Androgen Deficiency in Men (core) Flashcards Preview

Hugh's MD2 Intersession 2 > Androgen Deficiency in Men (core) > Flashcards

Flashcards in Androgen Deficiency in Men (core) Deck (17)
Loading flashcards...
1

What are the contraindications of TRT?

Evidence of prostate cancer

Breast cancer

Erythrocytosis or hyperviscosity

Untreated OSA

Severe lower urinary tract symptoms (obstructive due to prostate growth)

Class III and IV HF

Desire to have a child

2

What is the normal volume of the testes?

>20mL

2

Why isn't oral testosterone used?

Metabolished in the liver 

- interacts with other drugs

- Causes derangement of LFTs

3

What are some causes of primary deficiency?

Acquired - testicular damage

- Trauma

- Toxins

- Drugs - spironolactone/ketoconazole

Congenital

- Klinefelter syndrome

- Cryptorchidism

4

What are some conditions associated with decrease SHBG?

Morbid obesity

Nephrotic kidney

Hypothyroidism

Use of glucocorticoids, progestins, and androgenic steroids

5

What are some side effects of testosterone?

Common:

Erythrocytosis

Acne and oily skin

Prostate cancer

Reduced sperm production and fertility

 

Uncommon:

Gynecomastia

Male pattern balding

Worsening of BPH symptoms

Growth of breast cancer

OSA

6

What is the advantage of testosterone gel?

Slow rise in testerone to avoid rapid pubertal effects

7

What are some causes of secondary deficiency?

Structural - tumour

- Surgery, radiation, trauma

- Infiltration - sarcoid

Genetic

- Kallmann's syndrome

Functional

- Hyperprolactinaemia

- Morbid obesity

 - Cushing

Partial/Transient

- Acute/chronic illness

7

What is the karyotype and prevalence of Klinefelter's?

XXY

1:660

8

What are some conditions associated with elevated SHBG?

Ageing 

Cirrhosis

Hyperthyroidism

Use of anticonvulsants 

HIV

10

What are some organ specific features of testosterone deficiency?

Reduced muscle mass and strength

Osteoporosis and fractures

Increased fat mass

Gynaecomastia

11

How does bone respond to testosterone?

Increase in bone mass density

12

What are some negative physiological effects of testosterone

Increased haematocrit

Increase prostate volume

13

What are the hormone levels in Klinefelter's?

Low/normal TT (total testosterone) - declines with age

LH high

14

Why does testosterone effect fertility? 

It switches off endogenous testosterone production and disrupts the FSH, LH axis - temporary or permanently

16

How does Klinefelter's present?

Low IQ

Disruptive at school

Tiny testes (pea-like)

17

What is the most effective testosterone replace therapies available?

Reandron - 4 yearly deep IM injection

Testa gel - on the forearm