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23 Cards in this Set
- Front
- Back
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male hypogonadism- classified by age of onset
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1. early fetal life: ambiguos genitalia
2. late fetal life: micropenis 3. before end of puberty: eunuchoidism with span>height and lower segment > upper segment 4. Adult: not eunuchoid; loss of some features of virilization |
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MANIFESTATIONS OF ANDROGEN DEFICIENCY - PREPUBERTAL ONSET
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1. infantile genitalia
2. decreased pubic, chest and facial hair 3. scalp hair in female pattern 4. voice high-pitched 5. poor skeletal muscle development 6. oligo or azospermia 7. eunuchoidal skeleton: -span 2 inches greater than height -lower segment 2 inches greater than upper |
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MANIFESTATIONS OF ANDROGEN DEFICIENCY - POSTPUBERTAL FAILURE
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1. decreased pubic, chest and facial hair
2. normal hairline and voice 3. non-eunchoidal 4. small, often soft, testes 5. poor libido and possibly impotence 6. dec muscle strength 7. low E, dec aggressiveness |
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male hypogonadism- classified by site of defect
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-Hypergonadotropic (increased LH/FSH) - testicular defect (Klinefelter’s syndrome, mumps orchitis, testicular trauma, cancer chemotherapy or radiation therapy, etc.)
- Hypogonadotropic (low or normal LH/FSH) - pituitary or hypothalamic lesions |
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MALE HYPOGONADISM - LAB
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-serum hormones- drawn in AM
1. testosterone (total, bioavailable or free) 2. LH and FSH 3. prolactin 4. estradoil -semen analysis- may need several' vary with stress and acute illness. Collect after 2-3 days of abstinence |
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semen analysis-nml parameters
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Volume 2-6 mL
Sperm count > 20 million/mL >30% normal morphology >50% actively motile |
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MALE HYPOGONADISM FEATURES IN ADULTS
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1. loss of body and facial hair
2. fine facial wrinkles 3. decreased libido, possibly impotence 4. usually small testes 5. often gynecomastia 6. osteoporosis |
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history
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1. libido
2. potency 3. fertility 5. virilization 6. breast enlargement or tenderness 7. hx of testicular trauma or exposure to toxins |
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physical exam
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1. habitus- body proportions, eunuchoidism
2. skeletal muscle mass 3. scalp hair: temporal recession, male pattern baldness 4. facial and chest hair- note ethnic and familial differences 5. pubic and axillary hair 6. fine facial wrinkles 7. penile development 8. testicular size (nml >4cm( and consistency 9. breast tissue-palpably present in at least 30% of nml men |
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Causes of impotence
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1. Drugs: ethanol, many antihypertensives, antipsychotics, antidepressants; ?statins
2.Vascular: arterial inflow, venous leak, disease of the corpora cavernosa 3. Neurogenic: diabetes, spinal cord injury 4. Psychogenic: often selective 5. Hormonal: hyperprolactinemia; low testosterone 6. Possibly associated with sleep apnea |
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Testicular function in aging men
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-there is progressive decline in testicular function after age 50 in many nml men
-serum total test and particularly, free or bioavailable test may be low -serum LH and FSH are elevated in some pts, but are more often nml -this pathogenesis of this hypogonadism of aging is unknown |
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Klinefelter's syndrome
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-common
-XXY -long legs, small firm testes, gynecomastia -virilization variable -sexual function often nml -serum test low-nml or low -LH and FSH inc -usually azospermic -increased risk of breast ca |
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Kallmann's syndrome
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-anosmia or hyposmia due to hypoplasia of the olfactory bulbs
-hypogonadotropic hypogonadism (low LH and FSH) due to hypoplasia of GnRH-producing nuclei -associated midline defects: cleft lip or palate -Vascular: arterial inflow, venous leak, disease of the corpora cavernosa Neurogenic: diabetes, spinal cord injury Psychogenic: often selective Hormonal: hyperprolactinemia; low testosterone Possibly associated with sleep apnea |
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5alpha-REDUCTASE DEFICIENCY
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-46, XY karyotpe; testes present
-autosomal recessive inheritance -mullerian derivative absent, Wolffian derivatives present -ambiguous external genitalia; small phallus with severe hypospadias; blind vaginal pouch |
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5alpha-REDUCTASE DEFICIENCY- cont
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-nml male habitus; no gynecomastia; decreased heard and body hair; prostate not palpable
-slightly increased serum LH and test; decreased conversion of test to dihydrotestosterone -may change gender identity from female to male at puberty |
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COMPLETE ANDROGEN RESISTANCE – TESTICULAR FEMINIZATION
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-46, XY karyotype; testes present
-x-linked inheritance; androgen receptor is on the X-chromosome -mullerian derivates absent; short, blind vaginal pouch; no uterus or fallopian tubes -absent or rudimentary wolffian derivatives |
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COMPLETE ANDROGEN RESISTANCE – TESTICULAR FEMINIZATION- cont
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-nml female habitus; breast development present' absent or scanty body hair; female external genitalia
-inc serum test, LH and estradiol. Serum FSH nml or slightly elevated -androgen receptor may be absent, unstable or nml -33% of pts develop testicular tumors |
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TREATMENT OF MALE HYPOGONADISM
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-long-acting test injections
-trans-dermal test patches or gels applied to skin daily; $$ -buccal tablet applied to gums daily -gonadotropins for fertility |
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AE of test therapy
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1. erythrocytosis
2. acne 3. growth of prostate Ca, BPH 4. infertility, gynecomastia 5. growth of breast ca 6. male balding 7. worsening of sleep apnea 8. skin rxns, gum irritation 9. fluctuations in mood of libido 10. hepatic dysfunction and hyperlipidemia |
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C/I to test therapy
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1. prostate ca
2. breast ca 3. undx prostate nodule or enlargement 4. unexplained PSA elevation 5. sever BPH sx 6. hematocrit >50% 7. untx obstructive sleep apnea 8. Class III or IV CHF |
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monitoring pts receiving testosterone replacement therapy
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-yearly prostate exam
-yearly measurements of: 1. serum PSA 2. hematocrit 3. serum lipids 4. serum testosterone |
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Gonadotropin replacement for fertility:
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1. used in pts with pituitary/hypothalamic disorders
-give IM or SC of hCG and FSH several times/wk 3. costly and inconvenient; 6-12 mo of therapy may be needed to achieve adequate spermatogenesis |
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Releasing factor (GnRH) replacement
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-for pts with hypothalamic disease (Kallmans) who have responsive pituitaries
-give pulsatile infusions of GnRH, using a portable pump |
