wk 14 key Flashcards
anejaculation
- Complete loss of seminal emission
- May result from: pelvic or retroperitoneal surgery or radiation, androgen deficiency, sympathetic
denervation as a result of spinal cord injury, and/or diabetes mellitus
which is priapism a medical emergency
when ischemic
primary vs secondary causes of hypogonadism and labs
primary (at testes)
-labs: low T, high LH and FSH
-causes: Klinefelter’s syndrome, undescended testicles, mumps orchitis, cancer
treatment, normal aging
secondary (at hypothalamus or pituitary)
-labs: low T, low or normal LH and FSH
-causes: Kallman syndrome, pituitary disorders, HIV, obesity, trauma
Androgen Deficiency in Aging Male (ADAM) test
for hypogonadism; screen old men
labs for hypogonadism
morning testosterone, FSH, LH, prolactin, TSH, free T4, vitamin D,
CBC, metabolic panel
meds impacting ED
SSRIs, tobacco, antihypertensive, antipsychotic, opioids
opioids impact HPG axis and decrease T
sudden onset of ED means which causes
drug or psychogenic (unless recent urologic surgery)
ED with normal morning erections means which cause
situational ED
ED with normal erections when masturbate
psychogenic
The International Index of Erectile Function (IIEF-5)
IIEF-5 is also referred to as the Sexual Health Inventory for Men (SHIM) Questionnaire
ok
“A naturopathic doctor wants to use a validated questionnaire that allows rapid assessment of ED and which can also be used later to monitor the effectiveness of ED treatments. “
slide 31 for red flags
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labs for ED
CBC (anemia)
serum lipids (hyperlipidemia)
fasting glucose or HbA1c (diabetes)
total testosteorne
TSH (hyperthyroid)
serum prolactin (hypogonad)
if take total testosterone in ED and abnormal then do what
- If abnormal, a follow-up measurement of morning total testosterone may be considered for
men with small testes, lack of male secondary sex characteristics, significantly low libido,
or a history of inadequate response to PDE-5 inhibitors - Patients with an abnormal total testosterone should have measurement of
free testosterone and LH to determine whether hypogonadism is primary (testicular) or
secondary (hypothalamic-pituitary) in origin
If Pt dont respond to oral medications to ED inject vasoactive drugs to induce erection
Drugs used: prostaglandin E1, papaverine, phentolamine
can see if deformed or curved
if still no erection do duplex ultrasound (gold standard to look at vascular function etc)
Penile cavernosography and pudendal arteriography
distinguish arterial from venous erectile dysfunction
vascular surgery possible
biothesiometry
sensory testing; vibrate penis, hot/cold, dx textures
prognosis of ED
pscyhogenic respond to counselling
most respond to PDE-5 inhibitors; if not can use vacuum, injections etc… then prosthesis implant surgery
when to refer for ED
not respond to meds
peyronie or penile deformed
history of surgery, radiation, trauma
priapism
CVD and ED
endothelial dysfunction
narrowed arteries, less NO and vasodilation
A 45-year-old man presents with small testes, significantly low libido, and a history of inadequate response to phosphodiesterase-5 inhibitors. Initial morning total testosterone testing showed an abnormal result.
What is the most appropriate next step in the management of this patient?
Question 3 Answer
a.
Immediately arrange initiation of phosphodiesterase-5 inhibitor therapy at a higher dose
b.
Repeat morning total testosterone testing in a few months
c.
Immediately arrange testosterone replacement therapy
d.
Immediately measure bioavailable testosterone levels to confirm the diagnosis
b.
Repeat morning total testosterone testing in a few months
