Reproductive - Male Hypogonadism, Erectile Dysfunction & Gynaecomastia

Question 1

Male hypogonadism is defined as a failure of the testes to produce one (or both) of what two things?

Answer 1

Testosterone or sperm

Question 2

What are the 3 main symptoms of male hypogonadism related to androgen deficiency?

Answer 2

Poor libido, erectile dysfunction and the loss of secondary sexual hair

Question 3

What are 2 features of male hypogonadism that are not specifically related to the reproductive system?

Answer 3

Low mood and osteoporosis

Question 4

What are some secondary (i.e. hypothalamic-pituitary) causes of male hypogonadism?

Answer 4

Kallmann’s syndrome, IHH, panhypopituitarism, severe systemic illness or weight loss

Question 5

A raised level of which pituitary hormone can contribute to the development of male hypogonadism?

Answer 5

Prolactin

Question 6

What is the most common congenital cause of primary hypogonadism in males?

Answer 6

Klinefelter’s syndrome

Question 7

Which chronic diseases may result in acquired hypogonadism in males?

Answer 7

CKD and chronic liver disease

Question 8

Basal levels of what three hormones should be measured in all males with signs suggestive of hypogonadism?

Answer 8

LH, FSH and testosterone

Question 9

What therapy can be commenced to control symptoms of hypogonadism in males and to prevent long-term osteoporosis?

Answer 9

Testosterone replacement

Question 10

What condition should always be screened for before starting testosterone therapy?

Answer 10

Prostate cancer

Question 11

Testosterone replacement as a therapy for hypogonadism is of most benefit in males of what age?

Answer 11

< 50 years

Question 12

Does testosterone therapy restore fertility in males with hypogonadism?

Answer 12

No

Question 13

What is the genotype of those with Klinefelter’s syndrome?

Answer 13

47 XXY

Question 14

What is the typical phenotype of those with Klinefelter’s syndrome?

Answer 14

A tall individual with poor sexual development +/- gynaecomastia

Question 15

Some patients with Klinefelter’s syndrome will have a normal puberty but will present later in life with what?

Answer 15

Infertility

Question 16

How is a diagnosis of Klinefelter’s syndrome confirmed?

Answer 16

Karyotyping

Question 17

Is it possible to treat the infertility associated with Klinefelter’s syndrome?

Answer 17

No

Question 18

How is Klinefelter’s syndrome managed?

Answer 18

Testosterone replacement

Question 19

Azoospermia with a normal testicular size and low FSH levels suggests what?

Answer 19

Blocked vas deferens

Question 20

Congenital bilateral absence of the vas deferens is a cause of infertility in males- what condition is this usually associated with?

Answer 20

CF

Question 21

What are the 3 biggest causes of erectile dysfunction?

Answer 21

Vascular disease, smoking and diabetes

Question 22

What are some examples of common drugs which may cause erectile dysfunction?

Answer 22

Digoxin, beta blockers, diuretics, anti-depressants

Question 23

The presence of satisfactory morning erections in someone presenting with erectile dysfunction suggests what diagnosis?

Answer 23

Psychogenic ED

Question 24

What is the first line pharmacological therapy for erectile dysfunction?

Answer 24

Phosphodiesterase-V inhibitors

Question 25

What is the most common side effect of treatment of erectile dysfunction with phosphodiesterase-V inhibitors?

Answer 25

Headache

Question 26

Phosphodiesterase-V inhibitors must not be used alongside which other drug?

Answer 26

Nitrates

Question 27

What are some examples of common drugs which may cause gynaecomastia?

Answer 27

Spironolactone, oestrogens, digoxin, cannabis

Question 28

What are some endocrine conditions which may cause gynaecomastia?

Answer 28

Hyperthyroidism, hyperprolactinaemia, hypogonadism

Question 29

What are some systemic conditions which may cause gynaecomastia?

Answer 29

Chronic renal or hepatic failure

Question 30

Pubertal gynaecomastia usually resolves within what timeframe?

Answer 30

6-18 months

Question 31

If gynaecomastia is a significant problem, what are some management options?

Answer 31

Tamoxifen or surgical removal

Question 32

What is the cause for physiological gynaecomastia in older age?

Answer 32

Increased aromatase activity