Hirsutism , Virilism, Gynaecomastia, Impotence
Upcoming SlideShare
Loading in...5
×
 

Like this? Share it with your network

Share

Hirsutism , Virilism, Gynaecomastia, Impotence

on

  • 2,408 views

 

Statistics

Views

Total Views
2,408
Views on SlideShare
2,405
Embed Views
3

Actions

Likes
0
Downloads
43
Comments
1

1 Embed 3

http://www.slideee.com 3

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Hirsutism , Virilism, Gynaecomastia, Impotence Presentation Transcript

  • 1. Hirsutism , Virilism, gynaecomastia, impotence
  • 2.
    • Hirsutism is common (10% of women)and usually benign .
    • It implies increased hair growth in women , in the male pattern .
    • If menstruation is normal there is almost certainly no increased testosterone production.
    • If menstruation is abdominal the cause is usually polycystic ovary syndrome.
    • (stein – Levelthl syndrome): bilateral polycystic ovaries; secondary oligomenorrhoea; infertility ; obesity, Hirsutism .
    • The cause is androgen hypersecretion.
  • 3. Tests :
    • Ultrasound ↑plasma LH:FSH ratio,
    • and less consistently,
    • ↑ testosterone and ↑ oestradiol.
    • Another cause of Hirsutism with irregular menses is late-onset congenital adrenal hyperplasia – deficiency of 21-hydroxylase enzyme in the adrenal gland. Ovarian tumours are a rare cause.
  • 4. Management :
    • operative . Explain that she is not turning into a man
    • Depilation with wax or creams, or electrolysis (which is expensive , and time-consuming, but does work).
    • 1:10 hydrogens help by increasing serum sex hormone-binding globulin – but always combine with a progesterone (= the Pill) to prevent excess risk of uterine neoplasia or cyproterone acetate ( an anti-androgen and progestogen ), eg up to 00 mg on days 1–11, with oestrogen on days 1–21.
    • Clomifene (= clomiphene) or infertility.
  • 5.
    • Virilism is rare .
    • It is characterized by amenorrhoea:
    • climoromegaly;
    • deep voice;
    • temporal hair recession; Hirsutism.
    • This condition needs further investigations for androgen secreating adrenal and ovarian tumours.
  • 6. Gynaecomastia :
    • implies an abnormal amount of breast tissue in males (it may occur in normal puberty).
    • It is due to an increase in the oesterogen/androgen ration.
    • It is seen in syndromes of androgen deficiency (eg Klinefleter’s, Kallman’s).
    • It may result from liver disease or testicular tumours (oestrogens ↑),
    • or accompany hyperthyroidism .
  • 7.
    • The commonest causes are drugs:
    • oestrogens, especially stiboestrol
    • (= diethylistible-strol);
    • spironolactone;
    • cimetidine ;
    • digoxin;
    • testosterone;
    • marijuana
  • 8. Impotence:
    • Failure in adult male to sustain adequate erection for viginal penetration .
    • It is common in old age.
    • Psychological causes are common and are more likely if impotence occurs only in some situations;
    • if there is a clear stress to account for the onset of the impotence, and if early morning erections occur (although these may persist at the onset of organic disease) .
    • Psychological causes may exacerbate organic causes.
    • The major organic cause is diabetes.
  • 9. Other organic causes are:
    • Drug causes:
    • Antihypertensives including diuretics and B –blockers),
    • major transquillizers,
    • alcohol ,
    • Oestrogens ,
    • antidepressants,
    • cimetidine.
  • 10. Pathological causes:
    • Hyperthyroidism,
    • hypepgonadism,
    • MS,
    • autonomic neuropahy,
    • atheoma,
    • bladder-neck surgery,
    • prolactin ↑,
    • cirrhosis,
    • cancer.
  • 11.
    • Tests:
          • UCEs,
          • LFT,
          • Glucose,
          • TFT;
          • LH;
          • FSH;
          • cholestrol;
  • 12.
    • testosterone (eg if libido ↓) Nocturnal tumescence studies are not usually needed if alprostadial does not induced erection, the cause is probably vasscular.
    • Doppler may show ↓ blood flow,
    • but is rarely needed as vascular reconstruction is difficult.
  • 13. Treatment:
    • Mange underlying causes.
    • Offer counseling + vacuum aids;
    • implants;
    • alprostadil, ie prostaglandin E1 (Injection or via urethra);
    • or sildenafil (Viagra), a phosphodiesterase inhibitor – increases GMP levels.
    • It is effective and administrated orally, SE; headache (16%); flushing (10%);
    • dyspepsia (7%);
    • nasal congestion (40%);
    • mild, transient.
    • Predominantly blue/green tingeing of vision (due to inhibition of isoenzyme of PDE6 in the retina or increased pulsatile choroidal flow)
  • 14. Contraindications to sildenafil (Viagra)
    • Concurrent use of nitrates
    • Hepatic impairment
    • BP > 90/50 mmHG
    • Recent stroke
    • Recent myocardial infraction
    • Bleeding disorders
    • Degenerative retinal disorders
    • Active peptic ulceration
  • 15. Other causations:
    • Peyronie’s disease
    • Risk of priapmism (sickle cell anaemia, myeloma , leukemia)
    • Concurrent complex antihypertensive régiments
    • Dyspnoea on minimal effort (sexual activity may be unsupportable)
    • There is a theoretical risk of interactions with inhibitors of cytochrome,
    • such as cimetidine.
    • Use in men with severe coronary disease has been a question, but in one careful study,
    • no adverse cardiovascular effects of were detected in men with severe coronary artery disease.
  • 16.  
  • 17.  
  • 18.  
  • 19.  
  • 20.  
  • 21.  
  • 22.  
  • 23.  
  • 24.  
  • 25.