This document discusses abnormalities in the process of sexual maturation, including precocious puberty, delayed puberty, and disynchronus puberty. It defines and describes the types of precocious puberty, including central precocious puberty which is GnRH dependent and follows a normal pattern of changes. Peripheral precocious puberty is GnRH independent and can be caused by tumors or functional cysts secreting sex hormones. The document also discusses the evaluation, causes, and treatment of patients presenting with sexual precocity.
Precocious puberty is defined as the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. It can be classified as central (gonadotropin-dependent) or peripheral (gonadotropin-independent) puberty. Central puberty is treated with GnRH agonists to slow progression, while peripheral causes like tumors require treatment of the underlying condition. Evaluation involves assessing pubertal development, growth, bone age, and hormone levels to distinguish central from peripheral puberty and identify any lesions.
Precocious puberty can be caused by central or peripheral conditions. Central precocious puberty is gonadotropin dependent and caused by organic brain lesions or idiopathically. Peripheral precocious puberty is gonadotropin independent and caused by conditions like McCune-Albright syndrome or adrenal tumors. Hypothyroidism can also cause precocious puberty by elevating TSH levels and interacting with FSH receptors. Evaluation involves assessing pubertal progression, growth, hormonal levels, and imaging. Treatment depends on the underlying cause, and may involve surgery, medication like GnRH agonists, or treating the primary condition in cases of hypothyroidism.
The document discusses various topics related to female reproductive health including:
1. It defines amenorrhea as the absence of menstruation and describes its different types and causes. Diagnosis involves taking a history, doing an examination, and running investigations.
2. Oligomenorrhea is defined as infrequent or light menstruation. It has various causes including stress, chronic illness, and eating disorders.
3. Dysmenorrhea is defined as painful menstruation. It can be primary or secondary and has various causes and treatments.
4. Menorrhagia is defined as blood loss greater than 80ml per period. It has various causes like fibroids and treatments including
1. The document discusses various causes of amenorrhea including hypothalamic, pituitary, ovarian, and outflow tract issues.
2. Evaluation involves assessing secondary sex characteristics, symptoms, family history, and targeted medical tests.
3. Treatment focuses on identifying and managing underlying disorders, hormone replacement, and addressing risks like osteoporosis or infertility.
This document discusses precocious puberty, including central precocious puberty and peripheral precocious puberty. Central precocious puberty is the early activation of the hypothalamic-pituitary-gonadal axis, leading to the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. Peripheral precocious puberty is caused by external sex hormones and may be isosexual or heterosexual. McCune-Albright syndrome is a rare cause of peripheral precocious puberty associated with patchy skin pigmentation and fibrous dysplasia. Treatment for central precocious puberty involves suppressing puberty with GnRH agonists to help increase adult height potential.
This document describes four case scenarios involving patients presenting with various endocrine-related symptoms. The first case involves a 17-year-old boy with gynecomastia and absence of secondary sex characteristics. The second case involves a 16-year-old girl with delayed menarche and short stature. The third case involves a 30-year-old woman with spontaneous milk discharge and infertility. The fourth case involves a 32-year-old man with headaches, vision issues, fatigue, and erectile dysfunction. The document then provides background information on conditions like hyperprolactinemia, prolactinomas, Cushing's syndrome, MEN type 1 and 2 syndromes, and their typical clinical presentations, evaluations
This document discusses abnormalities in the process of sexual maturation, including precocious puberty, delayed puberty, and disynchronus puberty. It defines and describes the types of precocious puberty, including central precocious puberty which is GnRH dependent and follows a normal pattern of changes. Peripheral precocious puberty is GnRH independent and can be caused by tumors or functional cysts secreting sex hormones. The document also discusses the evaluation, causes, and treatment of patients presenting with sexual precocity.
Precocious puberty is defined as the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. It can be classified as central (gonadotropin-dependent) or peripheral (gonadotropin-independent) puberty. Central puberty is treated with GnRH agonists to slow progression, while peripheral causes like tumors require treatment of the underlying condition. Evaluation involves assessing pubertal development, growth, bone age, and hormone levels to distinguish central from peripheral puberty and identify any lesions.
Precocious puberty can be caused by central or peripheral conditions. Central precocious puberty is gonadotropin dependent and caused by organic brain lesions or idiopathically. Peripheral precocious puberty is gonadotropin independent and caused by conditions like McCune-Albright syndrome or adrenal tumors. Hypothyroidism can also cause precocious puberty by elevating TSH levels and interacting with FSH receptors. Evaluation involves assessing pubertal progression, growth, hormonal levels, and imaging. Treatment depends on the underlying cause, and may involve surgery, medication like GnRH agonists, or treating the primary condition in cases of hypothyroidism.
The document discusses various topics related to female reproductive health including:
1. It defines amenorrhea as the absence of menstruation and describes its different types and causes. Diagnosis involves taking a history, doing an examination, and running investigations.
2. Oligomenorrhea is defined as infrequent or light menstruation. It has various causes including stress, chronic illness, and eating disorders.
3. Dysmenorrhea is defined as painful menstruation. It can be primary or secondary and has various causes and treatments.
4. Menorrhagia is defined as blood loss greater than 80ml per period. It has various causes like fibroids and treatments including
1. The document discusses various causes of amenorrhea including hypothalamic, pituitary, ovarian, and outflow tract issues.
2. Evaluation involves assessing secondary sex characteristics, symptoms, family history, and targeted medical tests.
3. Treatment focuses on identifying and managing underlying disorders, hormone replacement, and addressing risks like osteoporosis or infertility.
This document discusses precocious puberty, including central precocious puberty and peripheral precocious puberty. Central precocious puberty is the early activation of the hypothalamic-pituitary-gonadal axis, leading to the onset of secondary sexual characteristics before age 8 in girls and 9 in boys. Peripheral precocious puberty is caused by external sex hormones and may be isosexual or heterosexual. McCune-Albright syndrome is a rare cause of peripheral precocious puberty associated with patchy skin pigmentation and fibrous dysplasia. Treatment for central precocious puberty involves suppressing puberty with GnRH agonists to help increase adult height potential.
This document describes four case scenarios involving patients presenting with various endocrine-related symptoms. The first case involves a 17-year-old boy with gynecomastia and absence of secondary sex characteristics. The second case involves a 16-year-old girl with delayed menarche and short stature. The third case involves a 30-year-old woman with spontaneous milk discharge and infertility. The fourth case involves a 32-year-old man with headaches, vision issues, fatigue, and erectile dysfunction. The document then provides background information on conditions like hyperprolactinemia, prolactinomas, Cushing's syndrome, MEN type 1 and 2 syndromes, and their typical clinical presentations, evaluations
1) Precocious puberty is defined as the onset of secondary sexual characteristics before 8 years of age in girls and 9 years in boys.
2) Precocious puberty can be classified as gonadotropin-dependent (GDPP) or gonadotropin-independent (GIPP). GDPP is caused by early activation of the hypothalamic-pituitary-gonadal axis while GIPP is caused by excess sex hormone secretion from other sources.
3) Evaluation and management depends on determining if the cause is central or peripheral. Brain imaging is important to identify potential lesions for GDPP. GnRH agonists are the primary treatment for GDPP while treatment for
Disorders of pubertal development can involve delayed, premature, or arrested puberty. The document discusses the normal physiology of puberty and various conditions that cause abnormalities in pubertal development, including central precocious puberty, peripheral precocious puberty, premature adrenarche, constitutional delay of growth and puberty, and pubertal arrest. Evaluation and management of disorders of pubertal development involves assessment of signs of puberty, auxiliary investigations, and potential treatments depending on the underlying cause.
This document discusses precocious puberty, which is the early onset of sexual maturation before age 8-9. It classifies types as true (GnRH-dependent) or pseudo (GnRH-independent) precocity. True precocity is usually idiopathic and can be caused by brain lesions or hypothyroidism. Pseudo precocity has causes like ovarian cysts. Evaluation involves physical exams, blood tests, and imaging. Treatment depends on type but may include GnRH analogs. Supporting emotional health for those with precocious puberty is important.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
This clinical document summarizes guidelines for evaluating and managing amenorrhea. It presents a case study of a patient with primary amenorrhea and pseudohermaphroditism. It then provides definitions of primary and secondary amenorrhea and outlines an approach for diagnosis involving history, physical exam, ultrasound, and laboratory tests. Common causes of amenorrhea are identified and diagnostic and management guidelines are presented.
The document discusses precocious puberty in girls. It defines precocious puberty as the development of secondary sex characteristics before age 8 or menstruation before age 10. Precocious puberty can be caused by premature activation of the hypothalamic-pituitary-ovarian axis or peripheral conditions. Evaluation involves medical history, physical exam, blood tests, and imaging to determine the cause. Treatment options depend on the underlying etiology but may include GnRH agonists to suppress early puberty or other therapies specific to conditions like tumors. With appropriate treatment, prognosis is generally good.
Precocious puberty refers to the early onset of sexual maturation before 8 years in girls and 9 years in boys. It can be classified as true precocious puberty, which is GnRH-dependent, or pseudoprecocious puberty, which is GnRH-independent. Evaluation involves physical exam, lab tests, imaging and bone age assessment. Treatment depends on the type but may include GnRH analogues to suppress early puberty.
Delayed Puberty Topics in Adolescent Gynecology Delayed Puberty Topics in A...MedicineAndHealth14
This document discusses delayed puberty in adolescent girls. It begins by outlining normal pubertal development and defining delayed puberty. Delayed puberty is then classified into three categories: hypergonadotropic hypogonadism (43%), hypogonadotropic hypogonadism (31%), and eugonadism (26%). For evaluation and management, the document recommends obtaining a history, physical exam, initial labs (TSH, prolactin), and a progestational challenge to determine gonadotropin levels and identify underlying causes. Treatment strategies aim to correct the underlying pathology, prevent disease complications, and provide sex steroids.
Disorder of Sex Differentiattion ( ambiguos genitelia )Dr Anand Singh
Disorders of sex development (DSD) occur when the development of chromosomal, gonadal, or anatomical sex is atypical. Evaluation of DSD involves a physical exam, karyotype testing, hormone level testing, and imaging exams. Diagnosis is made based on gonadal status and further tests can include hormone stimulation tests, biopsy of gonads, and genetic analysis. Treatment is determined based on diagnosis and may include surgery and hormone replacement therapy.
Hypothyroidism and thyroid screening can be caused by primary or secondary issues. Neonatal screening uses dried blood samples to test TSH levels to detect congenital hypothyroidism. TSH is the most sensitive indicator for primary hypothyroidism. Precocious and delayed puberty can have various causes like tumors, infections, or genetic defects. Puberty is evaluated based on physical signs, lab tests, and sexual maturity ratings which characterize development. Treatment depends on the underlying cause and aims to initiate normal development.
Amenorrhea is the absence of menstrual periods. Primary amenorrhea refers to the absence of periods by age 14 with no secondary sex changes, or by age 16 regardless of sex changes. Secondary amenorrhea is the absence of periods for 3 or more cycles or 6 months in women with previous regular cycles. Common causes include pregnancy, hypothalamic or pituitary disorders, PCOS, and eating disorders like anorexia nervosa. Workup involves medical history, physical exam, and lab tests of hormones and imaging to determine the underlying cause and guide treatment.
This document discusses abnormalities of the external genitalia in pediatric patients, including hypospadias, cryptorchidism, micropenis, intersex conditions, hernias and hydroceles, testicular torsion, and varicoceles. It covers the etiology, evaluation, classification, management, and complications of these conditions.
The document discusses infertility, its causes and treatments. It defines infertility as the inability to conceive after one year of regular unprotected sex. Approximately 10-15% of couples experience infertility, with female factors accounting for 60% of cases, male factors 30% and both male and female factors in 10% of cases. Common female causes include problems with ovulation, fallopian tubes or cervical factors. Common male causes include abnormal sperm production or function. Treatments aim to address the specific cause, and may include ovulation induction medications, surgery, assisted reproduction technologies like IUI or IVF.
Polycystic Ovarian Disease & Hyperandrogenism Evidence Based Update on Di...Lifecare Centre
This document provides an overview of polycystic ovarian disease (PCOD) and hyperandrogenism. It discusses the prevalence of PCOD, risk factors like insulin resistance, and the etiology involving high levels of estrogen, androgens, LH and insulin. The document outlines the diagnostic criteria according to the Androgen Excess and PCOS Society, including signs of hyperandrogenism, ovarian dysfunction, and exclusion of related disorders. It emphasizes the importance of screening for conditions like congenital adrenal hyperplasia. The document also discusses the metabolic consequences of PCOD and recommendations for screening for metabolic syndrome.
Screening for any disorder in individuals is a strategy used for identifying a disease before the onset of signs or symptoms, thus enabling earlier detection and management with the aim to reduce morbidity and mortality.
This document discusses precocious puberty, including its definition, types, epidemiology, evaluation, and treatment. Precocious puberty is defined as the onset of puberty before age 8 in girls and age 9 in boys. It can be central, originating from the brain, or peripheral, originating from the gonads or adrenal glands. Evaluation involves medical history, physical exam, labs, imaging, and bone age assessment. Treatment is aimed at delaying further pubertal progression using GnRH analogs.
L6-8.Disorders of the reproductive system.pptxDr Bilal Natiq
In the male, the testis serves two principal functions: synthesis of testosterone by the interstitial Leydig cells under the control of luteinising hormone (LH), and spermatogenesis by Sertoli cells under the control of follicle-stimulating hormone (FSH) (but also requiring adequate testosterone).
This document discusses the approach to evaluating ambiguous genitalia in infants. It begins by describing normal sexual development and the causes of disorders of sexual differentiation. For 46XX infants, the evaluation involves examining for palpable gonads, karyotyping, and hormonal testing to diagnose conditions like congenital adrenal hyperplasia. For 46XY infants, karyotyping and HCG stimulation testing are used to diagnose conditions like partial androgen insensitivity or 5-alpha reductase deficiency. The case presentation demonstrates applying this approach to diagnose a patient with 5-alpha reductase deficiency based on physical exam, karyotyping, and hormonal response to HCG.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
1) Precocious puberty is defined as the onset of secondary sexual characteristics before 8 years of age in girls and 9 years in boys.
2) Precocious puberty can be classified as gonadotropin-dependent (GDPP) or gonadotropin-independent (GIPP). GDPP is caused by early activation of the hypothalamic-pituitary-gonadal axis while GIPP is caused by excess sex hormone secretion from other sources.
3) Evaluation and management depends on determining if the cause is central or peripheral. Brain imaging is important to identify potential lesions for GDPP. GnRH agonists are the primary treatment for GDPP while treatment for
Disorders of pubertal development can involve delayed, premature, or arrested puberty. The document discusses the normal physiology of puberty and various conditions that cause abnormalities in pubertal development, including central precocious puberty, peripheral precocious puberty, premature adrenarche, constitutional delay of growth and puberty, and pubertal arrest. Evaluation and management of disorders of pubertal development involves assessment of signs of puberty, auxiliary investigations, and potential treatments depending on the underlying cause.
This document discusses precocious puberty, which is the early onset of sexual maturation before age 8-9. It classifies types as true (GnRH-dependent) or pseudo (GnRH-independent) precocity. True precocity is usually idiopathic and can be caused by brain lesions or hypothyroidism. Pseudo precocity has causes like ovarian cysts. Evaluation involves physical exams, blood tests, and imaging. Treatment depends on type but may include GnRH analogs. Supporting emotional health for those with precocious puberty is important.
precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks
This clinical document summarizes guidelines for evaluating and managing amenorrhea. It presents a case study of a patient with primary amenorrhea and pseudohermaphroditism. It then provides definitions of primary and secondary amenorrhea and outlines an approach for diagnosis involving history, physical exam, ultrasound, and laboratory tests. Common causes of amenorrhea are identified and diagnostic and management guidelines are presented.
The document discusses precocious puberty in girls. It defines precocious puberty as the development of secondary sex characteristics before age 8 or menstruation before age 10. Precocious puberty can be caused by premature activation of the hypothalamic-pituitary-ovarian axis or peripheral conditions. Evaluation involves medical history, physical exam, blood tests, and imaging to determine the cause. Treatment options depend on the underlying etiology but may include GnRH agonists to suppress early puberty or other therapies specific to conditions like tumors. With appropriate treatment, prognosis is generally good.
Precocious puberty refers to the early onset of sexual maturation before 8 years in girls and 9 years in boys. It can be classified as true precocious puberty, which is GnRH-dependent, or pseudoprecocious puberty, which is GnRH-independent. Evaluation involves physical exam, lab tests, imaging and bone age assessment. Treatment depends on the type but may include GnRH analogues to suppress early puberty.
Delayed Puberty Topics in Adolescent Gynecology Delayed Puberty Topics in A...MedicineAndHealth14
This document discusses delayed puberty in adolescent girls. It begins by outlining normal pubertal development and defining delayed puberty. Delayed puberty is then classified into three categories: hypergonadotropic hypogonadism (43%), hypogonadotropic hypogonadism (31%), and eugonadism (26%). For evaluation and management, the document recommends obtaining a history, physical exam, initial labs (TSH, prolactin), and a progestational challenge to determine gonadotropin levels and identify underlying causes. Treatment strategies aim to correct the underlying pathology, prevent disease complications, and provide sex steroids.
Disorder of Sex Differentiattion ( ambiguos genitelia )Dr Anand Singh
Disorders of sex development (DSD) occur when the development of chromosomal, gonadal, or anatomical sex is atypical. Evaluation of DSD involves a physical exam, karyotype testing, hormone level testing, and imaging exams. Diagnosis is made based on gonadal status and further tests can include hormone stimulation tests, biopsy of gonads, and genetic analysis. Treatment is determined based on diagnosis and may include surgery and hormone replacement therapy.
Hypothyroidism and thyroid screening can be caused by primary or secondary issues. Neonatal screening uses dried blood samples to test TSH levels to detect congenital hypothyroidism. TSH is the most sensitive indicator for primary hypothyroidism. Precocious and delayed puberty can have various causes like tumors, infections, or genetic defects. Puberty is evaluated based on physical signs, lab tests, and sexual maturity ratings which characterize development. Treatment depends on the underlying cause and aims to initiate normal development.
Amenorrhea is the absence of menstrual periods. Primary amenorrhea refers to the absence of periods by age 14 with no secondary sex changes, or by age 16 regardless of sex changes. Secondary amenorrhea is the absence of periods for 3 or more cycles or 6 months in women with previous regular cycles. Common causes include pregnancy, hypothalamic or pituitary disorders, PCOS, and eating disorders like anorexia nervosa. Workup involves medical history, physical exam, and lab tests of hormones and imaging to determine the underlying cause and guide treatment.
This document discusses abnormalities of the external genitalia in pediatric patients, including hypospadias, cryptorchidism, micropenis, intersex conditions, hernias and hydroceles, testicular torsion, and varicoceles. It covers the etiology, evaluation, classification, management, and complications of these conditions.
The document discusses infertility, its causes and treatments. It defines infertility as the inability to conceive after one year of regular unprotected sex. Approximately 10-15% of couples experience infertility, with female factors accounting for 60% of cases, male factors 30% and both male and female factors in 10% of cases. Common female causes include problems with ovulation, fallopian tubes or cervical factors. Common male causes include abnormal sperm production or function. Treatments aim to address the specific cause, and may include ovulation induction medications, surgery, assisted reproduction technologies like IUI or IVF.
Polycystic Ovarian Disease & Hyperandrogenism Evidence Based Update on Di...Lifecare Centre
This document provides an overview of polycystic ovarian disease (PCOD) and hyperandrogenism. It discusses the prevalence of PCOD, risk factors like insulin resistance, and the etiology involving high levels of estrogen, androgens, LH and insulin. The document outlines the diagnostic criteria according to the Androgen Excess and PCOS Society, including signs of hyperandrogenism, ovarian dysfunction, and exclusion of related disorders. It emphasizes the importance of screening for conditions like congenital adrenal hyperplasia. The document also discusses the metabolic consequences of PCOD and recommendations for screening for metabolic syndrome.
Screening for any disorder in individuals is a strategy used for identifying a disease before the onset of signs or symptoms, thus enabling earlier detection and management with the aim to reduce morbidity and mortality.
This document discusses precocious puberty, including its definition, types, epidemiology, evaluation, and treatment. Precocious puberty is defined as the onset of puberty before age 8 in girls and age 9 in boys. It can be central, originating from the brain, or peripheral, originating from the gonads or adrenal glands. Evaluation involves medical history, physical exam, labs, imaging, and bone age assessment. Treatment is aimed at delaying further pubertal progression using GnRH analogs.
L6-8.Disorders of the reproductive system.pptxDr Bilal Natiq
In the male, the testis serves two principal functions: synthesis of testosterone by the interstitial Leydig cells under the control of luteinising hormone (LH), and spermatogenesis by Sertoli cells under the control of follicle-stimulating hormone (FSH) (but also requiring adequate testosterone).
This document discusses the approach to evaluating ambiguous genitalia in infants. It begins by describing normal sexual development and the causes of disorders of sexual differentiation. For 46XX infants, the evaluation involves examining for palpable gonads, karyotyping, and hormonal testing to diagnose conditions like congenital adrenal hyperplasia. For 46XY infants, karyotyping and HCG stimulation testing are used to diagnose conditions like partial androgen insensitivity or 5-alpha reductase deficiency. The case presentation demonstrates applying this approach to diagnose a patient with 5-alpha reductase deficiency based on physical exam, karyotyping, and hormonal response to HCG.
Similar to 15. PRECOCIOUS PUBERTY in the adolescent (20)
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. PRECOCIOUS PUBERTY
WHAT IS PRECOCIOUS PUBERTY?
Early onset of puberty before 8 years of age in girls
9 Y in boys
Difficult to ascertain the early age limit because
A -15% of black girls Breast development
- 5% of white girls at 7 Y of age without
associated early menarche
B -17.7% of black girls Pubic hair development
-2.8 % of white girls at 7 Y of age
Most cases of PP are 2ry to idiopathic premature maturation
of the HPO axis with Gn RH release
3. PRECOCIOUS PUBERTY
WHAT ARE THE ABNORMALITIES IN THE PROCESS OF
SEXUAL MATURATION?
1-Precocious puberty
2-Delayed puberty
3-Dissencronous (eg. Physical changes are not followed by
menarche after an appropriate interval)
4-Heterosexual changes
5-Timing of progression of pubertal changes
4. PRECOCIOUS PUBERTY
WHAT ARE THE TYPES OF PRECOCIOUS PUBERTY?
1- Central / true precocious puberty
2-Peripheral /GnRH independent precocious puberty
3-Incomplete precocious puberty
5. CENTRAL PRECOCIOUS PUBERTY
CPP is physiologically normal pubertal development that
occur at an early age
GnRH dependent
GnRH pulses gonadotropins ↑↑ ovarian
estrogen production & eventual ovulation
It follows the pattern of pubertal changes that occur in
normal puberty
More common in girls than boys
7. CAUSES OF CPP
1-Idiopathic ----- 80-90%
2-CNS tumors
a-Hypothalamic hamartomas
A congenital malformation
The most common type of CNS tumor that cause CPP
Size & shape do not change significantly over time
May be associated with seizures (the intrahypothalamic
type)
Rapidly progressing CPP in a child < 2 Y suggest this Dx
GnRH Rx is satisfactory & safe
b-Optic glyomas
c-Craniopharyngioma
d-Dysgerminoma
e-Epindymoma
f-ganglioneuroma
8. CAUSES OF CPP
3-CNS dysfunction
a-Space occupying lesion eg. Arachnoid cyst
b-Hydrocephalus
c-Irradiation
d-Trauma
e-Infection
f-Septooptic dysplasia (congenital)
g-Excessive exposure to sex steroids
(congenital adrenal hyperplasia)
9. PERIPHERAL PRECOCIOUS PUBERTY
PPP / Pseudo PP
GnRH independent
Due to inappropriate sex hormone secretion or exposure
to exogenous sex steroids
LH & FSH levels are low prepubertal , while estrogen
May present with some or all of the physical changes
of puberty
CAUSES
A-Exogenous sex steroids or gonadotropins
B-Abnormal secretion of gonadotropins (rare)
eg. Tumors secreting hCG (teratoma)
10. CAUSES OF PPP
C-Functioning ovarian tumors UNCOMMON
Granulosa cell 70% present with PP
Granulosa-thica cell
Mixed germ cell usually benign
Present with rapid progression of breast development ,
vaginal bleeding & abdominal pain
Palpable mass & dulling of vaginal mucosa
Estradiol level excessively elevated
U/S, CT, MRI, are helpful in confirming the Dx
Rx Excision regression of 2ry sexual chct
11. S 128
Malignant ovarian trs are responsible for 2-3% of all
cases of precocious pseudopuberty (PPP) in girls.
The most common are the granulosa cell tumors
S 127
12. S 138 S 140
S 139
8 Y old, 3 M Hx of vaginal bleeding , breast &pubic hair Tanner III ,Ht 70th
% Wt 95th %, pelvic mass. FSH 4.1 LH 3.2 TSH 2.3 prolactin 21 LDH 192
HCG 103 AFP 5.
Laparotomy BSO ,appendectomy , omentectomy.
Dx Bilateral Dysgerminoma arising in aGonadoblastoma , Karyotype XY
RX 8 coarses of chemotherapy, no recurrence at 20 M
13. CAUSES OF PPP
CONT’D C-Functioning ovarian tumors
Cystadenoma May produce estrogen
Gonadoblastoma or androgn or both
Lipoid Rare
D-Functional ovarian cysts
Secrete estrogen breast development
Rupture or resolution estrogen vaginal
bleed
Surgery should be avoided
E-Adrenal tumors RARE
F-Congenital adrenal hyperplasia
G-CHRONIC 1RY HYPOTHYROIDISM
TSH acts on FSH receptors PPP
RX thyroxin resolution of the PPP
19. Rx of PPP
1-TREAT THE CAUSE (IF POSSIBLE)
2-Drugs
Testolactone aromatase inhibitor , inhibit conversion
of testosterone to estrogen 35mg/kg/D 3 divided doses
Ketoconazole inhibit steroid biosynthesis 200mg tds
Cyproterone acetate Potent progestin & antiandrogen,
inhibit androgens at the receptor level / supress gonadal
& adrenal steroidogenesis : antigonadotrophic
100 mg/m2 2 divided doses
20. Rx of PPP
Spironolactone inhibit androgens at the receptor
level, ovarian androgen production,
antimineralocorticoid 50-100mg bd
Medroxyprogestrone acetate
Girls with prolonged PPP prolonged exposure of the
CNS to estrogen central precocious puberty CPP
21. INCOMPLETE PRECOCITY
Partial (often transient) pubertal development in the
absence of other stigmata of puberty
Slow progression , no change or waning of the physical
finding may occur
1-PREMATURE THELARCHE
Premature beast development in the absence of other
signs of sexual maturation
Estradiol level
Unilateral or bilateral , without areolar development
< 2 Y of age & non progressive
Follow up should distinguish cases of slow progressing CPP
No Rx is indicated & subsequent normal puberty occur
23. 2-PREMATURE PUBARCHE
THE APPEARANCE OF PUBIC HAIR BEFORE 8 Y OF
AGE IN GIRLS
Early maturation of the normal pubertal adrenal androgen
production “Adrenarche”
It is evidence of premature adrenarche without activation
of the HPO axis
Beast development is absent
Slightly accelerated growth velocity & advanced skeletal
maturation
Puberty occur normally at the appropriate age
Dx by exclusion of CAH, androgen secreting tumors &
CPP
24. 2-PREMATURE PUBARCHE
50% of pt. with premature pubarche progress to PCO
Hyperandrogenism & insulin resistance are chct of PCO
Late onset CAH may have a similar presentation
Dx ---ACTH stimulation test
Marked of 17-OH progestrone
--- plasma level of 17-OH progestrone, AND, DHEA
Rx ---- glucocorticoids
CPP can occur 2ry to late Dx or inadequate Rx of CAH
25. 3-ANDROGEN SECRETING TUMORS
ADRENAL TUMORS
RARE
Function autonomously
DHEA , DHEAS, testosterone
Cortisol
Could benign or malignant with poor prognosis
OVARIAN TUMORS
Arrhenoblastoma, lipoid cell tumors
Testosterone , AND
DHEA, DHEAS NORMAL
26. 4-PREMATURE MENARCHE
Uncommon
We should role out serious cause of bleeding
1-Neonatal period
Due to withdrawal of estrogen produced by the
fetoplacental unit
2-Spontaneous regression of ovarian cysts
3-Hypothyroidism
4-McCune Albright Syndrome
D. Dx
Vulvovaginitis
Foreign body in the vagina
Trauma
Sexual abuse
Vaginal tumors
28. WE HAVE TO DIFFERENTIATE BETWEEN CPP &
PPP
1-HISTORY
Onset & progression of symptom
(N tempo CPP, Abrupt & rapid estrogen sec Tr)
Hx of CNS trauma or infection
Symptoms associated with neurological dysfunction
Symptoms associated with endocrine dysfunction
Exposure to exogenous steroids
Hx of abdominal pain or swelling
Family Hx early puberty, short stature
29. 2-PHYSICAL EXAMINATION
Tall stature for age / changes in HT velocity
2ry sexual chct (Tanner staging) synchronous CPP
Neurological examination
Fundoscopy & gross visual field evaluation
Virilization
Evidence of hypothyroidism or hyperadrenalism
Examin the skin for acne, odor, café-au-lait spots,
hirsutism
Abdomen masses
PR
31. INVESTIGATIONS
GnRH stimulation test
100 ugm of GnRH IV
Check FSH & LH baseline, 20,40,60 min
Prepubertal Pubertal
FSH > LH ↑ LH > FSH
LH rise is minimal LH peak above
< 10 IU/ml upper limit for
prepubertal
32. GnRH STIMULATION TEST
■ 6 Y old with
CPP
□14Y old with
normal puberty
▲ 16Y old with
H-P destruction
2ry to cranio-
pharyngioma
5Y old
prepubertal
33. INVESTIGATIONS
2-Bone age radiography
Advanced in both CPP & PPP
Premature adrenarche slightly
Premature thelarche Normal
3- CT / MRI OF THE HYPOTHALAMIC PITUITARY
REGION
Important in all Pt. with suspected CPP or Pt. with
neurological symptoms & signs
34. INVESTIGATIONS
4-U/S
Adrenal
Ovaries role out ovarian cysts or tumors & to assess
size
Uterus to assess size
5-Vaginal smear for pyknotic index
A simple method of assessing the level of estrogen
stimulation
Result is expressed in the form of % of basal ,
parabasal & superficial cells
The greater the % of superficial cells the greater the
estrogen effect
35. TREATMENT OF CPP
Purpose of treatment
To gain normal adult height
(Pt with CPP will have an ultimately shortened adult height)
Amelioration of the psychosocial consequences of size
unrealistic adult expectations
Who should be treated?
Pt. with early puberty (<6Y) , accelrated growth & advanced
skeletal age should be treated, (bone age >2Y>chronologic
age. Menarche <8Y
Pt. with early onset but without indication that puberty is
advancing should be followed up
36. TREATMENT OF CPP
1-THE TREATMENT OF CHOICE IS A GnRH ANALOGUE
GnRH agonists (zoladex) bind to GnRH receptors
( competitive inhibition ) down regulation of receptor
function gonadotropin secretion inhibition of the
HPO axis estrogen secretion regression of the
manifestation of puberty
The goal of therapy is complete suppression of
gonadotropin secretion prepubertal GnRH stimulation
test result
Adult Ht of Rx pt. > utreated
Adult Ht is related to skeletal age at the onset of Rx
Adult Ht of Rx pt. is still < target Ht / predicted Ht
37. TREATMENT OF CPP
Rx is continued until the progress of puberty is age
appropriate
Best statural outcome pt. treated until bone age
12 -12.5 years
Growth hormone may be added to Rx
After discontinuation of Rx resumption of puberty occurs
& precedes at a normal pace
Side effects: local injection reaction & sterile abscess
2-Medroxyprogestrone acetate
Used in the past
Supress the progression of puberty & menses
NO effect on skeletal maturation & adult height
38. PSYCHOSOCIAL CONSEQUENCES
OF PRECOCITY
1-Children with PP are taller & appear older than their
peers unrealistic expectation from parents ,
teachers & others child will be under stress
2-They perceive them selves as different however this
does not have any long term effect & they do well
psychologically
3-Sexual maturity at an immature age make them
vulnerable to be victims of sexual abuse