This is a really weird topic, think it might depend on how the source defines primary/secondary/tertiary. Commenting to check back once I have time
@anking-maintainers not sure how secondary (AKA hypogonadotropic hypogonadism) could have increased GnRH… that doesn’t make any sense? Support the change, card is based on old Sketchy Path
I get this card wrong everytime cuz it doesnt make sense as well lol
I guess some causes of secondary may have increased GnRH if the problem is with the pituitary (low LH, FSH) instead of the hypothalamus? Because in that case GnRH would try to compensate… idk
Think the same, will need to check thoroughly
AMBOSS says secondary has decreased GnRH (which makes sense) - It doesn’t tease out different types of secondary hypogonadism that could cause increased GnRH so I think we can change this
Support update. Can add “(sometimes elevated)” to the extra if anyone knows of it ever being tested as elevated. otherwise not sure its worth the confusion
Closest I could find: UQ 1 QID 17545
Secondary hypogonadism is common in patients with pituitary masses. Potential etiologies include the following:
High prolactin levels from a prolactin-secreting adenoma (prolactinoma) can suppress secretion of GnRH, leading to decreased LH secretion and lower testosterone production
Non–prolactin-secreting tumors can disrupt the inhibitory dopaminergic regulation of prolactin secretion, leading to hyperprolactinemia and (usually mild) hypogonadism
Direct compression of gonadotrope cells with loss of LH secretion (independent of prolactin effect), which is likely in this patient with a normal prolactin level
Step 2 QID:15794
Secondary hypogonadism is a common adverse effect of opioids. Opioids suppress GnRH and LH secretion
Step 3 QID: 5826
Delayed puberty in boys is defined as lack of testicular enlargement (>4 mL) by age 14 and is due to the inadequate secretion of testosterone required for normal pubertal development. Hypogonadism may be classified as primary due to gonadal failure or, more commonly, secondary due to impaired GnRH (hypogonadotropic hypogonadism).…….Initial evaluation includes FSH, LH, and testosterone levels to differentiate between primary (elevated FSH/LH) and secondary (low to normal FSH/LH) hypogonadism
22902
Patients with unexplained secondary hypogonadism should have measurement of serum prolactin, which may be elevated due to a prolactin-secreting pituitary adenoma (prolactinoma) or disruption of inhibitory dopaminergic hypothalamic neurons. Hyperprolactinemia is a common cause of secondary hypogonadism due to the suppression of GnRH secretion.
Seems like UWorld doesn’t even want to touch on GnRH unless it’s prolactinoma.
Think we can confidently make this change now given info provided above.
Tertiary/hypothalamic hypogonadism doesn’t exist as a separate classification. This is the case for some other disorders in this system (tertiary adrenal insufficiency is due to lack of CRH) but hypogonadism is only defined as primary (at the gonad) or secondary (at the pituitary/hypothalamus)
Agree. Every single cause of secondary hypogonadism that I can find (opioid use, Kallman syndrome, pituitary adenoma, functional hypothalamic amenorrhea) seems to be decreased GnRH. The only one that has increased GnRH is non-prolactin secreting pituitary mass (e.g., craniopharyngioma) that compresses the stalk and results in low FSH/LH with compensatory increase in GnRH. We can add that to extra and move on with life.
Love it
ready to go