Hypogonadism and Gonadal Failure
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Questions and Answers

What is the most common cause of delayed puberty?

  • Constitutional delay (correct)
  • Functional gonadotrophin deficiency
  • Structural hypothalamic/pituitary disease
  • Isolated gonadotrophin deficiency

    • What is the appropriate investigatory step for adolescents with hypergonadotrophic hypogonadism?

  • Thyroid function tests
  • Genetic testing for Hemochromatosis
  • Karyotype testing to exclude Turner and Klinefelter syndromes (correct)
  • MRI of the pituitary and hypothalamus

    • What can be estimated by X-rays of epiphyses in cases of constitutional delay?

  • Body mass index (BMI)
  • Pubertal stage
  • Chronological age
  • Bone age (correct)

    • What is the consequence of untreated isolated gonadotrophin deficiency?

    <p>Tall stature with disproportionately long arms and legs relative to trunk height</p> Signup and view all the answers

    Which factor is NOT a cause of hypogonadotrophic hypogonadism?

    <p>Chemotherapy</p> Signup and view all the answers

    What is the psychological impact of delayed puberty according to the text?

    <p>Significant psychological distress is often associated</p> Signup and view all the answers

    What do children with constitutional delay have always been small, but maintain?

    <p>A normal growth velocity appropriate for bone age</p> Signup and view all the answers

    Which condition results in a eunuchoid habitus if left untreated?

    <p>Kallmann syndrome</p> Signup and view all the answers

    At what chronological age is puberty considered to be delayed in girls in the UK?

    <p>13</p> Signup and view all the answers

    What is the major influence in determining the timing of the onset of puberty?

    <p>Genetic factors</p> Signup and view all the answers

    What acts as a trigger for normal puberty alongside genetic factors?

    <p>Body weight</p> Signup and view all the answers

    What is the key issue in determining the cause of delayed puberty?

    <p>Pathology in the hypothalamus/pituitary or gonads</p> Signup and view all the answers

    What should be carefully documented during the general history and physical examination for delayed puberty?

    <p>Parental heights</p> Signup and view all the answers

    What is the key measurement in boys to investigate hypergonadotrophic hypogonadism?

    <p>Testosterone</p> Signup and view all the answers

    What should be noted in boys during the general history and physical examination for delayed puberty?

    <p>Presence or absence of testes in the scrotum</p> Signup and view all the answers

    In girls, what should be measured to investigate hypergonadotrophic hypogonadism?

    <p>Oestradiol</p> Signup and view all the answers

    What should be performed if gonadotrophin concentrations are elevated?

    <p>Chromosome analysis</p> Signup and view all the answers

    If gonadotrophin concentrations are low, what is the differential diagnosis between?

    <p>Constitutional delay and hypogonadotrophic hypogonadism</p> Signup and view all the answers

    What is the primary treatment for inducing puberty in girls with hypogonadism?

    <p>Low doses of oral oestrogen</p> Signup and view all the answers

    In non-pregnant women, what is almost invariably a consequence of either ovarian or hypothalamic/pituitary dysfunction?

    <p>Secondary amenorrhoea</p> Signup and view all the answers

    What should be excluded in women of reproductive age by measuring urine or serum hCG?

    <p>Pregnancy</p> Signup and view all the answers

    What is the mechanism for the reduction in sex hormone-binding globulin?

    <p>Insulin secretion by cytokines</p> Signup and view all the answers

    How is male hypogonadism confirmed?

    <p>By demonstrating a low fasting 0900-hr serum testosterone level</p> Signup and view all the answers

    What should be performed in patients with hypergonadotrophic hypogonadism?

    <p>Performance of a karyotype</p> Signup and view all the answers

    What is the main concern regarding testosterone replacement therapy in older men?

    <p>It may aggravate prostatic carcinoma</p> Signup and view all the answers

    What is a potential harmful effect of androgen replacement therapy on the cardiovascular system?

    <p>Venous thrombosis</p> Signup and view all the answers

    What is the recommended age for prescribing hormone replacement therapy?

    <p>50 and above</p> Signup and view all the answers

    What do large randomized trials need to determine regarding testosterone therapy in mildly hypogonadal men?

    <p>If the benefits outweigh potentially harmful effects on the prostate and cardiovascular system</p> Signup and view all the answers

    What occurs in those rare patients with elevated androgen levels?

    <p>Ovarian tumour</p> Signup and view all the answers

    What hormonal profile suggests primary ovarian failure?

    <p>High LH and FSH with low or low-normal oestradiol</p> Signup and view all the answers

    In women with PCOS, what hormonal levels are commonly observed?

    <p>Elevated LH, prolactin, and testosterone levels with normal oestradiol</p> Signup and view all the answers

    What is the recommended treatment to test the capacity for menstruation in women with hypogonadotrophic hypogonadism?

    <p>Cyclical oestrogen and progestogen for 1 month</p> Signup and view all the answers

    What are the clinical features of both hypo- and hypergonadotrophic hypogonadism?

    <p>Gynaecomastia and delayed puberty</p> Signup and view all the answers

    What is the recommended therapy for women who have had a hysterectomy?

    <p>Oestrogen alone</p> Signup and view all the answers

    What is the purpose of cyclical hormone replacement therapy (HRT) regimens typically giving oestrogen on days 1–21 and progestogen on days 14–21 of the cycle?

    <p>To prevent osteoporotic fractures</p> Signup and view all the answers

    What is a potential concern with regard to the use of higher-dose oral or transdermal HRT?

    <p>Thrombosis</p> Signup and view all the answers

    In patients with premature menopause, when should HRT be continued?

    <p>Up to the age of around 50 years</p> Signup and view all the answers

    What are the key measurements for investigating hypergonadotrophic hypogonadism in boys and girls?

    <p>Testosterone and oestradiol</p> Signup and view all the answers

    What is the method for inducing puberty in girls with hypogonadism?

    <p>Oral oestrogen</p> Signup and view all the answers

    What is the consequence of untreated isolated gonadotrophin deficiency?

    <p>Delayed puberty</p> Signup and view all the answers

    In non-pregnant women, which condition is almost invariably a consequence of either ovarian or hypothalamic/pituitary dysfunction?

    <p>Secondary amenorrhoea</p> Signup and view all the answers

    What is defined as premature menopause?

    <p>Occurring before 40 years of age</p> Signup and view all the answers

    What is the primary cause of primary amenorrhoea in females?

    <p>Anatomical defects of the female reproductive system</p> Signup and view all the answers

    Which of the following is NOT a cause of hypogonadotrophic hypogonadism?

    <p>Anorchidism</p> Signup and view all the answers

    What is the most common form of isolated gonadotrophin deficiency?

    <p>Kallmann syndrome</p> Signup and view all the answers

    What is the consequence of untreated isolated gonadotrophin deficiency?

    <p>Tall stature with disproportionately long arms and legs</p> Signup and view all the answers

    In constitutional delay of puberty, what can be estimated by X-rays of epiphyses?

    <p>Bone age</p> Signup and view all the answers

    What is the most common cause of delayed puberty?

    <p>Constitutional delay</p> Signup and view all the answers

    What is the main concern with regard to testosterone replacement therapy in older men?

    <p>Premature fusion of the epiphyses</p> Signup and view all the answers

    What is the mechanism for the reduction in sex hormone-binding globulin?

    <p>insulin resistance</p> Signup and view all the answers

    In male hypogonadism, what distinguishes hypo- and hypergonadotrophic hypogonadism?

    <p>Random LH and FSH levels</p> Signup and view all the answers

    What should be monitored before commencing testosterone therapy in men older than 50 years?

    <p>Prostate-specific antigen (PSA) levels</p> Signup and view all the answers

    What is the recommended route of administration for testosterone replacement therapy if smooth and stable testosterone levels are desired?

    <p>Transdermal gel application</p> Signup and view all the answers

    What potential concern must be carefully weighed against the benefits of testosterone therapy in older men with mild hypogonadism associated with aging and central adiposity?

    <p>Cardiovascular health</p> Signup and view all the answers

    What consequence can testosterone replacement therapy have on spermatogenesis?

    <p>Inhibition of spermatogenesis</p> Signup and view all the answers

    What is the threshold for body weight that acts as a trigger for normal puberty?

    <p>95th percentile</p> Signup and view all the answers

    What should be carefully documented during the general history and physical examination for delayed puberty?

    <p>Body proportions</p> Signup and view all the answers

    What is the major influence in determining the timing of the onset of puberty?

    <p>Genetic factors</p> Signup and view all the answers

    What do children with constitutional delay have always been small, but maintain?

    <p>Low body weight</p> Signup and view all the answers

    What is the differential diagnosis when gonadotrophin concentrations are low?

    <p>Hypogonadotrophic hypogonadism and hypergonadotrophic hypogonadism</p> Signup and view all the answers

    What is the management for women with functional amenorrhoea due to excessive exercise and low weight?

    <p>Reducing exercise and regaining some weight</p> Signup and view all the answers

    What is the appropriate treatment for women who have had a hysterectomy?

    <p>Oestrogen replacement therapy</p> Signup and view all the answers

    What is the consequence of unopposed oestrogen treatment in women with a uterus?

    <p>Increased risk of endometrial cancer</p> Signup and view all the answers

    What is the most appropriate investigatory step for adolescents with hypergonadotrophic hypogonadism?

    <p>Performing a karyotype test</p> Signup and view all the answers

    What is the key concern regarding higher-dose oral or transdermal HRT?

    <p>Increased risk of thrombosis</p> Signup and view all the answers

    What is the typical threshold for performing investigations after a couple has failed to conceive despite unprotected intercourse?

    <p>12 months</p> Signup and view all the answers

    What method is recommended for testing ovulation in women with regular periods?

    <p>Transvaginal ultrasound</p> Signup and view all the answers

    How can ovulation be confirmed in women with regular periods?

    <p>Blood progesterone concentration on day 21 of the menstrual cycle</p> Signup and view all the answers

    How may tubal patency be examined?

    <p>Hysterosalpingography (HSG)</p> Signup and view all the answers

    What is the primary recommendation for couples experiencing infertility?

    <p>'Spontaneous' pregnancies</p> Signup and view all the answers

    'Ovarian hyperstimulation syndrome' is characterized by which of the following?

    <p>'Grossly enlarged ovaries'</p> Signup and view all the answers

    What is the success of IVF primarily dependent on?

    <p>Age</p> Signup and view all the answers

    What is the primary cause of infertility in men?

    <p>Reduced motility of sperm</p> Signup and view all the answers

    What is a potential cause of severely abnormal spermatogenesis in men?

    <p>Microdeletions of the Y chromosome</p> Signup and view all the answers

    What is an indicator of anovulatory cycles in women?

    <p>Infrequent menstrual periods</p> Signup and view all the answers

    What should be explored sensitively during the sexual history assessment?

    <p>Frequency of intercourse</p> Signup and view all the answers

    Which structural abnormality should be examined in men during clinical assessment for infertility?

    <p>Varicocele</p> Signup and view all the answers

    What is the most common cause of infertility in women?

    <p>PCOS</p> Signup and view all the answers

    What may result from anovulation or abnormalities of the reproductive tract in women?

    <p>Damaged Fallopian tubes</p> Signup and view all the answers

    What is a key factor often present when more than one factor causing subfertility is identified in couples?

    <p>No identifiable cause</p> Signup and view all the answers

    What is a potential consequence of untreated isolated gonadotrophin deficiency?

    <p>Elevated androgen levels</p> Signup and view all the answers

    What is the primary cause of gynaecomastia?

    <p>Imbalance between androgen and oestrogen activity</p> Signup and view all the answers

    What is the most common cause of gynaecomastia in older men?

    <p>Decreasing testosterone concentrations</p> Signup and view all the answers

    Which hormone excess alone does NOT cause gynaecomastia?

    <p>Prolactin</p> Signup and view all the answers

    What is the recommended investigatory step if a clinical distinction between gynaecomastia and adipose tissue cannot be made?

    <p>Ultrasonography or mammography</p> Signup and view all the answers

    What should be sought during the clinical assessment to distinguish between gynaecomastia and adipose tissue?

    <p>Palpation and examination of testes</p> Signup and view all the answers

    What is the primary influence on normal breast development in women?

    <p>Oestrogen excess</p> Signup and view all the answers

    In which group does gynaecomastia occur due to the earlier elevation of oestradiol levels compared to testosterone?

    <p>Newborn babies</p> Signup and view all the answers

    What is the most effective treatment for gynaecomastia in hypogonadal males?

    <p>Androgen replacement</p> Signup and view all the answers

    Which anti-oestrogen may be effective in reducing the size of breast tissue in gynaecomastia?

    <p>Tamoxifen</p> Signup and view all the answers

    What is the most common cause of isolated gonadotrophin deficiency?

    <p>Idiopathic</p> Signup and view all the answers

    What treatment is recommended for polycystic ovary syndrome (PCOS) to address minor elevation of androgens and mild hyperprolactinaemia?

    <p>Metformin, glitazones</p> Signup and view all the answers

    What is the key clinical feature that distinguishes congenital adrenal hyperplasia (95% 21-hydroxylase deficiency)?

    <p>Virilisation</p> Signup and view all the answers

    What is the most common cause of hirsutism in women associated with an androgen-dependent distribution of terminal hair?

    <p>Polycystic ovary syndrome (PCOS)</p> Signup and view all the answers

    What investigation finding confirms congenital adrenal hyperplasia (95% 21-hydroxylase deficiency)?

    <p>Abnormal rise in 17-OH-progesterone with ACTH</p> Signup and view all the answers

    What is the recommended treatment for androgen-secreting tumour of the ovary or adrenal cortex?

    <p>Surgical excision</p> Signup and view all the answers

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