Reproductive - Male Hypogonadism, Erectile Dysfunction & Gynaecomastia Flashcards
Male hypogonadism is defined as a failure of the testes to produce one (or both) of what two things?
Testosterone or sperm
What are the 3 main symptoms of male hypogonadism related to androgen deficiency?
Poor libido, erectile dysfunction and the loss of secondary sexual hair
What are 2 features of male hypogonadism that are not specifically related to the reproductive system?
Low mood and osteoporosis
What are some secondary (i.e. hypothalamic-pituitary) causes of male hypogonadism?
Kallmann’s syndrome, IHH, panhypopituitarism, severe systemic illness or weight loss
A raised level of which pituitary hormone can contribute to the development of male hypogonadism?
Prolactin
What is the most common congenital cause of primary hypogonadism in males?
Klinefelter’s syndrome
Which chronic diseases may result in acquired hypogonadism in males?
CKD and chronic liver disease
Basal levels of what three hormones should be measured in all males with signs suggestive of hypogonadism?
LH, FSH and testosterone
What therapy can be commenced to control symptoms of hypogonadism in males and to prevent long-term osteoporosis?
Testosterone replacement
What condition should always be screened for before starting testosterone therapy?
Prostate cancer
Testosterone replacement as a therapy for hypogonadism is of most benefit in males of what age?
< 50 years
Does testosterone therapy restore fertility in males with hypogonadism?
No
What is the genotype of those with Klinefelter’s syndrome?
47 XXY
What is the typical phenotype of those with Klinefelter’s syndrome?
A tall individual with poor sexual development +/- gynaecomastia
Some patients with Klinefelter’s syndrome will have a normal puberty but will present later in life with what?
Infertility
How is a diagnosis of Klinefelter’s syndrome confirmed?
Karyotyping
Is it possible to treat the infertility associated with Klinefelter’s syndrome?
No
How is Klinefelter’s syndrome managed?
Testosterone replacement
Azoospermia with a normal testicular size and low FSH levels suggests what?
Blocked vas deferens
Congenital bilateral absence of the vas deferens is a cause of infertility in males- what condition is this usually associated with?
CF
What are the 3 biggest causes of erectile dysfunction?
Vascular disease, smoking and diabetes
What are some examples of common drugs which may cause erectile dysfunction?
Digoxin, beta blockers, diuretics, anti-depressants
The presence of satisfactory morning erections in someone presenting with erectile dysfunction suggests what diagnosis?
Psychogenic ED
What is the first line pharmacological therapy for erectile dysfunction?
Phosphodiesterase-V inhibitors
What is the most common side effect of treatment of erectile dysfunction with phosphodiesterase-V inhibitors?
Headache
Phosphodiesterase-V inhibitors must not be used alongside which other drug?
Nitrates
What are some examples of common drugs which may cause gynaecomastia?
Spironolactone, oestrogens, digoxin, cannabis
What are some endocrine conditions which may cause gynaecomastia?
Hyperthyroidism, hyperprolactinaemia, hypogonadism
What are some systemic conditions which may cause gynaecomastia?
Chronic renal or hepatic failure
Pubertal gynaecomastia usually resolves within what timeframe?
6-18 months
If gynaecomastia is a significant problem, what are some management options?
Tamoxifen or surgical removal
What is the cause for physiological gynaecomastia in older age?
Increased aromatase activity
