t20 - hypogonadism

male primary hypogonadism

-deficient testosterone secretion by the testes

Hypergonadotropic hypogonadism

-testicular failure with high LG

-problem with the gonads

male primary hypogonadism etiology

-age

-klinefelter syndrome

-cryptorchidism

-orchitis

-radiation therapy

male primary hypogonadism sx

-delayed puberty if congenital or during childhood

-decreased libido with acquired

-erectile dysfunction, hot flashes

-depression, irritability

-infertility

-osteoporosis and fractures in chronic or untreated hypogonadism

-decreased body hair

-loss of muscle mass and weight gain

-decreased testicular size

male primary hypogonadism dx

Step 1

-free and total testosterone = low

-nonfasting in the morning

Step 2

-differentiate primary from secondary

-serum LH = high

Step 3

-karyotype for klinefelter's

-serum prolactin = normal in primary

male primary hypogonadism tx

Testosterone replacement therapy

-boys who have no yet entered puberty by age 14

-men with primary testicular failure

male secondary hypogonadism

-pituitary or hypothalamus etiology leading to inadequate GnRH secretion

Hypogonadotropic hypogonadism

-low testosterone with normal or low LH

male secondary hypogonadism etiology

-pituitary disorders: cushing, hyperprolactinemia, tumors

-illness

-prader willi, GnRH mutation

-radiation, glucocorticoids

-extremes in weight

male secondary hypogonadism sx

-decreased libido, erectile dysfunction, infertility

-fatigue, reduced muscle mass, increase body fat

-depression, mood changes

-decreased bone density, hot flashes

male secondary hypogonadism dx

Step 1

-free and total testosterone = low

-nonfasting in the morning

-repeat

Step 2

-differentiate primary from secondary

-serum LH = low

Step 3

-serum PRL: elevated if prolactinoma present

-MRI of pituitary/hypothalamus to search for lesion

male secondary hypogonadism tx

-significant weight loss

Testosterone replacement therapy

-mainstay

-indications: serum testosterone <150

-men without elevated LH and average of 2 morning serum total testosterone <275

-applied to upper arms, shoulders, abdomen

females hypogonadism

-deficient estrogen or progesterone secretion by the ovaries

Primary

-problem within ovaries themselve > decreased estrogen production

Secondary

-problem with the hypothalamus or pituitary gland > affects regulation of the ovaries and can result in reduced estrogen production

females primary hypogonadism etiology

-premature ovarian insufficiency: menopause

-surgical removal of the ovaries

-genetics: turner syndrome

female secondary hypogonadism etiology

-tumors or lesion in hypothalamus or pituitary

-medications

females hypogonadism sx

-irregular menstrual periods

-infertility

-decreased bone density

-hot flashes, vaginal dryness, mood changes

females hypogonadism dx

Step 1

-primary = elevated FSH/LH, low estrogen

-secondary = low FSH/LH, low estrogen

Step 2

-primary: karyotypes, ultrasound

-secondary: serum prolactin, MRI of pituitary/hypothalamus

females hypogonadism tx

Hormone replacement therapy with estrogen

-oral estrogen, transdermal estrogen, vaginal estrogen, injectable estrogen

-progesterone and estrogen combined for postmenopausal women to mimic natural menstrual cycle

-risk: breast cancer, CV risk, VTE. endometrial cancer, gallbladder disease, bone health