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52 Cards in this Set
- Front
- Back
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testicular compartments
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interstitial compatment
seminiferous tubule compartment |
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interstitial compartment
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leydig cells maek testosterone
blood cells provide immune recogntion |
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seminerous tubule compartment
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contents not recognized by immune system
germ cells, sperm precursosrs & sperm sertoli cells: support & nourish sperm |
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free vs bound T
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most T (97%) circulates bound to sex hormone binding gglobulin : SHBG
assays of bound (total) T more reliable than free most actions thought to result from free hormone but some discussion abou possible role of bount T or SHBG itself |
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what increasessex hormone binding globulin
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estrogens
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what decreases SHBG
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androgens
acute illness nephrotic syndrome malnutrition |
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T-SHBG movement into tissue from blood
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5 alpha reductase forms DHT & T in cell , which o to nucleus
aromatase forms E in cells, which goes to nucleus |
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best overall screen of male reproductive system
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semen analysis for fertility
total T, LH, FSH for endocrine disease |
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earliest evens of pubery
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GnRH pulsations
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events of puberty
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history
PE: secondary sexual characteristics lab testing |
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history in puberty
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axillary sweating and body odor
growth velocity (spurt), laryngeal changes voice deepening or "breaking") |
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PE in puberty
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amount and distribution of sexually dependent hair
scrotal changes: rugae, pigmentation testicular enlargement : orchiometer or longest diameter |
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lab testing in puberty
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LH increases first at night
increasing bone age : x ray of wrist |
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precocious puberty
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events before age 9
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delayed onset of pubety
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no events by age 14
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length of puberty for males
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can continue through teen years into early twenties
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male menopause?
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total T decreases with advanced age
illness and meds: decrease T and SHBG (more common in older men) bioavailable T decreases with age even when T normal "hot flashes" only with sudden decrease T : orchiectomy |
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male hypogonadism : presentation based on timing
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prenatal: phenotypicmale = female (intersexuality)
pre puberty: eunuchoidism post pubety: findings are subtle |
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prenatal hypogonadism
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spectrum: near normal male to normal female
hypospadias; urethra opens anywhere but at end of penis cryptorchidism: failure of testicular descent failreu of scrotal fusion micropenis |
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peripubertial hypogonadism
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eunuchoidism
LS>US (more than 2 cm) female fat distribution gynecomastia decrease body hair high pitched voice decrease muscle strength no male pattern baldness female esutcheon |
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post pubertael hypogonadism
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no acne
decreased shaving freq decreased libido imotence failure of male pattern baldness fine wrinkling of skin gynecomastia less likely small testes: < 4 cm |
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primary hypogonadism
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only FSH increase
- sertoli cell/spermatogenesis compartment failure only T low and only LH high - leydig cell compartment fialure only T low and LH & FSH high - most common; fialure of boh compartments - Klinefelter's syndrome, radiation |
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Klinefelters syndrome
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eunuchoidal body habitus
variable androgenization gynecomastia decreased body hair long extremtiies small fibrotic testes genotype: XXY |
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most common endocrine cause of hypogonadism
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klinefelter's syndrome
- FSH always increased - T variably affected ; T decreased or normal - fertility rare: in mosaics only - tx: T if needed, but won't treat infertility |
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secondary hypogonadism
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pituitary tumor
T low LH, FSH, normal enlared sella |
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Kallman's syndrome
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hypothamic hypogonadism
hyposmia or anosmia: olfactorry bulbs don't develop GnRH neuron: failure of normal migration absence of pubety |
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Kallman's syndrome labs
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T low
LH & FSH "normal" LH response to nRH normal if "primed" |
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secondary hypogonadism
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T low and LH & FSH "noral
- pit or hypothalamic failure pit failure is permanent hypothalmic failure usually temporary |
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pit fialure iin secondary hypogonadism
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causes: surgery, vascular, tumor
MRI: my or may not show cause look for other hormone def |
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hypothalamic failure in secondary hypogonadism
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usually temporary
depression, stress, illness exception: kallman's syndrome, CNS tumor MRI: tumor or no olfactory bulb in Kallman's syndrome |
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untreated hypogonadism consequences
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decrease libido, infertility, imotence
sarcopenia: loss of muscle mass : falls decrease bone mass: osteoporosis ab obesity & increasse vascular dz accelerated cognitive loss |
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Tx contraindications for hypogonadism
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prostate cancer
polycythemia (increase RBC mass) severe untreated benign prostate hyperplasia sleep apnea? |
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Tx principles for hypogonadism
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determine primary (LH/FSH high) vs secondary (LH/FSH "normal) and specific cause if possible
replace unless contraindicated, temporary, with dose based on age |
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androgen replacement therapy: areas of discussion
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should u treat temporary hypogonadsm: such as with stress or depression
should dose or decision to treat depend on age? is overall risk benefit neutral, positive or negative with androgen replacement? |
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androgen replacement therapy options
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oral T: daily;
- complications: liver disease patch T: daily - skin irriation; nonadherance Gel T: daily - partner contamination T injection: 1-3 wks - greater risk of polycythemiaa "peaks & valleys" follow up required: CBC, PSA, and digital rectal exam b4 and after initiation ma change lipids, aggravate sleep apnea |
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gynecomastia definition
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abnromal breast development in men
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gynecomastia cause
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change in T/E concentration
- puberty - alcholism or other liver disease - high dose androgens or estrogens - hpogonadism - choriocarcinoma (B-hCG secreting tumor) |
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gynecomastia evaluation
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testicular exam
T, LH, FSH, quantitative B- hCG prolactin only if T low |
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many causes of infertility
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hormonal
toxins accessory gland dysfunction: prostatitis anatomic illness or fever erection or ejaculation probs absence of other fertilization factors immune: anti sperm antibodies |
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hormonal causes of infertility
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decrease T
increase E or PRL sertoli cell failure (decrease inhibin) |
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toxin that cause infertility
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radiation
insecticides chemo |
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anatomic causes of infertility
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vas deferens blocked
varicocele increase local temp |
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illness or fever that can cause infertility
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arrested spermatogenesis
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erection or ejactulation problems that cause infertility
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retrograde ejaculation
decrease NO from vascular enodthelial disease |
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infertility/hypogonadism evaluation history
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change in shaving freq
mumps orchitis radiation exposure head trauma/concussion libido recent illness new meds: opiods & glucocorticoids affect T history of pelvic survery |
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infertility/hypogonadism PE evaluation
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secondary sexual characteristics
gynecomatia testis size or mass varicocele cryptorchidism |
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infertiity/hypogonadism labs
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check t, LH, FSH, semen analysis
if T, FSH normal, but sperm # low: testis biopsy |
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infertility/ hypogonadism tx depnds on cause
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repair varicocele
stimulate spermatogensis intracytopllasmic sperm injection (ICSI) |
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impotence
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failure of erectile function
functional: stress, temporary toxins: ethanol, recreational drugs meds: sedatives, BP agents, drugs that cause increase prolactin endocrine: hypogonadism, increase prolactin nervous system: diabtes, pelvic surgery, prostatectomy vascular: decreaes NO with endothelial dysufnction, peripheral vascular disease, pelvic surgery |
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Tx of ED
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treat cause:::: remove med, treat hypogonadism, quit smoking, treat CV riskk factors
pharmacologic approaches mechanical approaches |
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pharm approaches to ED
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Sildenafil pill : Viagra: increase NO for < 24 hr
Vardenafill pill: Levitra: increase NO for < 24 hr Tadalafil : Cialis: increase NO for 36 hr Prostaglandins: alprostad; intraurethral or intrapneile |
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mechanical approaches to ED
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vacuum pump
rigid or inflatable penle implant |
