Mksap Endocrine Reproductive Male

Front 1

Male Reproductive Physiology

Back 1

Pulsatile GnRH causes FSH release causing Setori cell spermatogenisis. LH causes Leydig cell testosterone production.

Front 2

Serum Total Testosterone Measurment

Back 2

Early morning.

Front 3

Primary Hypogonadism

Back 3

Failure of leydig cells to produce testosterone and setori cells causing oligospermia. Typicall caused kleinfelter sydnrome, chemotherapy, radiation.

Front 4

Kleinfelter Syndrome

Back 4

47XXY. Results in tall stature, fatiuge, olgoasthenospermia, testicular failure, hypogonadism.

Front 5

Secondary Hypogonadism Causes

Back 5

Congenital - Kallaman

Acquired - Exogenous testorone administration, OSA and obesity, hyperprolactinemia, chornic opiod use, glucocorticoid use, infiltrative disease.

Front 6

Testosterone Exogenous Use and Risk Factors

Back 6

CVD, VTE, Prostate cancer. Increased hemoglobin, worsened sleep apnea, decreased HDL level

Front 7

Indications for Male Hypogonadism Work up

Back 7

Specific symptoms of gynecomastia, diminished testicular volumes, abscence of morning erections.

Front 8

Work up of Male Hypogonadism

Back 8

Total testosterone early morning. Positive if 2 separate tests are low. If low testosterone than FSH, LH, TSH, Prolactin. If FSH and LH are high and testosterone low than primary hypogonadism. Karyotype testing should then be perfomed, as well as Transferrin saturation. If FSH and LH are low or normal and testosterone level low than secondary hypogonadism. Then check prolactin if elevated than pituitary MRI. If elevated transferrin saturation, ferritin hemochromotisis.

Front 9

Treatment of Male Hypogonadism

Back 9

Testosterone. Topical usually choice. Can cause virlization and early puberty in children who are exposed. Also may cause decreased spermatogensis. Should not be given to men seeking fertility.

Front 10

Testosterone Treatment Monitoring

Back 10

3 to 6 months after intiation. Follow PSA and hematocrit levels.

Front 11

Symptoms of Exogenous Anabolic steroid Use

Back 11

Excessive muscl bulk, acne, gynecomastia, decreased testicular volume. Low or noraml gonadotropin levels and low testosterone level use of on testosteron containing product (androstenedione), or recent cessation of long standing anabolic steroid use. Can result in failure to recover endogenous testosterone function.

Front 12

Male Infertility Evaluation

Back 12

Physical examination of vas deferens (if not present cystic fibrosis), testicular volume, hernia, varicocele, tumor. Sperm sample 48 to 72 hours after sex. If physical abnormal than urologist. If abnormal sperm then reproductive endocrinologist.

Front 13

Causes of Gynecomastis

Back 13

Drug.

Hypogonadism (secondary or primary)

Endocrien Disorders

Obesity and aging

Estrogen Secreting tumors

Front 14

Drugs and Gynecomastia

Back 14

Marijuana, alchol, 5 alpa reductase, H2 receptor antagonists, spironlactone, digoxin, ketoconazole, CCB, ACE inhitors, antiretroviral, SSRI

Front 15

Chronic Illnes and Gynecomastia

Back 15

Hepatic cirrhosis, CKD.

Front 16

Endocrine Disorders and Gynecomastis

Back 16

Hyperprolactinemia, acromegaly, hyperthyroidism, Cushing sydnrome.

Front 17

Obesity and Gynecomatia

Back 17

Increase aromatase acitivity.

Front 18

Estrogen Secreting Tumors

Back 18

Leydig or Sertoli tumors. Adrenal Cortical tumors.

Front 19

HCG Secreting Tumors

Back 19

Germ Cell tumors. Hepatic carcinomas.

Front 20

Unilateral Gynecomastia

Back 20

Requires mammogram to rule out breast cancer.

Front 21

Gynecomastia Work UP

Back 21

Total testerone, LH, FSH, TSH, Cr, LFT. If physical exam warrant thatn prolactin, estradiol, and HCG. Imaging warrent if abnormalites found including testular US, adrenal CT, pituritary MRI.