week 14- erectile dysfunction and hypogonadism

Question 1

erectile dysfunction causes

Answer 1

organic and psychological causes

• ED may result from neurological, vascular, hormonal, or psychological changes
• Common conditions related to ED include: diabetes mellitus, hypertension, hyperlipidemia,
  obesity, testosterone deficiency, and prostate cancer treatment.

Question 2

ED and metabolic syndrome

Answer 2

↑ fasting serum glucose levels,
diabetes, hypertension, and abdominal obesity

Question 3

most common cause of ED

Answer 3

decreased arterial flow resultant from progressive vascular
disease

Question 4

loss of libido possible causes

Answer 4

androgen deficiency and depression

Question 5

anejactulation causes

Answer 5

loss of seminal emission from pelvic or retroperitoneal surgery or radiation, androgen deficiency, sympathetic
denervation as a result of spinal cord injury, and/or diabetes mellitus

Question 6

premature ejaculation types

Answer 6

primary/lifelong and secondarhy/acquired

Question 7

retrograde ejaculation causes

Answer 7

Occurs when semen enters the bladder instead of emerging through the penis during orgasm.
* Although sexual climax reached, little or no semen emerges (“dry orgasm”)

• May result from: age-related prostate enlargement or mechanical disruption of the bladder neck due
  to congenital abnormalities, transurethral prostate surgery, pelvic radiation, sympathetic
  denervation, or treatment with alpha-blocker

Question 8

peyronie disease

Answer 8

• A fibrotic disorder of the tunica albuginea
• Results in varying degrees of penile pain, curvature, or deformity

Question 9

priapism

Answer 9

Prolonged penile erection in the absence of sexual stimulation

from improper dosing of PDE5 inhibitors

result in ischemic injury of the corpora cavernosa from venous congestion, blood coagulation
within the cavernous sinuses, and complete cessation of arterial inflow

Question 10

ischemic priapism

Answer 10

medical emergency

Question 11

CVD causing ED

coronary artery disease, PAD

Answer 11

endothelial dysfunction (non obstructive CAD) causes large blood vessels to contract instead of dilate –> decrease NO

Question 12

ED can predict

Answer 12

CAD and PAD (heart disease)

ED can come first

Question 13

men with ED and DV ents

Answer 13

44% more cardiovascular events, 62% more myocardial infarctions,
39% more strokes and a 25% increased risk of death

Question 14

diabetes and ED

Answer 14

5-24% of cases

Question 15

metbaolic syndrome and ED

Answer 15

increased fasting
serum glucose levels, diabetes, hypertension, and abdominal obesity, as well as to an increased risk of CVD

low serum testosterone

Question 16

hypogonadism and ED

Answer 16

not enough sex hormones (testosterone) and LH to make T

sx: Reduced sexual desire/decreased libido, decreased spontaneous erections, loss of hair,
declining testicular volume, hot flashes

Question 17

primary vs secondary hypogonadism

Answer 17

primary: in testes, testicular streoidogeneis insufficient
–> Klinefelter’s syndrome, undescended testicles, mumps orchitis, cancer
treatment, normal aging

secondary: in hypothalamus or pituitary
-signaling to testes from LH or GnRH is not enough from leydig cell testosterone prodcution
–>Kallman syndrome, pituitary disorders, HIV, obesity, trauma

Question 18

lab findings in primary vs secondary hypogonadism

Answer 18

primary: low testosterone, high LH and FSH

secondary: low testosterone, low or normal LH and FSH

Question 19

congenital vs acquired hypogonadism

Answer 19

congenital:
Manifestations in pre-pubertal males: ambiguous genitalia, micropenis, cryptorchidism
* Karyotype testing can help rule out conditions like Turner syndrome and Klinefelter
syndrome

acquired
–> Causes include aging, mumps orchitis, cancer treatment, and secondary factors like
obesity or trauma

Question 20

Androgen Deficiency in Aging Male (ADAM) test for hypogonadism

Answer 20

screening tool for testosterone deficiency

Questions cover reduced sexual desire, decreased spontaneous erections, loss of axillary
and pubic hair, declining testicular volume, hot flashes, and low or zero sperm count

Question 21

labs for hypogonadism

Answer 21

Laboratory tests include morning testosterone, FSH, LH, prolactin, TSH, free T4, vitamin D, CBC, metabolic panel

Question 22

Ddx for hypogonadism

Answer 22

Consider hyperprolactinemia, congenital adrenal hyperplasia, anorexia nervosa, androgen
insensitivity syndrome, etc

Question 23

LUTS and BPH and ED

Answer 23

5% of ED

Question 24

prostate cancer and ED

Answer 24

Radical prostatectomy surgery → 85% of patients can expect ED as a post-operative SE

Question 25

bike riding and ED

Answer 25

possible

Question 26

most common medications and substances to cause ED

Answer 26

SSRIs and tobacco

Question 27

medications and ED

Answer 27

antihypertensive, antidepressant, antipsychotic, and opioid agents Chronic opioid use is associated with an increased risk of hypogonadism (opioid may disrupt hypothalamic pituitary gonadal axis)

Question 28

smoking cessation and ED

Answer 28

good

Question 29

psychogenic causes of ED

Answer 29

anxiety, relationship conflicts impairing arousal situational, not consistent depressed Problems such as premature ejaculation, genital pain, or dyspareunia can lead to psychogenic ED, as can cultural or religious taboos or a history of sexual abuse

Question 30

sudden onset of ED

Answer 30

drugs or psychogenic

Question 31

meds for men with depression and EDs

Answer 31

PDE-5 inhibitors to help

Question 32

one question approach for erections

Answer 32

“Are you always, usually, sometimes, or never able to achieve and maintain a good erection?”

Question 33

medical history for ED

Answer 33

* Inquire about dyslipidemia, hypertension, depression, neurologic disease, diabetes, kidney disease, endocrine disorders, and cardiac or peripheral vascular disease * Inquire about past surgeries or injuries to the low back and groin * Specifically elicit histories of prostate cancer treatment and Peyronie disease * Evaluate for the presence of associated urinary symptoms (LUTS and BPH)

Question 34

ED and sex partner

Answer 34

* Having the sexual partner involved in the treatment process significantly improves outcomes

Question 35

The International Index of Erectile Function (IIEF-5)

Answer 35

5 questions

Question 36

physical exam for ED

Answer 36

anxiety, depress vitals (BP) BMI, waist genitals -Stretched length of the penis; Fibrosis of the penile shaft; Any abnormalities in size or consistency of either testicle. male secondary sex characterisitcs Cardiovascular exam neurological * Assessment of anal sphincter tone * Investigation of the bulbocavernosus reflex * Testing for peripheral neuropathy

Question 37

red flag symptoms in ED

Answer 37

Concurrent hip and buttock cramps with walking --> abdominal aortic aneurism Leg weakness or numbness; perineal numbness --> spinal cord compress, pelvic mass bowel and bladder incontiennce --> spinal cord compress, pelvic mass galactorrhea --> pituitary tumor abnormal secondary sex characteristics (loss of body hair, female) --> pituitary tumor visual field loss --> pituitary tumor

Question 38

lab testing for ED

Answer 38

CBC (anemia) lipids (hyperlipidemia) glucose and hba1c (diabetes) total testosterone (if abnormal do LH and free testosterone) TSH (hypothyroid) serum prolactin (hypogonad)

Question 39

pt that dont response to oral medications for ED can do injection of vasoactive meds into penis

Answer 39

* Drugs used: prostaglandin E1, papaverine, phentolamine * These drugs induce erections in men with an intact penile vascular system * Patients who respond with a rigid erection require no further vascular evaluation * Such testing also allows for visualization and measurement of penile curvature or deformity

Question 40

if cant get erection from penile injection then need complex reconstructive surgery how to test

Answer 40

Duplex Ultrasound * Gold Standard for assessing penile hemodynamics, vascular function, and anatomy assess penile vascular function and characterize normal and abnormal penile structural anatomy, including fibrosis or calcification from Peyronie disease

Question 41

Penile cavernosography and pudendal arteriography

Answer 41

Can distinguish arterial from venous erectile dysfunction * Can help predict which patients may benefit from vascular surgery. Magnetic resonance angiography may provide advanced detail of penile anatom

Question 42

biothesiometry for ED

Answer 42

sensory testing -vibrating device on penis -compare sensitivity to fingertips -assess hot and cold sensitivity

Question 43

ED treatemtn

Answer 43

oral PDE5 inhibitors or other options external vacuum devices, intraurethral prostaglandin pellets, intracavernosal injections, and combined therapy counselling if psychogenic penile prostethisis implantation surgery

Question 44

referral in ED

Answer 44

* Patients with unsatisfactory response to oral medications * Patients with Peyronie disease or other penile deformity * Patients with a history of pelvic surgery, radiation, or perineal trauma * Patients with priapism for emergent intervention to allow restoration of penile perfusion

Question 45

ED as senintel sx

Answer 45

ED represents a “sentinel symptom” in patients with occult cardiovascular and peripheral vascular disease * “sentinel symptoms” are symptoms that act as indicators and markers in a certain symptom cluster

Question 46

risk factors for ED

Answer 46

old CVD smoking DM pelvic irradiation or surgery hormones (hypogonad, hypothyroid) hypertension illicit drugs medication nerulogic (AZ, MS, pakrinsons) obesity psychological (depress, anxiety) peyronie disesae venous leakage sedentary lifesytle