energy
- increased libido
- increased bone density
most popular T preparation
- gels
- daily application - can be expensive
- use caution
- f/u at 3 and 6 months
T side effects
- acne, gynocomastia, baldness, hairy back/face
- sex drive (up or down), depression, mania
- BPH, infertility, polycythemia, HTN
gynocomastia
- smooth, firm mobile, tender disk of breast tissue behind areolas in males
- can be uni or bilateral
- common in boys going through puberty
- also present in men w/ hormonal imbalance (castration, taking estrogen)
**SEE DR. V’S DEMO ON EXAMINATION :)
other causes of gynocomastia
- meds
- steroid hormones (exogenous or Cushing’s)
- liver failure (cirrhosis)
