Clinical Approach to Male Reproductive Endocrine Disorders Flashcards Preview

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Flashcards in Clinical Approach to Male Reproductive Endocrine Disorders Deck (26):
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

26

*** What is Reifenstein's syndrome (androgen insensitivity syndrome)?

- condition that results in the partial or complete inability to respond to androgens.
- leads to hypogonadism and gynecomastia
- phenotypically looks like a female, but is genetically a male.