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Toronto Notes 2019
Male Reproductive Endocrinology
Endocrinology E47
DEFECTS IN ANDROGEN ACTION
Etiology
• completeandrogeninsensitivity(CAIS) • partialandrogeninsensitivity(PAIS)
• 5-α-reductasedeficiency
• mixedgonadaldysgenesis
• defectsintestosteronesynthesis
• infertilemalesyndrome
• undervirilizedfertilemalesyndrome
Clinical Features
• dependsonageofonset
Table 38. Effects of Testosterone Deficiency
First Trimester in utero Third Trimester in utero Prepuberty
Postpuberty
Incomplete virilization of external genitalia (ambiguous genitalia)
Incomplete development of Wolffian ducts to form male internal genitalia (male pseudohermaphrodism)
Micropenis
Cryptorchidism (failure of normal testicular descent)
Incomplete pubertal maturation (high pitch voice, sparse pubic + axillary hair, absence of facial hair) Eunuchoidal body habitus (greater growth of extremity long bones relative to axial bones)
Poor muscle development, reduced peak bone mass
Decrease in energy, mood, and libido
Fine wrinkles in corners of mouth and eyes
Decrease in pubic/axillary hair, hematocrit, muscle mass, strength, and BMD
Adapted from: UpToDate, 2010; Cecil’s Essentials of Medicine
Treatment
• genderassignmentinthenewborn
• hormonereplacementorsupplementation
• psychologicalsupport
• gonadectomyforcryptorchidism(duetoincreasedriskfortesticularcancer) • reductionmammoplastyforgynecomastia
Erectile Dysfunction
• seeUrology,U32 Gynecomastia
Definition
• truegynecomastiareferstobenignproliferationoftheglandularcomponentofthemalebreast, resulting in the formation of a concentric, rubbery, firm mass extending from the nipple(s)
• pseudogynecomastiaorlipomastiareferstoenlargementofsoftadiposetissue,especiallyseeninobese individuals
Etiology
Physiologic
• puberty
• elderly(involutional)
• neonatal(maternalhormone)
Pathologic
• endocrinopathies:primaryorsecondaryhypogonadism,hyperthyroidism,hyperprolactinemia(causes hypogonadism), adrenal disease
• tumours:pituitary,adrenal,testicular,breast,ectopicproductionofhCG
• chronicdiseases:cirrhosis,renal,malnutrition(withrefeeding)
• drugs:estrogensandestrogenagonists,spironolactone,ketoconazole,cimetidine,digoxin,
chemotherapy, marijuana, alcohol
• congenital/genetic:Klinefelter’ssyndrome,androgeninsensitivity
• other:idiopathic(majorityofgynecomastiaisclassifiedasidiopathic),familial
Pubertal Gyencomastia
• This benign condition peaks between 13-14 years of age and spontaneously regresses in 90% of cases within 2yr
• Waiting is often the best approach
Causes of Gynecomastia
DOC TECH Drugs
Other Congenital Tumour Endocrine CHronic disease