TESTICULAR ATROPHY
TESTICULAR ATROPHY: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is it unilateral? The presence of unilateral atrophy would suggest hernia surgery, previous orchitis from mumps, gonorrhea, syphilis, tuberculosis or elephantiasis, varicocele, hydrocele, and an undescended testicle.
- Is there a history of trauma or surgery? A history of surgery would suggest that the testicular atrophy is related to hernia surgery or surgery for undescended testicle, vasectomy, or prostatectomy. History of trauma may suggest that the patient had an acute orchitis or hemorrhage from trauma.
- Is there a history of an infection? A history of infection would suggest mumps, gonorrhea, syphilis, tuberculosis, or elephantiasis.
- Is there a loss of secondary sex characteristics? These findings would suggest Klinefelter's syndrome.
- Is there an enlarged liver? The presence of an enlarged liver or other signs of hepatic dysfunction would suggest cirrhosis or hemochromatosis.
- Are there abnormal neurologic findings? The presence of abnormal neurologic findings would suggest myotonia atrophica.
DIAGNOSTIC WORKUP
Unilateral testicular atrophy usually requires no workup as long as there are no complaints of sexual infertility or impotence. A smear and culture of any urethral discharge should be done. Sometimes, prostatic massage may be necessary to obtain a good specimen.
The workup of bilateral testicular atrophy may include a serum testosterone, FSH, urine gonadotrophins, and chromosome studies to rule out Klinefelter's syndrome; liver function tests and liver biopsy to rule out cirrhosis and hemochromatosis; and EMG and muscle biopsies to rule out myotonia atrophica. A testicular biopsy may be necessary ultimately. A urologist will be consulted long before most of these tests would be performed.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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