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Year 2 Endocrine > Male Hypogonadism > Flashcards

Male Hypogonadism Flashcards

1
Q

Where is testosterone produced?

A

Leydig cells within the testes

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2
Q

What hormone controls testosterone production?

A

LH

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3
Q

How is the majority of the testosterone found?

A

Bound to SHBG Sex Hormone Binding Globulin
Some to albumin
0.5% is free

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4
Q

What is the active form of testosterone?

A

Dihydrotestosterone

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5
Q

What happens to dihydrotestosterone in adipose tissue?

A

Converted to oestradiol

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6
Q

What enzyme converts dihydrotestosterone to oestradiol?

A

Aromatase

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7
Q

What is the function of oestreadiol?

A

Epiphyseal fusion
Bone mass maintenance
Lipid control

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8
Q

What is primary hypogonadism?

A

Testes are affected

Spermatogenesis is more affected than testosterone

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9
Q

What is the most common primary hypogonadism?

A

Hypergonadotrophic hypogonadism

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10
Q

How does primary hypogonadism present?

A

Reduced testosterone
Increased LH and FSH
Low sperm count
Reduced testes volume

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11
Q

What is secondary hypogonadism?

A

Hypothalamus and pituitary is affected

Spermatogenesis and testosterone are both reduced

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12
Q

What is the main cause of secondary hypogonadism?

A

Hypogonadotrophic Hypogonadism

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13
Q

How does secondary hypogonadism present?

A

LH/FSH is low or inappropriately normal

Low testosterone

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14
Q

Some causes of primary hypogonadism

A 
Genetic- Klinefelters, Cryptorchidism, 
Trauma - Surgery Torsion Varicole veins
Orchitis (mumps)
Infiltrative disease 
Medications
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15
Q

What is Cryptorchidism?

A

Y chromosome micro deletions

Failure of the testes to descend

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16
Q

What is klinefelters?

A

Non inherited, non disjunction mosaic

47XXY

17
Q

Why is klinefelters difficult to diagnose, and how is it done?

A

The phenotype varies making difficult to initially diagnose.

Diagnosis is via karyotyping

18
Q

What are some clinical signs of klinefelters?

A

Poor beard growth, no frontal balding, Narrow shoulder wide hips, Breasts, Long limbs, female type pub hair, small testes.

19
Q

What is there an increased risk off with Klinefelters?

A

Learning difficulties

20
Q

What medications can cause primary hypogonadism?

A

Glucocorticoids

21
Q

Some causes of secondary hypogonadism

A 
Congenital - Kallmans, Prader-willi
Aquired - Pituitary damage, tumour etc
               -Medications
               -Acute systemic disorders
               -excessive exercise 
               -Eating disorders
22
Q

What is kallmans?

A

Isolated GnRH deficiency

23
Q

How does kallmans present?

A

Hyposmia - no sense of smell
Reg green colour blind
Cleft lip or palate

24
Q

If the onset of secondary hypogonadism occurs pre-puberty how does it present?

A

Small male sexual organs, Reduced libido
Decreased body hair, High voice, Gynaecomastia
Tall slim long arms and legs, Reduced bone and muscle mass

25
Q

If the onset of secondary hypogonadism occurs post puberty how does it present?

A

Normal skeletal muscular mass and genitals
Decreased Libido and spontaneous errections
Reduced facial and pubic hair
Reducing muscle mass, gynaecomastia
Increased lethargy

26
Q

If the patient presents with signs and symptoms of low testosterone what is the first step in diagnosing?

A

Perform semen analysis

AM testosterone levels

27
Q

Following AM testosterone levels coming back low, what should be the follow up test?

A

Repeat in 4 weeks

Measure LH and FSH aswell

28
Q

If testosterone comes back low but LH and FSH are high what is the main diagnosis?

A

Primary hypogonadism

29
Q

Following the diagnosis of primary hypogonadism what should be done?

A

Karyotyping

Iron studies

30
Q

What is incredibly important to take into consideration before administering testosterone replacement?

A

Prostate and other hormone responsive cancers will grow

NEVER administer if there is a suspicion of cancer.

31
Q

What are the main goals in the management of hypogonadism?

A

Establish or maintain puberty and sexual function

Improve fertility and physique

32
Q

What are the two main methods of administering testosterone?

A

Testogel

IM injection

33
Q

What is Testogel

A

A gel which has a fast onset and mimic circadian rhythm

Can cause irritation and must be applied using gloves if being applied by another person.

34
Q

What are the two main types of testosterone IM injection?

A

Nebido - long acting

Sustanon - 2-3 weeks

35
Q

What are the issue with using a long acting testosterone injection like Nebido?

A

If there are side affects its very difficult to withdraw from the therapy.

Year 2 Endocrine (21 decks)

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