CC May 2017 Male hypogonadism

echoecho's version from 2017-05-14 16:03


Question Answer
What does the clinical presentation of hypogonadism depend upon at which it occurs? developmental stage
Define primary hypogonadism?decreased testosterone production due to a testicular problem resulting in increased FSH and LH levels
What does prenatal hypogonadism result in?ambiguous or underdeveloped genitalia
What does childhood hypogonadism cause?delayed puberty
How do adolescents present?with persistent gynecomastia
How do young adults present?infertility or sexual dysfunction
List the characteristics of late-onset hypogonadism?1) fatigue 2) loss of muscle mass 3) depression 4)reduced vitality 5)decreased libido 6)elective dysfunction 7) osteoporosis 8) vasomotor symptoms
Define secondary hypogonadism?normal or low gonadotropins due to hypothalamic or pituitary disorders
What imaging study is recommended to evaluate the sella if testosterone levels are markedly reduced (< 150 ng/dL) or if secondary hypogonadism is suspected?CT of the head
Are abnormal physical findings required to diagnose hypogonadism, why?because changes in male secondary sex characteristics may persist for years AFTER the onset of hypogonadism
What do current guidelines recommend regarding screening asymptomatic men for testosterone deficiency?guidelines recommend AGAINST screening
*** Testosterone levels should be checked in all men with what two conditions?1) osteoporosis. 2) those men with other signs and symptoms suggestive of hypogonadism
*** Evaluation should begin with a morning level of _____ testosterone?total
*** Abnormal values should be confirmed with _____ measurement?repeat
When should measure of FREE testosterone be considered in?1) men with low-normal total testosterone 2)in medical conditions with the potential to affect levels of sex hormone binding globulin (SHBG)
Why should assays for free testosterone only be performed in reliable reference labs?because free testosterone assays are not universally available
List 5 causes that may have the potential to affect SHBG (sex hormone binding globulin) levels?1) obesity 21) chronic illness 3) diabetes 4) thyroid disorders 5) medications
*** In patients with confirmed hypogonadism on repeat measurement, what 2 levels should be obtained to differentiate between primary and secondary hypogonadism?LH, FSH
Symptomatic men with confirmed LOW testosterone levels are candidates for supplementation, however, replacement therapy is only initiated AFTER investigation of what?to establish the etiology of hypogonadism has been conducted
List causes of low testosterone levels?1) Cushing's syndrome 2)DM 3) morbid obesity 4) thyroid disease 5) renal failure 6) sickle cell disease 7) hemochromatosis 8) AIDS
List the two modalities that testosterone supplementation may be given?1) intramuscularly 2)transdermal
Prior to initiating therapy, patients should be assessed for _________ and advised of risks and benefits?contraindications
*** Testosterone therapy has historically been contraindicated in men with _____ cancer and relatively contraindicated in men with high risk of ____cancer?prostate; prostate
*** More recent studies indicate that men whose prostate cancer is _____ risk and who were treated with ____ procedures may be candidates for testosterone therapy when hypogonadism is diagnosed, with careful follow-up by their _______?1) low 2) curative 3) urologist
Is the use of testosterone therapy in men who are undergoing watchful waiting after prostate cancer diagnosis well defined?no
What is the risk of prostate CA after initiation of testosterone therapy among patients WITHOUT prostate cancer?very low
*** Some recommend that a basal ____ level be obtained and monitored periodically in men receiving testosterone supplementation?PSA
Men with what two conditions should NOT be treated with testosterone until these conditions are controlled?OSA; CHF
Comment of significant erythrocytosis (hematovcrit > 52%), can a patient receive testosterone therapy?no, it is a contraindication
Why are there a higher rate of cardiovascular events for those on testosterone?lipid levels are adversely affected
However in 2015, the American Association of Clinical Endocrinologists and the American College of Endocrinology's position statement concluded what?there is no compelling evidence that testosterone therapy either increases or decreases cardiovascular risk and calls for more definitive research
Adequate of testosterone supplementation is determined by what?measuring blood levels
Patients receiving testosterone therapy should be reevaluated periodically and treatment should be stopped in _______?nonresponders
Most symptoms respond within ____ to ____ months, although improvement in bone mineral density requires a longer duration of therapy?3; 6
*** SUMMARY = Symptoms of male hypogonadism include?fatigue, decreased libido and erectile dysfunction
*** SUMMARY = Dx is established by what?repeatedly low fasting testosterone levels
*** SUMMARY = Replacement therapy may be either what modality?IM or transdermal