Flashcards in Clinical Approach to Male Reproductive Endocrine Disorders Deck (26):
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.
BMI: 30 (obese)
- 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
What are some contributing factors to androgen deficiency (hypogonadism) in men?
- Klinefelter's or Kallmann's syndrome
- testicular injury
- pituitary tumors
- pelvic or head irradiation
Does male testosterone decrease as we age?
What symptoms will you see with low testosterone?
- decreased libido
- sexual dysfunction
- decreased muscle strength and mass
- breast discomfort or gynecomastia
- loss of body hair
- shrinking testes
- height loss
- inability to father children
- hot flashes
When should you draw testosterone levels?
- in the morning when they are highest.
What is the normal range of testosterone?
- 300-1200 mg/dL
*tightly bound to sex hormone-binding globulin
What percent of testosterone is free?
*so FREE testosterone is a VERY IMPORTANT TEST.
What will LH and FSH levels help us to distinguish?
- between primary (high LH and FSH) and secondary (low LH and FSH) gonadal failure
How will the testes look in Klinefelter's (XXY)?
- small firm testes
What is the most common cause of organic impotence (inability to achieve or to maintain a penile erection)?
How do pts with Klinefelter's present? (PICMONIC)
- mental abnormalities
- elevated LH and FSH
- chromatin-positive smear
How do we treat Klinefelter's?
- correct androgen deficiency
- treat the gynecomastia
- psychiatric care
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
Should you do a testicular biopsy in a pts with myotonic dystrophy?
*however in most cases of low testosterone, we do NOT do biopsies.
Should we treat myotonic dystrophy with androgen therapy?
What is important to know about seminiferous tubular failure?
- common cause of adult infertility
What is Noonan's syndrome?
- the male version of Turner's syndrome causing primary gonadal failure.
What are the clinical features of Noonan's syndrome?
- cubitus valgus
- short stature
- webbe neck
- low set ears
- shieldlike chest
- pulmonic stenosis
*** 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.
What is cryptorchidism?
- undescended testes
*treat with HCG or orchiopexy
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
How do we treat Kallmans?
What are the types of testosterone formulations?
- T enanthate
- scrotal patch
- nongenital transdermal system (most common)
- T gel (buccal)
- injectable in oil
- subcutaneous pellets
What are the side effects of testosterone?
- can reduce sperm count and testicular volume
- increased prostate size
- hepatotoxicity (peliosis hepatitis) with oral testosterone
What drugs can lead to gynecomastia?
- diethylstilbestrol for prostate carcinoma