Health Questions and Answers

Archive for May, 2008

Question: What medical therapies are available for ED?

Saturday, May 31st, 2008

Answer:

Alpha2-adrenergic receptor blocker: yohimbine (oral).
Phosphodiesterase 5 inhibitors: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis). All three are administered orally, but none should be used in combination with nitrates.
Intracavernosal injections of vasodilating medications: alprostadil (Caverject), prostaglandin E1, papaverine, phentolamine.
Transurethral alprostadil suppositories (MUSE)

Reference: Basa ALP, Afsharkharaghan H (Zollo A, ed): Endocrinology in Medical Secrets, 3rd ed. 2001.

Posted in Reproductive Endocrinology | No Comments »


Question: What are the potential treatment options for men with ED?

Friday, May 30th, 2008

Answer:

Correction of any hormonal abnormality (testosterone replacement for hypogonadism after carefully determining etiology, correction of thyroid dysfunction, maximal glycemic control in diabetes, treatment of hyperprolactinemia with dopamine agonist)
Treatment of any underlying systemic disorders, including depression (SSRIs can cause ED but may help to prevent premature ejaculation)
Mechanical devices (rings, vacuum pump device): cumbersome to some patients, [...]

Posted in Reproductive Endocrinology | No Comments »


Question: What is the most important step in the management of ED?

Thursday, May 29th, 2008

Answer:
The most important step is to reverse the underlying organic etiologies and discontinue any offending medications, if possible.
Reference: Basa ALP, Afsharkharaghan H (Zollo A, ed): Endocrinology in Medical Secrets, 3rd ed. 2001.

Posted in Reproductive Endocrinology | No Comments »


Question: Describe the typical evaluation of a patient with ED?

Wednesday, May 28th, 2008

Answer:
A typical initial evaluation includes history (with particular attention to medications), physical exam, and laboratory testing to rule out endocrine abnormalities. Start by checking TSH, prolactin, and testosterone and ruling out systemic disease with urinalysis, complete chemistry panel and blood count, and HbA1c level in patients with diabetes. Carefully review the patient’s medication list and [...]

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Question: What are the six main categories of ED?

Tuesday, May 27th, 2008

Answer:

Hormonal: hypogonadism (primary or secondary), hyperprolactinemia (with resultant hypogonadism), hyperthyroidism or hypothyroidism, and diabetes. Less common: adrenal insufficiency and Cushing’s syndrome.
Pharmacologic: long list of implicated medications: antihypertensives (clonidine, beta blockers, vasodilators, thiazide diuretics, spironolactone); antidepressants (selective serotonin reuptake inhibitors [SSRIs], tetracyclic antidepressants), antipsychotics, anxiolytics, cimetidine, phenytoin, carbamazepine, ketoconazole, metoclopramide, digoxin. Alcohol is a major culprit. [...]

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Question: Define erectile dysfunction (ED)?

Monday, May 26th, 2008

Answer:
ED is the inability to obtain and maintain an erection sufficient for sexual intercourse. ED is usually multifactorial in etiology, and most men have at least some psychogenic factors that contribute to the disorder (i.e., performance anxiety can exacerbate underlying organic etiology).
Reference: Larson PR, et al: Williams Textbook of Endocrinology, 10th ed. Philadelphia, W.B. Saunders, [...]

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Question: What are the important risk factors for cardiovascular disease?

Sunday, May 25th, 2008

Answer:

 

Age: male ≥ 45 years, female ≥ 55 years
Family history: coronary heart disease (CHD) in a male first-degree relative < 55 years or female first-degree relative < 65 years
Current cigarette smoking
Hypertension (≥ 140/90 mmHg or on antihypertensive medications)
Low HDL cholesterol: < 40 mg/dL (Note: High HDL-c is a negative risk factor; if the patient has [...]

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