Androgens Flashcards

1
Q

-Where is testosterone mainly synthesized? What cells?

A

-In testes and ovaries – Leydig cells

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2
Q

Hypothalamic-Pituitary-Gonadal axis

-Describe this sucker

A

1) gonadotropin-releasing hormone (GnRH) synthesized and released by hypothalamus
- pulsatile release
2) GnRH binds to gonadotropes=release of lutinizing hormone (LH) + follicle stimulating hormone
3) LH bind leydig cells–> testosterone production + secretin
- testosterone diffuses to sertoli cells=spermatogenesis
- acts on other cells via blood
4) FSH stimulates sertoli cells to produce ABP-androgen binding protein–>concentrates testosterone at the site of spermatogenesis
5) FSH stim sertoli cells to produce inhibin–>inh FSH production @ ant pit

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3
Q

Negative feedback pathways of the Hypothalamic-pit-gonadal axis:

A

1) Testosterone –> inh ant pituitary release of LH + inh GnRH release by hypothala
2) testosterone and its products converted into 5alhpa-dihydrotestosterone and estradiol –> inh ant pit release of LH
3) FSH stim sertoli cells to produce inhibin–>inh FSH production @ ant pit

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4
Q

What enzyme do LEydig cells have that is different from the adrenal cortex? What does it convert?

A
  • 17beta-hydroxysteroid dehydrogenase (17beta-HSD)

- converts androstenedione to testosterone

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5
Q

Testosterone in the blood…

A

bound to albumin (weak binding - considered bioavailable) or bound to sex hormone-binding globulin (SHBG-strong binding=not bioavailable)

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6
Q

Testosterone MOA & conversion products:

A
  • binds to intracellular androgen receptor (AR) –> inc or dec gene transcription
  • converted to 5alpa-dihydrotestosterone in prostate(DHT)= way hgiher biological activity when bound to AR then - longer t.5
  • converted to estradiol by CYP19 (aromatase-in many tissues)
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7
Q

5alpha-Dihydrotestosterone role in male vs testosterone role:

A
  • 5alpha role=dev of penis, scrotum, urethra, prostate, sebum, beard, sperm production,
  • testosterone role = epidydimis, vas deferens,
  • both do: seminal vesicles, sperm production, penis size
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8
Q

Anabolic effects of androgens:

A
  • stimulates resting metabolic rate

- inh lipid accumulation in adipocytes, stimulates lipolysis, inh differentiation of adipocyte precursors

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9
Q

Androgen effects on skeleton:

A
  • reduces bone reabsorption and enhances bone formation

- testosterone converted to estradiol = estrdiol closes epiphyseal plate (stops bone growth)

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10
Q

Androgen effects on RBC:

A

-inc erythropoietin production

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11
Q

Androgen effect on muscle:

A

inc protein synthesis and inh protein breakdown

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12
Q

Primary hypogonadism:

  • what happens?
  • causes?
A

1) problem is testicular dysf=dec in testosterone production
- loss of neg feedback=inc in circulating gonadotrophins (hypergonadotropic hypognadsm)
2) Causes: cryptorchidism(undescended testes); kleinfelters; medication (chemo)

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13
Q

Secondary hypogonadism

-what happens?

A

-problem is w/ hypothalapituitary or morbid obesity
dec is circulating gonadotrophins (hypogonadotropic hypognadsm)
-low testosterone with low LH and FSH

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14
Q

Which hypogonadism has low and which has high levels of circulating gonadotropins?

A

primary has HYPERGONADOTROPIC hypogonadism bc loss of neg feedback (testicular dysfunction)

secondary has HYPOGONADOTROPIC hypogonadism (hypothala/pit are broken)

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15
Q

relationship bw metabolic syndrome and hypogonadism:

A
  • go hand in hand (obesity+insulin resistance+ hypogonadism)

- testosterone converted to estradiol by adipose

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16
Q
  • What does adipose tissue do to testosterone?

- What effect does this have?

A
  • testosterone converted to estradiol by adipose
  • estradiol effects–> inh LH release from pit ==> reduced testosterone levels ==> less Testosterone means more adipose and its a viscious cycle
17
Q

Hypogonadism - what dec leydig cells production of testosterone?

A

insulin resistance due to adipose tissue

18
Q

Hypogonadism - what dec hypothala/pit producion of LH (and less LH = dec stimulation of leydig cells to produce testosterone)?

A

leptin, adipokines, and estradiol from adipose tissue

19
Q

As we age what happens to free testosterone?

A
decreases and associated wtih a much of conditionss
-prostate cancer
-libido
-cognition
muscle stretngth
-mood
...etc
20
Q

androgen therapeutic uses:

A
  • stimulate sexual dev + inc in height in teens
  • repleacement therapy in hypogonadal men
  • aging-maintain vitality/vigor, reduce bone loss, sexual dysf
  • osteoporosis
  • gynecological disorders
  • anabolic effects a) debilitated states-AIDS,prolonged immobilization b) athletics
21
Q

17alpha-alkylated androgen drugs? route of administration?

A
  • methyltestosterone (oral + sublingual)
  • fluoxymesterone (oral)
  • danzaol (oral)
22
Q

testosterone ester androgen drugs? route of administration?

A

(fatty acids added to testosterone)

  • testosterone enanthate (IM)
  • testosterone cypionate (IM)

-slower metabolism and longer duration

23
Q

Which androgen drug is administrated as a transdermal/topical gel?

A

testosterone itself bro

24
Q

testosterone ester androgen drugs- benefit to use?

A
  • slower metabolism and longer duration

- fatty acid attached = fat soluble = given intramuscular

25
17 alkylated androgen drugs - benefit to use?
- more anabolic effects and less androgenic effects (dont want these effects) - oral
26
Androgen therapy (abuse) - AEs (DOSE DEPENDENT):
1) musculoskeletal - premature epiphyseal closure - inc muscle and tendon injuries (cant handle inc muscle mass) 2) hepatic dysf (with 17-alkyated) - cholestatic jaundice - peliosis - carcinoma 3) lipid metabolism - dec HDL - inc LDL - inc risk for atherosclerosis and MI 4) edema- fluid retention (HTN)- Renal dysf 5) mental disturb - mood swing, aggression, depression, pschosis
27
antiandrogen- uses?
-female=hirsutism -male= precocious puberty prostatis hyperplasia/cancer alopecia contraceptive -psychosocial deviance (chemical castration)
28
GnRH analogs - the drugs? - use to treat?
- Leuprolide - Goserelin -prostate cancer
29
GnRH analogs: - compared to actual GnRH hormone? - effects? - problems?
1) inc receptor binding affinity and dec proteolysis vs regular GnRH 2) inc LH and testosterone production 3) over time get de-sensitization and down reg of GnRH receptors on pituitary - need AR receptor antagonist bc initial testosterone surge can inc (prostate)cancer growth
30
GnRH antagonist - name the drugs? - benefits to use/effects?
- Degarelix - faster onset that GnRH agonsits - no LH (testosterone) surge - reduce LH/FSH production and release - dec testosterone production --> more effective testosterone suppression
31
Degarelix is what kind of drug? | what does it do?
GnRH antagonist - faster onset that GnRH agonsits - no LH (testosterone) surge - reduce LH/FSH production and release - dec testosterone production --> more effective testosterone suppression
32
Testosterone synthesis inh drugs??
- spironolactone | - ketoconazole
33
Spironolactone - type? - used for? - MOA?
- testosterone synth inh - used to treat hirsutism - lowers androgen synth by reducing 17alpha-hydroxylase activity - competitive inh of androgen receptor (MOSTLY THIS
34
Ketoconazole - tpe? - use for? - MOA?
- anti-fungal but also testosterone synth inh - inh 17alpha-hydroxylase acitivty - not generally used to inh androgen synth bc it also inh cortisol synthesis
35
5alpha-reductase inh drugs: - name these guys - used for? - side effects?
- Finasteride - Dutasteride - reduce prostate growth in BPH - reduce baldness but at high levels reduces hair growth -impotence and gynecomastia are infrequent
36
Androgen receptor antagonists | -name the drugs
- flutamide - nilutamide - bicalutamide
37
Flutamide - type? - MOA? - TX? - AE? - use?
- androgen receptor antagonist - competitive antagonisms at androgen receptor - treats prostate cancer; prevents testosterone sruge if given prior to GnRH administration - mild gynecomastia - reversible liver tox