Flashcards in Clinical Approach to Male Reproductive Endocrine Disorders Deck (26)
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1
59 y/o male with fatigue and ED. Has gained 7lbs in 2 months. No longer exercises. Gets headaches. Hx of HTN, T2DM, and hyperlipidemia. Takes amlodipine, metfomrin, and simvastatin.
BP: 138/82
HR: 72
RR: 16
BMI: 30 (obese)
- mono-gynecomastia
- normal prostate exam
- HbA1c= 7.2
- TSH= 1.2 (normal)
- free T4= 0.6 (low)
- cortisol= 7.1
- total testosterone= 120
- free testosterone= 2.4
- LH= 1.2 (low)
- FSH= 1.6 (low)
- prolactin= 74 (HIGH)
What should we do?
- MRI to look at the pituitary for a prolactinoma
2
What are some contributing factors to androgen deficiency (hypogonadism) in men?
- Klinefelter's or Kallmann's syndrome
- testicular injury
- mumps
- orchiectomy
- pituitary tumors
- pelvic or head irradiation
3
Does male testosterone decrease as we age?
- YES
4
What symptoms will you see with low testosterone?
- decreased libido
- sexual dysfunction
- fatigue
- decreased muscle strength and mass
- depression
- breast discomfort or gynecomastia
- loss of body hair
- shrinking testes
- height loss
- inability to father children
- hot flashes
5
When should you draw testosterone levels?
- in the morning when they are highest.
6
What is the normal range of testosterone?
- 300-1200 mg/dL
*tightly bound to sex hormone-binding globulin
7
What percent of testosterone is free?
- 2%
*so FREE testosterone is a VERY IMPORTANT TEST.
8
What will LH and FSH levels help us to distinguish?
- between primary (high LH and FSH) and secondary (low LH and FSH) gonadal failure
9
How will the testes look in Klinefelter's (XXY)?
- small firm testes
10
What is the most common cause of organic impotence (inability to achieve or to maintain a penile erection)?
- DM
11
How do pts with Klinefelter's present? (PICMONIC)
- azoospermia
- gynecomastia
- mental abnormalities
- elevated LH and FSH
- chromatin-positive smear
12
How do we treat Klinefelter's?
- correct androgen deficiency
- treat the gynecomastia
- psychiatric care
13
What is myotonic dystrophy? (PICMONIC)
- chronically progressive disease due to tri-nucleotide repeats.
- lenticular opacities (aka cataracts confined to the lens)
- small testes
- normal puberty development
- leads to gonadal failure
14
Should you do a testicular biopsy in a pts with myotonic dystrophy?
- YES
*however in most cases of low testosterone, we do NOT do biopsies.
15
Should we treat myotonic dystrophy with androgen therapy?
- NO
16
What is important to know about seminiferous tubular failure?
- common cause of adult infertility
17
What is Noonan's syndrome?
- the male version of Turner's syndrome causing primary gonadal failure.
18
What are the clinical features of Noonan's syndrome?
- cubitus valgus
- short stature
- webbe neck
- low set ears
- shieldlike chest
- ptosis
- pulmonic stenosis
19
*** What are the obesity-hypogonadism syndromes?
- Laurence-Moon-Biedl syndrom retinitis pigmentosas polydactylyl, mental retardation.
- Alstrom syndrome= retinitis pigmentosa, nerve deafness, DM, primary gonadal failure.
- Prader-Willi syndrome= hypotonia and mental retardation.
20
What is cryptorchidism?
- undescended testes
*treat with HCG or orchiopexy
21
What will you see with hypgonadotropic (Kallman's) syndrome? (PICMONIC)
- anosmia (loss of sense of smell)
- hyposmia (reduced ability to smell)
- tall stature
- caused by failure to start or complete puberty due to defective migration of GnRH releasing neurons to the hypothalamus
22
How do we treat Kallmans?
- HCG
- Testosterone
23
What are the types of testosterone formulations?
- T enanthate
- scrotal patch
- nongenital transdermal system (most common)
- T gel (buccal)
- injectable in oil
- subcutaneous pellets
24
What are the side effects of testosterone?
- can reduce sperm count and testicular volume
- aggressiveness
- gynecomastia
- increased prostate size
- hepatotoxicity (peliosis hepatitis) with oral testosterone
25
What drugs can lead to gynecomastia?
- cyclophosphamide
- melphalan
- cimetidine
- SPIRONOLACTONE
- DIGOXIN
- diethylstilbestrol for prostate carcinoma
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