Testicular Disorders Flashcards by Jennifer Watson

What hormone stimulates Leydig cells?

Sertoli cells?

FSH

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What hormone stimulates LH and FSH?

GnRH

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What is the function of follistatin?

inhibit production of activins/inhibins

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What is the function of activins?

stimulate beta-subunit FSH production

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What is the function of inhibins?

suppress FSH production

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Activins are produced in ___ and act on ___.
Inhibins are produced in ___ and act on ___.
Follistatin is produced in ___ and acts on ___.

sertoli cells; pituitary
seminiferous tubules + sertoli cells; pituitary
testes; testes (autocrine)

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Injury to seminferous tubules results in:

elevated FSH (relative to LH)

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Primary hypogondism is failure of:

yo balls (testes, sorry)

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Low Gnrh →

failed FSH and LH production

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Low LH/FSH →

failed testosterone production +/- spermatogenesis

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Leydig cells’ function:

Sertoli cells’ function:

→ T

→ spermatogenesis

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No feedback from Leydig or Sertoli cells results in:

elevated FSH/LH

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Hormone abnormalities in germinal aplasia?

↑FSH

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Hormone abnormalities in testicular failure?

↑LH + ↑FSH

↓T

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Hormone abnormalities in hypogonadotropic hypogonadism?

↓T

nml or mildly ↓LH/FSH

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Signs/symptoms of Kallman’s syndrome?

hypothalamic disease

↓T
nml LH/FSH
anosmia

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Signs/symptoms of Prader-WIlli syndrome?

hypothalamic disease

↓T
nml LH/FSH
obesity
hypotonia
micropenis
small hands/feet

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Signs/symptoms of Lawrence-Moon syndrome?

hypothalamic disease

↓T
nml LH/FSH
retinitis pigmentosa
polydactyly

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Signs/symptoms of fertile eunuch syndrome?

pituitary disease

LH deficiency

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Signs/symptoms of hyperprolactinemia?

pituitary disease

inhibited GnRH release

low libido

Signs/symptoms of hemochromatosis?

pituitary disease

loss of LH/FSH
testes abn (1' or 2' hypogonadism)

Signs/symptoms of Kleinfelters?

tall
gynecomastia
eunuchoid habitus
(MR theoretically common)
XXY

Signs/symptoms of XYY individuals?

oligo/azospermia

Signs/symptoms of Noonan’s syndrome?

phenotypically similar to Turner’s

Signs/symptoms of XX Male syndrome?

azospermia | nml height/no MR

Signs/symptoms of pre-pubertal gonadal failure?

1. delayed puberty 2. gynecomastia 3. disproportionately long arms/legs 4. related pre-pubescent symptoms (high-pitched voice, reduced male musculature, scant pubic/axillary hair, small testes + phallus + prostate)

Signs/symptoms of post-pubertal gonadal failure?

1. progressive decrease in muscle mass 2. loss of libido + impotence 3. abn bone metabolism 4. oligo/azospermia 5. menopausal-like hot flashes 6. poor ability to concentrate

Physical exam of a hypogonadal patient should include:

1. arm span to height 2. axillary + pubic hair 3. phallus and testes

Provocative testing of a hypogonadal patient may include:

1. GnRH stimulation 2. clomiphene stimulation 3. hCG stimulation (blocks estrogen to ↑GnRH)

Lab testing of a hypogonadal patient may include:

T FSH LH PRL

Highest levels of T are during...

early morning

How does T circulate in blood?

Mostly bound to sex-hormone binding globulin and albumin 2% free (available for activity)

Normal T but elevated SHBG results in:

hypogonadism

How does SHBG change with aging?

levels increase (=less free T)

Most accurate way to measure T?

equilibrium dialysis

Low SHBG may be seen in what 3 conditions?

obesity acromegaly hypothyroidism

GnRH, LH and FSH are all released in a ____ pattern.

pulsitile

LH has a (shorter/longer) t1/2 than FSH

shorter (thus single low measurements may be misleading)

Test used to measure biologic activity of FSH/LH

2-site radioimmunometric assay

What affects biologic activity of FSH/LH?

post-translational glycosylation

What hormone directly down-regulates the release of LH/FSH?

PRL

Elevated PRL directly decreases ___ independent of T

libido

Primary test to assess a male's fertility

semen analysis

To evaluate semen, it should be collected after:

2-5 days of not doin' it (or spankin' it) | *and evaluated w/in 2 h

Fertility = motility of > ___% sperm count > ____ semen vol of ___mL

50% 20 mil/mL 1.5-6

What test should be performed in a semen sample showing azospermia?

fructose none = possible obstr of ejaculatory ducts or congenital absence of ej ducts +/- vas deferens **fructose secreted by seminal vesicles

↓ or inappropriately nml LH/FSH ↓ T = hallmark of...

hypothalamic or pituitary defects

↑LH/FSH | = hallmark of...

testicular failure

Soft (but nml) testes are evident of what hormonal deficit? Firm testes are evident of what hormonal deficit?

↓ LH/FSH ↑ GnRH