Pathophysiology: Testicular Disorders

Question 1

19 year old male with failure to enter puberty and anosmia (cant smell anything)

Answer 1

Kollman’s syndrome: no migration of nerves? Treatment: GnRH

Question 2

65 year old male with fatigue and erectile dysfunction with viral illness within 2 years. Testes normal size and firm.

Answer 2

Mumps orchitis! Tx: give T

Question 3

43 year old male with erectile dysfunction and headaches, mastodynia, bitemporal field defects, gynecomastia, normal testes but soft.

Answer 3

Prolactinoma. (vision defect) low FSH LH, high prolactin. Tx: MRI and Dopaminergics: Cabergoline, bromocriptine, T

Question 4

54 year old male with impaired memory while on testoterone therapy

Answer 4

SHBG

Question 5

What oes GnRH signal?

Answer 5

FSH from anterior pit

LH from anterior pit

Question 6

What does FSH do?

Answer 6

+ sertoli cells sperm production (testes)

Question 7

What does LH do?

Answer 7

+ leydig cells testosterone (testes)

Question 8

What does follistatin do?

Answer 8

Inhibits neighboring teste activins and inhibins

Question 9

What do activins do?

Answer 9

Sertoli cells make them, and they stimulate FSH beta subunit production

Question 10

What do inhibins do?

Answer 10

Seminiferous tubules and Sertoli cells make them, they suppress FSH secretion in the anterior pit.

Question 11

What does injucry to seminiferous tuble lead to chemically?

Answer 11

Elevated FSH, since inhbins are gone.

Question 12

Hypothalamic disorders look like what in testes/

Answer 12

Low GnRH–>low LH and FSH

Question 13

Pituitary disorders lead to what in the tests?

Answer 13

Low GnRH, low LH/FSH, low T, no spermatogenesis

Question 14

Gonadal disorders mean what?

Answer 14

Failure of testosterone production from leydig cells or spermatogenesis, no feedback leads to elevated LH and FSH

Question 15

Post gonadal disorders are caused by what?

Answer 15

No testosterone recepotr function

Question 16

Testicular failure labs?

Answer 16

FSH: High
LH: High
T: low

Question 17

Germinal aplasia labs?

Answer 17

FSH: high
LH: normal
T: normal

Question 18

Hypogonadotropic hypogonadism labs?

Answer 18

FSH: normal-low
LH: normal-low
T: Low

Question 19

Anabolic hormone labs?

Answer 19

Body builder +
FSH: 0
LH: 0

Question 20

What are testicular hypothalamic diseases?

Answer 20

*No puberty:
Kallman’s syndrome
Prader willi
Lawrence moon

Question 21

Kallman’s syndrome presentation?

Answer 21

Anosmia

Question 22

Prader Willi presentation?

Answer 22

Hyperphagia
Obesity
Hypotonia
Micropenis
Small hands
Small feet

Question 23

Lawrence moon syndrome presentation?

Answer 23

Retinitis pigmentosa

Polydactyly

Question 24

Pituitary diseases?

Answer 24

Fertile eunich syndrome: LH def.
Isolated FSH def.
Hyper prolactinemia: inhibit GnRH and libido
Hemochromatosis: loss of LH and FSH

Question 25

Marijuana effect on prolactin?

Answer 25

Decrease Dopa, increase prolactin

Question 26

Testicular disorders have high what?

Answer 26

Low T | HIGH FSH and LH due to absent feedback of T

Question 27

What are chromosomal disorders of testes?

Answer 27

Klinefelters XXY: tall, breasts, euchanoid, mar fan XYY- no sperm Noonan's syndrome (XO)-looks like turner's XX Male syndrome-normal height, no MR, azospermia

Question 28

What determines body shape in lack of androgens?

Answer 28

Prepubertal or Postpubertal

Question 29

What does pre puberty gonadal failure look like?

Answer 29

A child

Question 30

What does post puberty gonadal failure look like?

Answer 30

``` Decrease muscle mass Loss of libido Impotence No sperm Hot flashes Poor concentration ```

Question 31

When is testosterone usually highest?

Answer 31

Morning

Question 32

What is T bound to in blood?

Answer 32

Sex hormone binding globulin (SHBG)

Question 33

What percent of T is free?

Answer 33

2%

Question 34

What is the increase in SHBG in aging?

Answer 34

1% per year... this causes decline in free T

Question 35

What is the most accurate T test?

Answer 35

Equilibrium dialysis of free T

Question 36

What can cause low SHBG?

Answer 36

Hypothyroidism Acromegaly Obesity

Question 37

Is the half life of LH or FSH longer?

Answer 37

FSH is longer

Question 38

What does tonic release of FSH and LH cause? How is FSH and LH usually released?

Answer 38

``` Tonic= hypogonadism (like leupron) Pulsatile= normal ```

Question 39

What is the only tonic hormone released?

Answer 39

Prolactin

Question 40

What shuts off prolatin release?

Answer 40

Dopamine

Question 41

What does prolactin do to FSH and LH?

Answer 41

Decrease FSH and LH

Question 42

What does prolactin do to libido?

Answer 42

Decrease libido independent of T levels

Question 43

If you have a prolactin increase, think what iatrogenic?

Answer 43

DRUGS! OTC or illicit or prescription

Question 44

High prolactin does what?

Answer 44

Prevents fertility! Stress causes low dopa,increasing prolactin, cutting off libido and saving the herd from infants at a stressfull time.