Male Repro Flashcards
what estradiol formulations are detected in the estradiol assay?
estradiol VALERATE (long-acting form of estrogen, dissolved in oil and is metabolized in the body to estradiol) AND 17-BETA estradiol
once congenital hypogonadotropic hypogonadism is diagnosed, consider?
TARGETED GENETIC TESTING
Congenital hypogonadotropic hypogonadism:
This clinical feature is highly associated with what specific gene?
dental agenesis or digital bony abnormalities
FGF8/FGFR1
Congenital hypogonadotropic hypogonadism:
This clinical feature is highly associated with what specific gene?
hearing loss, Kallman syndrome
CHD7
Congenital hypogonadotropic hypogonadism:
This clinical feature is highly associated with what specific gene?
syndactyly
FGFR1
(“FINGERS”)
This clinical feature is highly associated with what specific gene? familial and sporadic congenital combined pituitary hormone deficiency (GH, TSH, LH, FSH)
PROP1
This clinical feature is highly associated with what specific gene?
hypogonadism
GNRHR
ingestion of a nonaromatizable androgen would cause what levels in testosterone and estradiol?
LOW testosterone and estradiol
Hyperprolactinemia leads to?
suppression of GNRH hormone
What subgroups of men are at increased risk of prostate cancer, and at what level PSA warrants a urology referral?
African American men and men with a first-degree relative with prostate cancer. Referral to a urologist is recommended if PSA is > 3.0
What is the most common adverse effect of testosterone therapy in older men?
erythrocytosis
Before initiating testosterone therapy, what should be measured?
baseline hematocrit. DO NOT start T therapy in patients with baseline hct >48% (or >50% in men living at higher altitudes). Need to investigate underlying causes of erythrocytosis first. Once T therapy is started, check hct in 3-6 months and then annually. If hct level is >54%, stop T replacement and evaluate for sleep apnea or hypoxia. Then resume T at a lower dose once hct normalizes.
acquired hypogonadotropic hypogonadism:
- normal seminal fluid volume and pH indicate?
- Men that have acquired this condition after puberty and with testes 12 ml or larger can often respond to?
- men that have acquired this condition before puberty and with tests <6 mL would need?
- nonobstructive azoospermia 2. hCG alone; typical response is within 6-12 months 3. LH (usually in the form of hCG) and FSH replacement therapy; may take 12-18 months for a response
Testosterone undecanoate 1. common side effect?
- cough and shortness of breath following the injection (due to pulmonary oil microembolism) -other symptoms include: urge to cough, dyspnea, throat tightening, chest pain, dizziness, and syncope. -must be administered in an office or hospital setting to monitor for adverse reactions for 30 minutes after the injection
Secondary hypogonadism (ITE 2020 Q33):
- All patients who are interested in fertility should first have?
- What is a prerequisite for GnRH treatment? 3. When to give hCG treatment?
- A semen analysis
- an intact pituitary gland (therefore not appropriate for a patient how has had a hypophysectomy). Give to a patient with a defect in hypothalamus. GnRH stimulates LH and FSH, which in turn stimulate the testes to make testosterone and sperm.
- For a patient without an intact pituitary/defect in the pituitary. Can give hCG alone or in combination with FSH. Patients who have congenital hypogonadotropic hypogonadism and prepubertal testes (<4 ml) need combination therapy to stimulate growth of seminiferous tubules.
