32 amenorrhea, oligomenorrhea, and hyperandrogenic disorders dr.hisham al hammami 2020 powerpoint

‫اﻟﻧﺳﺎﺋﯾﺔ‬ ‫اﻷﻣراض‬–‫اﻟﺧﺎﻣﺳ‬ ‫اﻟﺳﻧﺔ‬‫ﺔ‬
32-
32
5/2/2019 1
Dr.Hisham Al-Hammami Professor of Obstetrics and Gynecology
faculty of medicine Syrian private university

5/2/2019
faculty of medicine Syrian private university 2
‫ﺛﺎﻧوي‬ ‫طﻣث‬ ‫اﻧﻘطﺎع‬
‫ﻟ‬ ‫اﻟطﻣث‬ ‫ﯾﻐﯾب‬‫ﻣدة‬≤6
‫أ‬‫ﺷﮭر‬
‫طﻣث‬ ‫اﻧﻘطﺎع‬‫ﺑدﺋﻲ‬
‫ﻓﯾﮫ‬ ‫ﯾﺣدث‬ ‫ﻻ‬menarche
)‫اﻷول‬ ‫اﻟﺣﯾض‬(

Primary Amenorrhea
5/2/2019
‫اﻟﺗﺷﺧﯾص‬
‫ﻋدم‬‫ﺣد‬‫و‬‫ﺣﺗﻰ‬ ‫ﻋﻔوي‬ ‫رﺣﻣﻲ‬ ‫ﻧزف‬ ‫أي‬ ‫ث‬
‫اﻟ‬ ‫ﻋﻣر‬‫ـ‬16‫ﺳﻧﺔ‬
‫أن‬ ‫ﯾﺟب‬‫ﯾ‬‫اﻹ‬ ‫ﺑدأ‬‫ﺳﺗﻘﺻﺎء‬‫أﺻﻐر‬ ‫ﺑﻌﻣر‬‫إ‬‫ذا‬
‫ﻟم‬‫ﯾﺣدث‬‫اﻟﻧﮭود‬‫اﻟ‬ ‫ﻋﻣر‬ ‫ﺣﺗﻰ‬‫ـ‬14‫ﺳﻧﺔ‬
‫ﻋﻔوي‬ ‫طﻣث‬ ‫ﯾﺣدث‬ ‫ﻟم‬‫ﺑﻌد‬ ‫ﺳﻧﺗﯾن‬ ‫ﺧﻼل‬
‫اﻟﻧﮭود‬ ‫ﺣدوث‬

PRIMARY AMENORRHEA WITH SEXUAL INFANTILISM
5/2/2019
‫ﻋدم‬ ‫إﻟﻰ‬ ‫ﺗﺷﯾر‬‫اﻟﮭورﻣون‬ ‫إﻓراز‬‫اﻟﻘﻧدي‬
• Hypogonadotropic hypogonadism.
• Hypergonadotropic hypogonadism (gonadal
agenesis or dysgenesis).
•‫اﻟﺗﻣﯾﯾز‬‫ﻋﯾﺎر‬FSH‫اﻟﻣﺻل‬ ‫ﻓﻲ‬ ‫اﻟﻘﺎﻋدي‬
‫اﻟﺗﻔرﯾﻘﻲ‬ ‫اﻟﺗﺷﺧﯾص‬:

5/2/2019
‫ﻣﺳﺗوﯨ‬‫ﺎت‬FSH
‫ﻣﻧﺧﻔﺿ‬‫ﺔ‬
‫ﻋدم‬‫اﻟﺛدي‬ ‫ﺗطور‬
‫ﻧﻘص‬‫إﻓراز‬
‫اﻻ‬‫ﺳﺗروﺟﯾن‬
LH‫ﻗﯾﻣﺗﮫ‬
‫ﻣﺣدو‬ ‫اﻟﺗﺷﺧﯾﺻﯾﺔ‬‫دة‬
Primary Amenorrhea and Sexual InfantilismHypogonadotropic

5/2/2019
Primary Amenorrhea and Sexual InfantilismHypogonadotropic
‫أﺳﺑﺎب‬Hypogonadotropic hypogonadism:
•‫آﻓﺎت‬‫أو‬‫وظﯾﻔﯾﺔ‬ ‫اﺿطراﺑﺎت‬‫ﻓﻲ‬‫اﻟوطﺎء‬.
•‫أورام‬CNS‫ﻣﺣوري‬ ‫طﺑﻘﻲ‬ ‫أو‬ ‫ﻣرﻧﺎن‬
•‫اﻟﻧﺧﺎﻣﯾﺔ‬ ‫اﻟﻐدة‬ ‫آﻓﺎت‬
•‫أورام‬‫ﻏدﯾﺔ‬‫ﻟﻠﺑروﻻﻛﺗﯾن‬ ‫ﻣﻔرزة‬
•‫ﺷﺎﻣل‬ ‫ﻧﺧﺎﻣﻰ‬ ‫ﻗﺻور‬‫اﻷﺧرى‬ ‫اﻟﻧﺧﺎﻣﯾﺔ‬ ‫اﻟﮭرﻣوﻧﺎت‬ ‫ﻋوز‬ ‫ﻣﺳﺢ‬
•‫ﻗد‬‫ﺗﻣﺛل‬‫ﺗﺄﺧر‬‫ﺑﻠوغ‬‫ﺑﻧﯾوي‬

Hypergonadotropic Primary Amenorrhea and Sexual Infantilism
5/2/2019
‫ﻋﻧد‬‫ھن‬‫ﻣﻊ‬ ‫اﻟﺑﺎﻛر‬ ‫ﻗﺻوراﻷﻗﻧﺎد‬ ‫أو‬ ‫اﻷﻗﻧﺎد‬ ‫ﺗطور‬ ‫ﻓﺷل‬ ‫ﻣن‬ ‫ﺷﻛل‬FSH.
‫ﻋﻧد‬ ‫ّﻣﺎ‬‫ﺑ‬‫ر‬‫ھن‬‫أﻗﻧﺎد‬ ‫ﺗﻛون‬ ‫ﻋدم‬
•46 XY.
•‫اﻟﺧﺻﯾ‬ ‫ﺗطور‬ ‫ﻏﯾﺎب‬‫ﺔ‬
•‫اﻷﺳﺑوع‬ ‫ﺑﯾن‬)8-10((swyer syndrome):
•‫ظﺎھرﯾﺔ‬ ‫ﺗﻧﺎﺳﻠﯾﺔ‬ ‫أﻋﺿﺎء‬‫أﻧﺛوﯾﺔ‬
•‫ﻏﯾﺎب‬‫اﻷﻗﻧﺎد‬
•‫اﻟﺗﺻﻧﻊ‬ ‫ﻧﺎﻗص‬ ‫رﺣم‬
•‫ﺗﻧﺎﺳﻠﯾﺔ‬ ‫أﻗﻧﯾﺔ‬‫ﺑداﺋﯾﺔ‬
•‫اﻷﺳﺑوع‬ ‫ﺑﻌد‬)12-14(‫ظﺎھرة‬ ‫ﺗﻧﺎﺳﻠﯾﺔ‬ ‫أﻋﺿﺎء‬‫ذﻛرﯾﺔ‬
•‫َﺔ‬‫ﯾ‬ْ‫ﺻ‬ُ‫ﺧ‬‫اﻟ‬ ُ‫م‬‫ِدا‬‫ﻌ‬ْ‫ﻧ‬‫ا‬،‫ﺷرﯾطﯾﺔ‬ ‫أﻗﻧﺎد‬
‫ﺗﻛون‬ ‫ﻋﺳرة‬‫اﻷ‬‫ﻗﻧﺎد‬‫اﻟ‬‫ﺻ‬‫ر‬‫ﻓﺔ‬Pure)‫اﻟﺧﺻﯾﺔ‬ ‫ﺗﻘﮭﻘر‬ ‫ﻣﺗﻼزﻣﺔ‬Regression(

5/2/2019
‫ﺑﺳﺑب‬ ‫ﺗﻛون‬ ‫ﻗد‬‫ﻋ‬‫ﺳ‬‫ر‬‫ﺗ‬‫اﻷ‬ ‫ﻛون‬‫ﻗﻧﺎد‬ ‫ﺑﺳﺑب‬ ‫ﺗﻛون‬ ‫ﻗد‬‫ﻋ‬‫ﺳ‬‫ر‬‫ﺗ‬‫اﻷ‬ ‫ﻛون‬‫ﻗﻧﺎد‬
‫اﻟﺗﻔرﯾﻘﻲ‬ ‫اﻟﺗﺷﺧﯾص‬:
•45 XO
•‫ﺷذوذ‬‫اﻟﺻﺑﻐﻲ‬ ‫ﻓﻲ‬ ‫ﺑﻧﯾوي‬x
•‫اﻟﻣوزاﯾﯾﻛﯾﺔ‬Mosaicism
•‫اﻟﺻ‬ ‫اﻷﻗﻧﺎد‬ ‫ﺗﻛون‬ ‫ﻋﺳرة‬‫ر‬‫ف‬)46 XX‫و‬46 XY(
•‫ﺗوﺟد‬ ‫ﻗد‬ ‫ﻧﺎدرا‬‫ﻓﻌﺎﻟﯾﺔ‬‫ﺟرﯾﺑﯾﮫ‬‫ﻣﺑﯾﺿﯾﺔ‬‫ﻛﺎﻓﯾﺔ‬‫ﻟدﯾﮭم‬ ‫اﻟذي‬ ‫اﻷﻓراد‬ ‫ﻓﻲ‬‫ﻣوزاﯾ‬‫ﯾﻛﯾﺔ‬‫أو‬
‫ﻣﺗﻼزﻣﺔ‬‫ﺗورﻧر‬.

5/2/2019
‫ﻣرﺿﻰ‬ ّ‫ل‬‫ﻛ‬
hypergonadotropic
hypogonadism
‫ﻟﮭﺎ‬ ‫ﯾﺟرى‬ ‫أن‬ ‫ﯾﺟب‬‫اﻟﻧووي‬ ‫اﻟﻧﻣط‬
karyotype

5/2/2019
‫ﻧﺎدرا‬،‫ﻟدﯾﮭم‬ ‫ﯾﻛون‬ ‫ﻗد‬ ‫اﻟﻣرﺿﻰ‬ ‫ﺑﻌض‬‫ﻋﯾب‬‫اﻻﻧدروﺟﯾن‬ ‫و‬ ‫اﻻﺳﺗروﺟﯾن‬ ‫اﻧﺗﺎج‬ ‫ﻓﻲ‬
•‫ﻋوز‬17-hydroxylase‫ﺗ‬‫ﺛﯾﯾط‬‫اﻟﺟﻧﺳﯾﺔ‬ ‫اﻟﺳﺗﯾروﺋﯾدات‬ ‫ﺗرﻛﯾب‬
•‫ﺷرﯾﺎﻧﻲ‬ ‫ﺗوﺗر‬ ‫ارﺗﻔﺎع‬
•‫ﺑوﺗﺎﺳﯾوم‬ ‫اﻧﺧﻔﺎض‬

5/2/2019
‫ﻋﻼ‬ ‫ﯾﻣﻛن‬‫ﻣن‬ ‫ﺗدرﯾﺟﻲ‬ ‫ﺑﺷﻛل‬ ‫ﻣﺗزاﯾدة‬ ‫ﺟرﻋﺎت‬ ‫ﺑﺈﻋطﺎء‬ ‫اﻟﺟﻧﺳﯾﺔ‬ ‫اﻟطﻔﺎﻟﺔ‬ ‫ج‬‫اﻻﺳﺗروﺟﯾﻧﺎت‬
‫اﻟﻣوﺟﮭﺎت‬ ‫ﻧﺎﻗص‬ ‫اﻟﻣﻧﺎﺳل‬ ‫ﻗﺻور‬‫ﯾﺗ‬ ‫اﻟداﺋم‬‫إﻣﺎ‬ ‫طﻠب‬hMG‫أو‬GnRH‫ﻧﺑﺿﻲ‬ ‫ﺑﺷﻛل‬.
‫ﻣرﺿﻰ‬ ‫ﻟدى‬ ‫اﻟﺣﻣل‬ ‫ﯾﺣدث‬ ‫أن‬ ‫ﯾﻣﻛن‬‫ﺗﺻﻧﻊ‬ ‫ﻋﺳرة‬‫اﻷﻗﻧﺎد‬‫و‬‫اﻟ‬ ‫ﻋوز‬‫ـ‬17-‫ھﯾدروﻛﺳﯾﻼز‬‫ﺑطرﯾﻘﺔ‬IVF‫ﻓﻘط‬
‫ﻣﺗﺑرع‬ ‫ﻣن‬ ‫ﺑﯾوض‬ ‫ﺑﺎﺳﺗﺧدام‬.

5/2/2019
Disorder Notable
Diagnostic
Findings
Examples Notable Clinical
Features
PRIMARY AMENORRHEA WITH SEXUAL INFANTILISM
Hypogonadotropic
hypogonadism
Low FSH and LH, low
estrogen; screening
for other pituitary
hormones is indicated;
MRI of the
hypothalamic-pituitary
area is recommended
Central nervous
system or pituitary
tumor, constitutionally
delayed puberty,
Kallmann syndrome
Exclude serious causes
before diagnosing
constitutional delay;
anosmia/hyposmia
with Kallmann
syndrome
Hypergonadotropic
hypogonadism
Elevated FSH and LH,
low estrogen;
karyotype indicated to
rule out Y
chromosome
Gonadal
agenesis/dysgenesis
including Turner
syndrome (45 XO) and
pure gonadal
dysgenesis (46 XX or
46 XY)
May rarely present as
secondary
amenorrhea; streak
gonads, short stature,
and webbing of the
neck with Turner
syndrome
17-Hydroxylase
(P450c17)
deficiency
Low sex steroids
(estrogens and
androgens)
Hypertension and
hypokalemia due to
mineralocorticoid
excess (see Figure 32-
1)

5/2/2019

5/2/2019
•‫اﻟﻛﺎﻣﻠﺔ‬ ‫اﻟﺣﺳﺎﺳﯾﺔ‬ ‫ﻋدم‬ ‫ﻣﺗﻼزﻣﺔ‬
‫ﻟﻼﻧدروﺟﯾﻧﺎت‬(AIS)
•‫ﻋدم‬‫أو‬‫ﻋﺳر‬‫ﺗ‬ ‫ة‬‫ﻛون‬‫ﻣوﻟﻠر‬ ‫ﻗﻧﺎة‬
•Serum Testosterone.
•Karyotype.
‫ﻣﺟﻣوﻋﺗﺎن‬
‫ﻠ‬‫ﺮ‬
PRIMARY AMENORRHEA WITH BREAST DEVELOPMENT AND
MÜLLERIAN ANOMALIES

Androgen Insensitivity Syndrome
)AIS(
5/2/2019
‫ﻋﯾب‬‫اﻻﻧدروﺟﯾن‬ ‫ﻣﺳﺗﻘﺑﻼت‬ ‫ﻓﻲ‬
‫اﻟﺻﺑﻐﯾﺔ‬ ‫اﻟﺻﯾﻐﺔ‬46 XY
‫ﯾﺑد‬‫ﯾ‬‫ﻣن‬ ‫ذﻛرﯾﺔ‬ ‫ﻣﺳﺗوﯾﺎت‬ ‫ن‬
‫اﻟﺗﺳﺗوﺳﺗﯾرون‬
‫ﻣﺳﺗوﯾﺎت‬FSH‫و‬LH‫ﺑﺷﻛل‬ ‫ﻣرﺗﻔﻌﺔ‬‫ﺑﺳﯾط‬
)‫ﻣﻌﻠﻘﺔ‬ ‫ﺧﺻﯾﺔ‬cryptorchic(
‫ﺛدي‬ ‫ﺗطور‬
‫ﻏﯾﺎب‬ ‫ﻣﻊ‬ ‫ﻣﮭﺑﻠﻲ‬ ‫رﺗﺞ‬
‫رﺣم‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬:
‫اﻷ‬ ‫اﺳﺗﺋﺻﺎل‬‫ﻗﻧﺎد‬
‫ﺟدﯾد‬ ‫ﻣﮭﺑل‬ ‫ﺗﺻﻧﯾﻊ‬
‫ﻧﻔﺳﯾﺔ‬ ‫اﺳﺗﺷﺎرة‬

5/2/2019
‫ﺑدﺋﻲ‬ ‫طﻣث‬ ‫اﻧﻘطﺎع‬+‫ﺗطور‬‫أ‬‫ﺛد‬‫اء‬‫طﺑﯾﻌﻲ‬
karyotype:46 XX
‫ﻣﺳﺗوﯾﺎت‬Testosterone‫ﻣﻼﺋﻣﺔ‬‫ﻟﻺﻧﺎث‬
‫ﻋﯾوب‬‫ﻣوﻟﻠر‬ ‫ﻗﻧﺎة‬
•‫اﻟﺑﻛﺎرة‬ ‫ﻏﺷﺎء‬ ‫اﻧﺛﻘﺎب‬ ‫ﻋدم‬
•‫ﺳﺎد‬ ‫ﻣﻌﺗرض‬ ‫ﻣﮭﺑﻠﻲ‬ ‫ﺣﺟﺎب‬
•‫اﻟرﺣم‬ ‫ﻋﻧﻖ‬ ‫ﻏﯾﺎب‬
•‫ﻏﯾﺎب‬‫اﻟ‬‫ﻣﻊ‬ ‫رﺣم‬‫ﺑو‬‫ﻗ‬‫ﯾن‬‫طﺑﯾﻌ‬‫ﯾ‬‫ﯾ‬‫ن‬
Müllerian Dysgenesis or Agenesis

5/2/2019
‫ﺗراﺟﻊ‬ ‫ﻗد‬‫ﻧﺳﺎء‬‫ﻣﻣﺎﺛﻠﺔ‬ ‫ﺑﺄﻋراض‬‫ﺑدون‬ ‫ﻟﻛن‬
‫ﺗﻘﺑب‬‫ﻣﮭﺑﻠ‬‫ﻲ‬
‫اﻻﯾﻛو‬‫رﺣم‬ ‫ﯾؤﻛدوﺟود‬‫وﻣﺑﯾﺿ‬‫ﯾن‬
‫طﺑﯾﻌﯾ‬‫ﯾن‬‫ﺳﺎد‬ ‫ﻣﻌﺗرض‬ ‫ﻣﮭﺑﻠﻲ‬ ‫ﺣﺟﺎب‬/
‫رﺣم‬ ‫ﻋﻧﻖ‬ ‫ﻏﯾﺎب‬
‫اﻟﻣرﻧﺎن‬MRI:
•‫ﻣﻌﺗرض‬ ‫ﺣﺟﺎب‬‫ﺟراﺣﻲ‬ ‫اﺻﻼح‬
•‫رﺣم‬ ‫ﻋﻧﻖ‬ ‫ﻏﯾﺎب‬‫اﻟﺗﺻﻧﯾﻊ‬
‫ﺻﻌب‬ ‫اﻟﺟراﺣﻲ‬‫ﻟﻠﻐﺎﯾﺔ‬‫اﺳﺗﺋﺻ‬‫ﺎل‬
‫رﺣم‬

5/2/2019
‫اﻟﺷرﺟﻲ‬ ‫اﻟﻣس‬‫ﯾدﻻ‬ ‫ﻗد‬ ‫واﻻﯾﻛو‬‫ﻋﻠﻰ‬ ‫ن‬‫اﻟرﺣم‬ ‫ﻏﯾﺎب‬‫ﺗﻛون‬ ‫ﻋدم‬‫ﻗﻧﺎة‬‫ﻣوﻟﻠر‬
‫أو‬Meyer-Rokitansky-Küster-Hauser syndrome
‫ﻣوﻟﻠر‬ ‫ﻟﻘﻧﺎة‬ ‫اﻟﺑﻌﯾدﺗﯾن‬ ‫اﻟﻧﮭﺎﯾﺗﯾن‬ ‫اﻟﺗﺣﺎم‬ ‫ﻓﺷل‬‫ﻟ‬‫ﻣن‬ ‫اﻟﻌﻠوي‬ ‫اﻟﺟزء‬ ‫ﺗﺷﻛل‬‫اﻟﺗﻧﺎﺳﻠ‬ ‫اﻟﻘﻧﺎة‬‫ﯾﺔ‬
‫اﺟراء‬ ‫ﯾﺟب‬‫اﻟﺑوﻟﻲ‬ ‫ﻟﻠﺟﮭﺎز‬ ‫ظﻠﯾﻠﺔ‬ ‫ﺻورة‬‫أو‬‫دراﺳﺔ‬‫ا‬ ‫اﻟﺟﮭﺎز‬ ‫ﺳﻼﻣﺔ‬ ‫ﻣن‬ ‫ﻟﻠﺗﺄﻛد‬ ‫أﺧرى‬ ‫ﺗﺷﺧﯾﺻﯾﺔ‬‫ﻟﺑوﻟﻲ‬

5/2/2019
‫اﻧﻘطﺎع‬‫اﻟ‬‫طﻣث‬‫و‬‫ﻧدرة‬‫اﻟ‬‫طﻣث‬‫ﻣﻊ‬‫طﺑﯾﻌﻲ‬ ‫ﺛدي‬ ‫ﺗطور‬‫و‬‫ﺑﻧﯾﺎت‬‫ﻣوﻟﻠرﯾﺔ‬‫طﺑ‬‫ﯾﻌﯾﺔ‬
Amenorrhea and Oligomenorrhea with
Breast Development and Normal
Müllerian Structures

‫و‬‫ﻧﺪرة‬‫اﻟ‬‫ﻄﻤﺚ‬‫ﻣﻊ‬‫و‬
5/2/2019
‫إﺟراء‬ ‫ﯾﺟب‬‫اﻟﺣﻣل‬ ‫اﺧﺗﺑﺎر‬‫اﻟ‬ ‫اﻟﻣرﯾﺿﺎت‬ ّ‫ل‬‫ﻟﻛ‬‫ﻠوا‬‫ﻋﻧدھ‬ ‫ﺗﻲ‬‫ن‬‫ط‬ ‫ﻧزﻓﯾﺔ‬ ‫اﺿطراﺑﺎت‬‫ﻣﺛﯾﺔ‬
‫ّن‬‫ﻣ‬‫ﺗﺗﺿ‬ ‫أن‬ ‫ﯾﺟب‬‫ﺣول‬ ‫أﺳﺋﻠﺔ‬ ‫اﻷوﻟﯾﺔ‬ ‫اﻟﺳرﯾرﯾﺔ‬ ‫اﻟﻘﺻﺔ‬:
•‫زﻣن‬‫ﺣدوث‬‫اﻟﻧﮭود‬–‫اﻟﻌﺎﻧﺔ‬ ‫ﺷﻌر‬ ‫ظﮭور‬-‫اﻟطﻣث‬.
•‫أو‬ ‫اﻧﻘطﺎع‬ ‫وﺗطور‬ ‫ﺣدوث‬ ‫زﻣن‬‫ﻧدرة‬‫اﻟطﻣوث‬،
•‫اﻟﺷدﯾدة‬ ‫اﻟوزن‬ ‫ﺗﺑدﻻت‬،
•‫اﻟ‬‫رﯾﺎﺿﺔ‬‫اﻟﻌﻧﯾﻔﺔ‬،
•‫اﻟ‬‫ﻌﺎدات‬‫اﻟ‬‫ﻐذاﺋﯾﺔ‬،
•‫اﻟﺟﻧﺳﻲ‬ ‫اﻟﻧﺷﺎط‬،
•‫اﻟﺷﻛﺎ‬ ‫أو‬ ‫اﻷﻣراض‬‫ﯾﺎت‬‫اﻟﻣ‬‫راﻓﻘ‬‫ﺔ‬،
•‫اﻟﺟﺳم‬ ‫أو‬ ‫اﻟوﺟﮫ‬ ‫ﻟﺷﻌر‬ ّ‫ذ‬‫ﺷﺎ‬ ‫ﻧﻣو‬،
•‫اﻟﺻﻠﻊ‬،
•‫اﻟﺷﺑﺎب‬ ّ‫ﺣب‬،
•‫اﻟﻣﮭﺑل‬ ‫وﺟﻔﺎف‬ ‫اﻟﺳﺎﺧﻧﺔ‬ ‫اﻟﮭﺑﺎت‬ ‫ﻏﯾﺎب‬ ‫أو‬ ‫وﺟود‬.
•‫ا‬‫ﺗ‬ ‫اﻟﺗﻲ‬ ‫اﻟﻐذاﺋﯾﺔ‬ ‫واﻟﻣﺗﻣﻣﺎت‬ ‫ﻷدوﯾﺔ‬‫ﺗﻧﺎوﻟ‬‫ﮭﺎ‬.

5/2/2019
‫اﻟطﻣث‬ ‫اﻧﻘطﺎع‬ ‫ﻣرﯾﺿﺔ‬ ‫اﺳﺗﻘﺻﺎء‬
‫ﺣﻣل‬ ‫اﺧﺗﺑﺎر‬‫ﻣﺳﺗوى‬FSH
‫ﺗﺣدي‬ ‫اﺧﺗﺑﺎر‬‫اﻟـ‬
progestin
‫ﯾﺷﯾر‬‫اﻟﺳﺣب‬ ‫ﻧزف‬ ‫ﺣدوث‬ ‫ﻋدم‬
‫ﺷدﯾد‬ ‫اﺳﺗروﺟﯾن‬ ‫ﻧﻘص‬
hypoestrogenism
‫اﻧدروﺟﯾﻧﯾﺔ‬ ‫ﻓرط‬
hyperandrogenism
‫ﻋﯾﺑوب‬‫رﺣﻣﯾﺔ‬
‫اﻋطﺎء‬ ‫ﺑﻌد‬ ‫ﺳﺣب‬ ‫ﻧزف‬ ‫ﺑﺣدوث‬ ‫ﻧﻔﯾﮭﺎ‬ ‫ﯾﺗم‬‫اﺳﺗرو‬‫ﺟﯾن‬
‫ﻣﺗﻌﺎﻗﺑﯾن‬ ‫ﺑروﺟﯾﺳﺗﯾرون‬
‫ﺣﻣل‬
E2‫اﺳﺗرادﯾول‬

‫اﻟﺮﺣﻢ‬
UTERINE DEFECTS
5/2/2019
‫أﺷرﻣﺎن‬ ‫ﻣﺗﻼزﻣﺔ‬
Asherman's syndrome
•‫ﻻ‬‫ﯾﺣدث‬‫ﺳﺣب‬ ‫ﻧزف‬+
•‫اﻟرﺣم‬ ‫ﻋﻠﻰ‬ ‫ﺳﺎﺑﻖ‬ ‫ﺗداﺧل‬ ‫ﻗﺻﺔ‬ ‫ﯾوﺟد‬
•‫ﺑـ‬ ‫ﺗﺗﺻف‬:
•‫اﻟﺗﺻﺎﻗﺎت‬‫اﻟرﺣم‬ ‫داﺧل‬Synechiae
•‫ﯾ‬ ‫ﻗد‬‫وﺟد‬‫ﻋﻧدھﺎ‬‫اﻟطﻣث‬ ‫ﻗﺑل‬ ‫دورﯾﺔ‬ ‫أﻋراض‬ ‫ﻣﻊ‬ ‫طﺑﯾﻌﯾﺔ‬ ‫اﺑﺎﺿﯾﺔ‬ ‫دورات‬
•‫اﻹﺳﺗﻘﺻﺎء‬:Evaluation
•‫اﻟظﻠﯾل‬ ‫واﻟﺑوﻗﯾن‬ ‫اﻟرﺣم‬ ‫ﺗﺻوﯾر‬
•‫ﺑﺎﻻﯾﻛو‬ ‫اﻟرﺣم‬ ‫ﺗﺻوﯾر‬
•‫ﺑﺗﻧظﯾر‬ ‫ھﻲ‬ ‫اﻟﻣﺧﺗﺎرة‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬‫ﺑﺎطن‬‫اﻟرﺣم‬

5/2/2019
‫اﻧﻘﻄﺎع‬‫اﻟ‬‫ﻄﻤﺚ‬‫و‬‫ﻧﺪرة‬‫اﻟ‬‫ﻄﻤﺚ‬
AMENORRHEA AND OLIGOMENORRHEA
ASSOCIATED WITH HYPOESTROGENISM

5/2/2019
Hypothalamic-Pituitary Dysfunction
‫ﺗﺗﺿﻣن‬:
•‫اﻟﺷدﯾد‬ ‫اﻟوزن‬ ‫ﻧﻘص‬
•‫اﻟ‬‫رﯾﺎﺿﺎت‬‫اﻟﻌﻧﯾﻔﺔ‬
•‫إ‬‫ﺿطراب‬‫ﺷدﯾد‬ ‫ﻧﻔﺳﻲ‬
•‫ﺷدﯾدة‬ ‫ﺟﮭﺎزﯾﺔ‬ ‫أﻣراض‬
•‫ﻗﺻور‬‫اﻟ‬‫ﻧﺧﺎﻣﻰ‬‫اﻟﻌﺻﺑﻲ‬ ‫اﻟﻘﮭم‬ ‫أو‬
‫اﻷﺧرى‬ ‫اﻟﻧﺧﺎﻣﯾﺔ‬ ‫اﻟﮭرﻣوﻧﺎت‬ ‫ﺗﻘﯾﯾم‬ ‫ﯾﺟب‬
‫اﻟﻧﺧﺎﻣﯾﺔ‬ ‫اﻟﻐدة‬ ‫و‬ ‫اﻟوطﺎء‬ ‫ﻣن‬ ‫ﻟﻛل‬ ‫ﻣرﻧﺎن‬ ‫اﺟراء‬ ‫ﯾﺟب‬
‫اﻟﻌﻼج‬:
•‫ﺗ‬‫ﺷﺧﯾص‬‫ﻟﻠﺗﻌدﯾل‬ ‫اﻟﻘﺎﺑل‬ ‫اﻟﺗﺣﺗﻲ‬ ‫اﻟﺳﺑب‬
•OCP

Premature Ovarian Failure
5/2/2019
‫اﻟﺗﻌرﯾف‬:‫اﻟـ‬ ‫ﺳن‬ ‫ﻗﺑل‬ ‫اﻟﻣﺑﯾض‬ ‫ﻗﺻور‬40‫ﺳﻧﺔ‬
‫اﻷﺳﺑﺎب‬:
•‫اﻟﺻﺑﻐﯾﺔ‬ ‫اﻻﺿطراﺑﺎت‬‫اﻟﺻﺑﻐﻲ‬ ‫اﻟﻧﻣط‬
•‫آذﯾﺎت‬‫اﻟ‬‫اﻟﺟراﺣ‬ ‫ﻣﺑﯾض‬‫ﯾ‬‫ﺔ‬
•‫اﻷﺷﻌﺔ‬
•‫اﻟﻛﯾﻣﺎوي‬ ‫اﻟﻌﻼج‬
•‫اﻟدم‬ ‫ﻏﺎﻻﻛﺗوز‬ ‫ارﺗﻔﺎع‬Galactosemia
•‫اﻟﮭش‬ ‫اﻟﺻﺑﻐﻲ‬ ‫ﻣﺗﻼزﻣﺔ‬x.
•‫اﻟذاﺗﯾﺔ‬ ‫اﻟﻣﻧﺎﻋﺔ‬Autoimmunity
•‫ﺗ‬ ‫أن‬ ‫ﯾﻣﻛن‬‫ﺗﺄﺛر‬‫أﯾﺿﺎ‬ ‫أﺧرى‬ ‫ﻏدد‬
•‫ﻋﻧد‬ ‫ﻣﺎﯾﻠﻲ‬ ‫ﻣﺳﺢ‬ ‫ﯾﺟب‬‫ﻛل‬‫ﻣرﯾﺿﺎت‬‫ﻗﺻور‬‫اﻟ‬‫ﻏﯾر‬ ‫ﻣﺑﯾض‬‫اﻟ‬‫ﻣﻔﺳر‬:
•‫اﻟﺳﻛري‬
•‫اﻟدرق‬ ‫ﻗﺻور‬
•‫اﻟدرق‬ ‫ﺟﺎرات‬ ‫ﻗﺻور‬
•‫اﻟﻛورﺗﯾزول‬ ‫ﻧﻘص‬
‫ﻣن‬ ‫ﻟﯾس‬‫اﻟﻧﺎدر‬‫ﺗ‬ ‫أن‬‫ﺣدث‬‫طﺑﯾﻌﯾﺔ‬ ‫وطﻣﺛﯾﺔ‬ ‫ﻣﺑﯾﺿﯾﺔ‬ ‫وظﯾﻔﺔ‬ ‫ﻣن‬ ‫ﻧوب‬
‫ﺗﺣﺗﺎج‬‫اﻟﻣر‬‫ﯾ‬‫ﺿ‬‫ﺎت‬‫ھرﻣوﻧﻲ‬ ‫ﻋﻼج‬

5/2/2019

‫اﻧﻘﻄﺎع‬‫اﻟﻄﻤﺚ‬‫و‬‫ﻧﺪرة‬‫ﻣﻊ‬ ‫اﻟﻄﻤﺚ‬‫اﻟ‬
5/2/2019
‫اﻟرﺋﯾﺳﯾﺔ‬ ‫اﻟوظﯾﻔﺔ‬
‫ھﻲ‬ ‫ﻟﻠﺑروﻻﻛﺗﯾن‬‫ﺣث‬‫اﻧﺗﺎج‬
‫اﻟﺣﻠﯾب‬)‫اﻻرﺿﺎع‬(
‫اﻟﺑروﻻﻛﺗ‬ ‫اﻓراز‬ ‫ﻓرط‬‫ﯾن‬
‫اﻟﻰ‬ ‫ﯾؤدي‬‫ﻋﺳر‬‫وظﯾﻔ‬‫ﺔ‬
‫اﻷﻗﻧﺎد‬
‫اﻟ‬‫ﻣؤ‬‫ﺛر‬‫ﻋﻠﻰ‬ ‫اﻟرﺋﯾﺳﻲ‬
‫ھو‬ ‫اﻟﺑروﻻﻛﺗﯾن‬ ‫اﻓراز‬
‫اﻟﺗﺛﺑﯾط‬‫اﻟﻣﻘوي‬
tonic
inhibition‫ﻣن‬
‫اﻟﻣﻔرز‬ ‫اﻟدوﺑﺎﻣﯾن‬
input‫اﻟوطﺎء‬ ‫ﻣن‬

5/2/2019
‫اﻟدم‬ ‫ﺑروﻻﻛﺗﯾن‬ ‫ﻓرط‬‫اﺿطراﺑ‬‫ﺎت‬‫طﻣﺛ‬‫ﯾﺔ‬‫و‬‫ﺣﻠﯾب‬ ‫ﺛر‬
‫ﯾﺟب‬‫ﻋﯾﺎر‬‫اﻟﺑروﻻﻛﺗﯾن‬‫ﻣﺟﮭ‬ ‫اﻟطﻣث‬ ‫اﻧﻘطﺎع‬ ‫ﺣﺎﻻت‬ ‫ﻛل‬ ‫ﻓﻲ‬‫وﻟﺔ‬
‫اﻟﺳﺑب‬
‫اﻟطﺑﯾﻌﻲ‬ ‫اﻟﺑروﻻﻛﺗﯾن‬ ‫ﻣﺳﺗوى‬>20 ng/dl
‫اﻟﺑر‬ ‫ﻣﺳﺗوﯾﺎت‬ ‫ﺗﻛون‬ ‫ﻟﻠﺑروﻻﻛﺗﯾن‬ ‫اﻟﻣﻔرزة‬ ‫اﻷورام‬ ‫ﻓﻲ‬‫وﻻﻛﺗﯾن‬
<100 ng/dl
‫ﻣﺳﺗوى‬ ‫ﻗﯾﺎس‬ ‫ﯾﺟب‬TSH‫ﻟﺗﺷﺧﯾص‬‫اﻟدرق‬ ‫ﻗﺻور‬
‫اﻧﻘﻄﺎع‬‫اﻟﻄﻤﺚ‬‫و‬‫ﻧﺪرة‬‫ﻣﻊ‬ ‫اﻟﻄﻤﺚ‬‫اﻟ‬

5/2/2019
BOX 32-1 Causes of Elevated Prolactin
 Pregnancy (10-fold rise from baseline)
 Excessive exercise
 Postprandial states
 Stimulation of the chest wall or nipple
 Medications
o Metoclopramide
o Phenothiazines
o Butyrophenones
o Risperidone
o Monoamine oxidase inhibitors
o Tricyclic antidepressants
o Serotonin reuptake inhibitors
o Verapamil
o Reserpine
o Methyldopa
o Estrogens
 Craniopharyngiomas
 Granulomatous infiltration of the pituitary or hypothalamus
 Acromegaly
 Severe head trauma
 Prolactinomas
 Pituitary stalk compression
 Hypothyroidism
 Chronic renal failure
 Marijuana or narcotic use

5/2/2019
‫ﻟم‬ ‫إذا‬‫ﯾ‬‫ﻔﺳر‬‫ارﺗﻔﺎع‬‫اﻟﺑروﻻﻛﺗﯾن‬ ‫ﻣﺳﺗوى‬‫دواء‬ ‫اﺳﺗﻌﻣﺎل‬ ‫أو‬ ‫اﻟدرق‬ ‫ﺑﻘﺻور‬‫ﯾﺟب‬ ،
‫إﺟراء‬CT‫أو‬MRI‫اﻟﺗرﻛﻲ‬ ‫ﻟﻠﺳرج‬.
‫اﻟﺣﻠﯾب‬ ‫ﺛر‬Galactorrhea‫اﺿطراب‬ ‫أﺷﯾﻊ‬ ‫ھو‬‫ﯾ‬‫ﺑروﻻﻛﺗﯾن‬ ‫ﻓرط‬ ‫ﻣﻊ‬ ‫ﺗراﻓﻖ‬
‫اﻟدم‬
‫ﯾﺗم‬ ‫أن‬ ‫ﯾﻣﻛن‬‫ﺗﺣﺿﯾر‬‫ﻓﺣﺻﮭﺎ‬ ‫و‬ ‫ﻟطﺎﺧﺔ‬‫ﻣﺟﮭرﯾﺎ‬‫وﺟود‬ ‫ﻋن‬ ‫ﻟﻠﻛﺷف‬‫ﺷﺣﻣ‬ ‫ﻗطرات‬‫ﯾﺔ‬
‫ﻣﺗﻌددة‬
‫اﻧﻘﻄﺎع‬‫اﻟﻄﻤﺚ‬‫و‬‫ﻧﺪرة‬‫ﻣﻊ‬ ‫اﻟﻄﻤﻮث‬‫اﻟ‬

5/2/2019
‫اﻟﻤﻔﺮزة‬ ‫اﻷورام‬
Prolactinomas

5/2/2019
‫اﻟﺠ‬ ‫ﻓﻲ‬ ‫أﺧﺮى‬ ‫آﻓﺎت‬‫ﻤﻠﺔ‬‫ﺔ‬‫ﺔ‬‫ا‬ ‫ﻋﻠﻰ‬ ‫ﺗﺆﺛﺮ‬
Other CNSLesions Affecting Prolactin
‫اﻟﻧﺧﺎﻣﯾﺔ‬ ‫اﻷورام‬:
60%‫ﻣﻧﮭﺎ‬‫ﯾﻧﺗﺞ‬ ‫ﻻ‬‫ا‬‫ﻟﺑروﻻﻛﺗﯾن‬‫ﻗد‬ ‫ﻟﻛن‬‫اﻟدم‬ ‫ﺑروﻻﻛﺗﯾن‬ ‫ﻓرط‬ ‫ﺗﺳﺑب‬
‫اﻟﻔﺎرغ‬ ‫اﻟﺗرﻛﻲ‬ ‫اﻟﺳرج‬ ‫ﻣﺗﻼزﻣﺔ‬:‫اﻟﻌﻧﻛﺑوﺗﻲ‬ ‫ﺗﺣت‬ ‫اﻟﻐﺷﺎء‬ ‫ﻓﺗﻖ‬
‫ﻗد‬‫ﺗ‬‫ﺗ‬‫ﻣﻊ‬ ‫واﺟد‬‫ﻣﻔرز‬ ‫ﻧﺧﺎﻣﻲ‬ ‫ﻏدي‬ ‫ورم‬‫ﻟﻠﺑروﻻﻛﺗﯾن‬
‫اﻟوطﺎﺋﯾﺔ‬ ‫اﻷورام‬:‫اﻟدوﺑﺎﻣﯾن‬ ‫ﻧﻘل‬ ‫أو‬ ‫اﻧﺗﺎج‬ ‫ﻓﻲ‬ ‫ﺗﺗدﺧل‬
‫اﻟﺑﻠﻌوﻣﻲ‬ ‫اﻟﻘﺣﻔﻲ‬ ‫اﻟورم‬Craniopharyngiomas‫اﻷﻛﺛر‬ ‫ھو‬
‫ﺷﯾوﻋﺎ‬

5/2/2019
‫ﻣن‬ ‫ﻋدد‬‫اﻷدوﯾﺔ‬‫ﻓرط‬ ‫ﺗﺳﺑب‬ ‫أن‬ ‫ﯾﻣﻛن‬‫ﺑروﻻﻛﺗﯾن‬‫ﻣرﺿﻲ‬ ‫ﺣﻠﯾب‬ ‫وﺛر‬ ‫اﻟدم‬
‫اﻵﻟﯾﺔ‬:‫اﻓراز‬ ‫ﻧﻘص‬‫اﻟدوﺑﺎﻣﯾن‬‫اﻟوطﺎء‬ ‫ﻣن‬
‫اﻟدواء‬ ‫اﯾﻘﺎف‬ ‫ﻋﻠﻰ‬ ‫اﻟﻣرﯾﺿﺔ‬ ‫ﺗﺷﺟﯾﻊ‬ ‫ﯾﺟب‬
‫ا‬ ‫اﻓﺮاز‬ ‫ﻋﻠﻰ‬
Pharmacologic Agents Affecting the Secretion of Prolactin

5/2/2019
‫أﺳﺒﺎب‬‫ﻣﺘﻔ‬‫ﺮﻗﺔ‬‫ﻟﻔﺮط‬‫اﻟﺪم‬
Miscellaneous Causes of Hyperprolactinemia
‫اﻟ‬‫ﻘﺻور‬‫اﻟ‬‫ﻛﻠوي‬
‫ﺟراﺣ‬ ‫ﻧدﺑﺎت‬‫ﺔ‬‫ﺳﺎﺑﻘﺔ‬‫اﻟ‬ ‫ﻋﻠﻰ‬‫ﺻدر‬
‫اﻟﻣﻧطﻘﺔ‬ ‫داء‬
‫اﻟﺑدﺋﻲ‬ ‫اﻟدرق‬ ‫ﻗﺻور‬)3–5%(
•‫ﯾﺟب‬‫إ‬‫ﻋط‬‫ﺎء‬4T
‫اﻟﻘﺻﺑ‬ ‫ﺳرطﺎن‬‫ﺎت‬‫اﻟﻛﻠﯾﺔ‬ ‫وﺳرطﺎن‬

5/2/2019
‫اﻟﺪم‬
Treatment of Galactorrhea and
Hyperprolactinemia

5/2/2019
OBSERVATION
‫اﻹ‬‫ﺳﺗطﺑ‬‫ﺎﺑﺎت‬
‫طﺑﯾﻌﻲ‬ ‫طﻣث‬+‫ﺣﻠﯾب‬ ‫ﺛر‬+‫ﺑروﻻﻛﺗﯾن‬ ‫ﻣﺳﺗوﯾﺎت‬‫اﻟ‬‫ّﺎ‬‫ﻣ‬‫إ‬ ‫ﻣﺻل‬‫طﺑﯾﻌﯾﺔ‬‫أو‬‫ﺗﺑدي‬‫أ‬ ‫إرﺗﻔﺎﻋﺎت‬‫ﺳﺎﺳﯾﺔ‬
‫اﻟطﻣث‬ ‫ﻧدرة‬+‫ﺑﺎﻟﺣﻣل‬ ‫ﺗرﻏب‬ ‫ﻻ‬progestins‫دورﯾﺔ‬‫أو‬ ،SOCP
•‫ﻧزف‬ ‫ﺣدوث‬ ‫ﻓﺷل‬‫اﻟ‬‫ﺳﺣب‬‫اﻷﺳﺗروﺟﯾن‬ ‫ﻧﻘص‬)‫ﻣﺳﺗوﯾﺎت‬‫اﺳﺗرادﯾول‬‫ﻣﻧﺧﻔﺿﺔ‬ ‫اﻟﻣﺻل‬(
‫دوري‬ ‫ھورﻣوﻧﻲ‬ ‫ﻋﻼج‬)estrogen‫و‬progestin(
‫اﻟﻣد‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬‫ﯾدة‬‫ﺑـ‬bromocriptine‫ﺑﻣﺳﺗوﯾﺎت‬ ‫اﻟﻧﺳﺎء‬ ‫ﻋﻧد‬estrogen‫طﺑﯾﻌﯾﺔ‬‫ﻏﯾر‬‫ﻣﺳﺗطﺑﺔ‬.

5/2/2019
MEDICAL THERAPY

5/2/2019
‫اﻻرﻏوت‬ ‫ﻣرﻛﺑﺎت‬
dopamine agonists
Bromocriptine
‫اﻟﺗﺄﺛﯾرات‬
‫اﻟﺟﺎﻧﺑﯾﺔ‬‫اﻷوﻟﯾ‬‫ﺔ‬
‫ﻣرﺗﻔﻌﺔ‬
‫ﺗﻌطﻰ‬ ‫أن‬ ‫ﯾﻣﻛن‬
‫اﻟﻣﮭﺑل‬ ‫ﻋﺑر‬
Cabergoline
‫أﺳﺑوﻋﯾﺎ‬ ‫ﻣرﺗﺎن‬

5/2/2019
‫اﻟﻌﻼج‬ ‫ﯾوﻗف‬
‫ﺑﺎﻟﺑروﻣوﻛرﯾﺑ‬‫ﺗﯾن‬
‫ﺗﺄﻛﯾد‬ ‫ﻋﻧد‬ ‫ﻋﺎدة‬
‫اﻟﺣﻣل‬
‫زﯾﺎدة‬ ‫ﯾﺳﺑب‬ ‫ﻻ‬
‫اﻟﺗﺷوھﺎت‬ ‫ﻓﻲ‬
‫اﻟﺟﻧﯾﻧﯾﺔ‬
‫اﯾﻘﺎف‬ ‫ﯾﻣﻛن‬
‫ﺑﻌد‬ ‫اﻟدواء‬
‫ا‬‫ﻧ‬‫ﺗ‬‫ﮭﺎء‬‫اﻟﺣﻣل‬
‫ﺑﺣدوث‬ ‫ﻟﻠﺳﻣﺎح‬
‫اﻻرﺿﺎع‬
.‫ّم‬‫ﯾ‬‫ﯾﻘ‬ ‫ﻟم‬
Cabergoline
‫ﻛﺎﻓﻲ‬ ‫ﺑﺷﻛل‬
‫ﻟﻺﺳﺗ‬‫أﺛﻧﺎ‬ ‫ﺧدام‬‫ء‬
‫اﻟﺣﻣل‬

5/2/2019
‫اﻟﻄﻤﺚ‬ ‫اﻧﻘﻄﺎع‬‫وﻧﺪرة‬‫ﻣﻊ‬ ‫اﻟﻄﻤﺚ‬
Amenorrhea and Oligomenorrhea with
Normal Estrogen Levels
‫اﻟﻣرﯾﺿﺎت‬ ‫ﻋﻧد‬:
•‫ﺷﻛل‬‫اﻟ‬ ‫ﻣن‬ ‫ﺧﻔﯾف‬‫ﻼ‬‫إ‬‫ﺑﺎﺿﺔ‬‫اﻟوطﺎﺋﯾﺔ‬hypothalamic anovulation:
•‫ﻧﻘص‬‫وزن‬
•‫ﻋﻧﯾﻔﺔ‬ ‫ﺗﻣﺎرﯾن‬
•‫ﺷدة‬‫ﻧﻔﺳﯾﺔ‬
•‫ﺣدﯾث‬ ‫ﺣﻣل‬
•‫اﻻرﺿﺎع‬
•Iatrogenic:‫اﺳﺗﺧدام‬‫ﻟـ‬ ‫ﺣدﯾث‬SOCP‫أو‬Depo Provera
•‫ﺷﻛل‬‫ﻣن‬ ‫ﺧﻔﯾف‬PCOS)‫اﻷﻧدروﺟﯾن‬ ‫زﯾﺎدة‬(
‫ﻋﻧد‬‫ﺑ‬ ‫اﻟرﻏﺑﺔ‬‫ﺎﻟﺣﻣل‬‫اﻟ‬ ‫اﻟﺗدﺑﯾر‬‫ﻣﻼﺋم‬‫ھو‬‫ﺳﺣب‬‫اﻟـ‬progestin‫اﻟدوري‬
‫ﻋﻧد‬‫ﺑﺎﻟﺣﻣل‬ ‫اﻟرﻏﺑﺔ‬ ‫ﻋدم‬‫اﻟ‬ ‫اﻟﺗدﺑﯾر‬‫ﻣﻼﺋم‬‫ھو‬SOCP

5/2/2019
‫ﻣﻊ‬ ‫اﻟﻤﺘﺮاﻓﻖ‬ ‫اﻟﻄﻤﺚ‬ ‫ﻗﻠﺔ‬ ‫و‬ ‫اﻟﻄﻤﺚ‬ ‫اﻧﻘﻄﺎع‬‫ﻓﺮط‬
Amenorrhea and Oligomenorrhea with Hyperandrogenism
ُ‫ط‬ْ‫َر‬‫ﻓ‬‫ﱠﺔ‬‫ﯾ‬‫َﻧدروﺟﯾﻧ‬‫ﻷ‬‫ا‬Hyperandrogenism‫اﻟ‬ ‫ھو‬‫اﻟﺳرﯾري‬ ‫ﺗظﺎھر‬‫ﻹ‬‫رﺗﻔ‬‫ﺎ‬‫ع‬‫ﻣﺳﺗوﯾﺎت‬‫ا‬‫اﻟﻧﺳﺎء‬ ‫ﻋﻧد‬ ‫اﻟذﻛرﯾﺔ‬ ‫ﻟﮭورﻣوﻧﺎت‬
‫اﻟﻌﻼﻣﺎت‬Features
‫ﻓﻲ‬ ‫طﻔﯾﻔﺔ‬ ‫زﯾﺎدة‬‫اﻷ‬ ‫ﻧﻣو‬‫ﺷﻌ‬‫ﺎ‬‫ﻏﯾر‬ ‫ر‬‫اﻟ‬‫ﻣرﻏوب‬‫ﺑﮭﺎ‬
ّ‫د‬‫اﻟﻌ‬
‫اﻟﺛﻌﻠﺑﺔ‬Alopecia
‫اﻷﻛﺛر‬ ‫اﻟﺷﻌراﻧﯾﺔ‬‫اﺗﺳﺎﻋﺎ‬
‫اﻻذﻛﺎر‬
Masculinization
‫اﻟﻧﻣط‬ ‫ﻏﯾﺎب‬‫اﻷ‬‫ﻧ‬‫ﺛو‬‫ي‬‫ﻟ‬‫اﻟﺟﺳم‬ ‫ﺷﺣم‬
‫ﺗراﺟﻊ‬‫ﺣﺟم‬‫اﻷﺛداء‬
‫اﻻﺳﺗرﺟﺎل‬
Virilization
‫ﺻدﻏﻲ‬ ‫ﺻﻠﻊ‬
‫اﻟﺻوت‬ ‫ﺧﺷوﻧﺔ‬
‫اﻟﺑظر‬ ‫ﺿﺧﺎﻣﺔ‬

5/2/2019
Figure 32-2 The Ferriman-Gallwey scoring system for
hirsutism.

5/2/2019
Hyperandrogenic
Disorders

5/2/2019
BOX 32-2 Hyperandrogenic Disorders
‫اﻟﻛظرﯾﺔ‬ ‫اﻟﻐدة‬ ‫اﺿطراﺑﺎت‬Adrenal Disorders
•‫اﻟﺧﻠﻘﻲ‬ ‫اﻟﻛظرﯾﺔ‬ ‫اﻟﻐدة‬ ‫ﺗﺻﻧﻊ‬ ‫ﻓرط‬CAH)(
•‫ﻛوﺷﯾﻧﻎ‬ ‫ﻣﺗﻼزﻣﺔ‬
•‫اﻟﻛظرﯾﺔ‬ ‫اﻟﻐدة‬ ‫وﺳرطﺎﻧﺎت‬ ‫أورام‬
‫اﻟﻣﺑﯾض‬ ‫اﺿطراﺑﺎت‬Ovarian Disorders
•‫اﻟﻛﯾﺳﺎت‬ ‫اﻟﻣﺗﻌدد‬ ‫اﻟﻣﺑﯾض‬ ‫ﻣﺗﻼزﻣﺔ‬)PCOS(
•‫ﻣﺗﻼزﻣﺔ‬HAIR-AN syndrome
•‫اﻟﻣﺑﯾﺿﯾﺔ‬ ‫اﻷورام‬
•‫ﺧﻼﯾﺎ‬ ‫أورام‬Sertoli-Leydig
•‫اﻟﺳرة‬ ‫ﺧﻠﯾﺔ‬ ‫أورام‬Hilus cell tumors
•‫اﻟﺷﺣﻣﯾﺔ‬ ‫اﻟﺧﻼﯾﺎ‬ ‫أورام‬Lipoid cell tumors
‫اﻟﺳﺑب‬ ‫ﻣﺟﮭول‬ ‫اﻟﺷﻌراﻧﯾﺔ‬Idiopathic hirsutism

5/2/2019
ADRENAL
DISORDERS

5/2/2019
‫اﻟﺨﻠﻘﻲ‬ ‫اﻟﻜﻈﺮ‬ ‫ﺗﺼﻨﻊ‬ ‫ﻓﺮط‬
Congenital Adrenal Hyperplasia
•‫اﻟﻛﻼﺳﯾﻛﻲ‬ ‫اﻟﻧﻣط‬Classic:
•‫ﺷدﯾد‬ ‫ﺷﻛل‬‫ﯾ‬‫اﻟﻣﻠﺢ‬ ‫ﻓﻘدان‬ ‫ﺳﺑب‬
•‫اﻟﺑﺳﯾط‬ ‫اﻻﺳﺗرﺟﺎﻟﻲ‬
•‫اﻟﻛﻼﺳﯾﻛﻲ‬ ‫ﻏﯾر‬ ‫اﻟﻧﻣط‬)‫ّر‬‫ﺧ‬‫اﻟﻣﺗﺄ‬ ‫اﻟﺑدء‬ ‫ذو‬(
•‫ﺑﺷذوذات‬ ‫ﯾراﺟﻌن‬ ‫ﻻ‬‫اﻟ‬ ‫اﻷﻋﺿﺎء‬ ‫ﻓﻲ‬‫ﺗﻧﺎﺳﻠﯾﺔ‬
•، ‫ﺑﺎﻟﺷﻌراﻧﯾﺔ‬ ‫ﯾﺻﺑن‬ ‫ﻗد‬‫اﻟﻌد‬‫و‬ ،‫إﺿطراﺑﺎت‬‫وإﺑﺎﺿﯾﺔ‬ ‫طﻣﺛﯾﺔ‬
‫ﻟـ‬ ‫ﺳﺑب‬ ‫أﺷﯾﻊ‬CAH‫ﻋوز‬ ‫ھو‬21-hydroxylase
‫ﻣﺳﺗوى‬ ‫ﺑﺎرﺗﻔﺎع‬ ‫ﯾﺗﺻف‬17-hydroxyprogesterone‫ارﺗﻔﺎع‬ ‫ﻣﻊ‬
‫ﻓﻲ‬Androstenedione‫و‬Testosterone.
‫ﻣﻘﮭورة‬ ‫ﺟﺳﻣﯾﺔ‬ ‫ﻛﺻﻔﺔ‬ ‫ﯾورث‬

Cushing's Syndrome
5/2/2019
‫اﻟﻛورﺗﯾزول‬ ‫ﻓرط‬hypercortisolism‫اﻟ‬‫ﻣﺳﺗﻣر‬
‫اﻟوﺻﻔﯾﺔ‬ ‫اﻟﻌﻼﻣﺎت‬Characteristic cushingoid signs
•‫ﺟذﻋﯾﺔ‬ ‫ﺑداﻧﺔ‬Truncal obesity
•‫اﻟﺑدري‬ ‫اﻟوﺟﮫ‬Moon-like faces
•‫ﺷرﯾﺎﻧﻲ‬ ‫ﺗوﺗر‬ ‫ﻓرط‬
•‫اﻟﺗﻛدم‬ ‫ﺳﮭوﻟﺔ‬Easy bruisability
•‫اﺿطراب‬‫ﺗﺣﻣل‬‫اﻟﺟﻠوﻛوز‬
•‫اﻟﻌﺿﻠﻲ‬ ‫اﻟﮭزال‬Muscle wasting
•‫اﻟﻌظﺎم‬ ‫ﺗرﻗﻖ‬
•‫اﻟﻔزر‬‫اﻟﺑطﻧﯾﺔ‬Abdominal striae
•‫اﻟ‬‫وﺳﺎدات‬‫اﻟ‬‫و‬ ‫ة‬َ‫ُو‬‫ﻗ‬ْ‫ﱠر‬‫ﺗ‬‫اﻟ‬ َ‫َوق‬‫ﻓ‬ ‫ﺷﺣﻣﯾﺔ‬‫اﻟر‬ ‫اﻟﻔﻘري‬ ‫اﻟﻌﻣود‬‫ﻗ‬‫ﺑ‬‫ﻲ‬Supraclavicular and cervical spinal fat pads
•‫اﻟﺷﻌراﻧﯾﺔ‬
•ّ‫د‬‫اﻟﻌ‬
•‫اﻟطﻣث‬ ‫اﺿطراب‬

5/2/2019
‫ﺗﻧﺷﺄ‬ ‫ﻗد‬
‫ﻣﻔرز‬ ‫ﻛظري‬ ‫ورم‬
‫ﻟﻠﻛورﺗﯾزول‬.
‫ﻟﻠـ‬ ‫ﻣﻔرز‬ ‫ﻧﺧﺎﻣﻲ‬ ‫ﻏدي‬ ‫ورم‬
ACTH)‫ﻣرض‬
‫ﻛوﺷﯾﻧﻎ‬(
‫ﻹ‬ ‫ﻧﺎدر‬ ‫ﺳﺑب‬‫ﺿطراب‬‫اﻟوظﯾﻔﺔ‬
‫اﻟﻧﺳﺎء‬ ‫ﻋﻧد‬ ‫اﻟطﻣﺛﯾﺔ‬

5/2/2019
Adrenal Neoplasms
‫اﻟﺗﻲ‬ ‫اﻟﻛظرﯾﺔ‬ ‫اﻷورام‬
‫ﻓرط‬ ‫ﺗﺳﺑب‬‫اﻷ‬‫ﻧدروﺟﯾﻧﯾ‬‫ﺔ‬
‫ﻧﺎدرة‬ ‫ﺗﻌﺗﺑر‬
‫اﻟﻐدﯾﺔ‬ ‫اﻷورام‬
‫ﻛﻣﯾ‬ ‫ﺗﻔرز‬‫ﺎت‬‫ﻛﺑﯾرة‬
‫ﻣن‬DHEA-S
‫اﻟﻛظر‬ ‫ﻛﺎرﺳﯾﻧوﻣﺎ‬
‫ﻛﺑﯾرة‬ ‫ﻛﻣﯾﺎت‬ ‫ﺗﻔرز‬‫ﻣن‬
‫اﻟﺳﻛرﯾ‬ ‫اﻟﻘﺷراﻧﯾﺎت‬‫ﺔ‬
‫واﻷﻧدروﺟﯾﻧﺎت‬

5/2/2019
OVARIAN
DISORDERS

5/2/2019
Polycystic Ovary Syndrome
PCOS
6-10%‫اﻟـ‬ ‫أﺷﻛﺎل‬ ‫أﺣد‬ ‫ﻟدﯾﮭم‬ ‫اﻟﺗﻧﺎﺳﻠﻲ‬ ‫اﻟﻧﺷﺎط‬ ‫ﺳن‬ ‫ﻓﻲ‬ ‫اﻟﻧﺳﺎء‬ ‫ﻣن‬PCOS
‫ﻣزﻣﻧﺔ‬ ‫ﻣرﺿﯾﺔ‬ ‫ﺣﺎﻟﺔ‬ ‫ھﻲ‬
‫اﺑﺎﺿﺔ‬ ‫ﻧدرة‬ ‫أو‬ ‫اﺑﺎﺿﺔ‬ ‫ﻻ‬+‫اﻻﻧدروﺟﯾن‬ ‫ﻓرط‬ ‫ﻋﻠﻰ‬ ‫ﻣﺧﺑري‬ ‫أو‬ ‫ﺳرﯾري‬ ‫دﻟﯾل‬+‫وﺟ‬ ‫ﻋدم‬‫ود‬
‫ﺣﺎﻟﺔ‬ ‫أي‬ ‫ﻋﻠﻰ‬ ‫دﻟﯾل‬‫أﺧرى‬ ‫ﺗﺣﺗﯾﺔ‬
‫ﻋﺎدة‬ ‫اﻟﺑداﯾﺔ‬‫ﻣﻊ‬‫اﻟﺑﻠوغ‬ ‫ﺳن‬
‫ﻟﻠ‬ ‫ﻗﺎﺑﻠﺔ‬ ‫ﺳﻣﺔ‬ ‫ھﻧﺎك‬‫ﺗ‬‫ور‬‫ﯾ‬‫ث‬‫ﻟـ‬PCOS‫اﻷوﻟﻰ‬ ‫اﻟدرﺟﺔ‬ ‫ﻣن‬ ‫اﻷﻗرﺑﺎء‬ ‫ﻟﺗﺄﺛر‬ ‫ﻋﺎﻟﻲ‬ ‫اﺣﺗﻣﺎل‬ ‫ﻣﻊ‬
.
27/08/1440

5/2/2019
PCOS

5/2/2019
‫اﻟﻣرﯾﺿﺎت‬ ‫ﻣﻌظم‬ ‫ﻓﻲ‬
•‫ﻓﻌﺎﻟﺔ‬ ‫ﻏﯾر‬ ‫ﺟرﯾﺑﯾﺔ‬ ‫ﻛﯾﺳﺎت‬ ‫ﻋدة‬
•‫ﻣﺣﯾطﯾﺎ‬ ‫اﻟﻛﯾﺳﺎت‬ ‫ھذه‬ ‫ﺗﺗوﺿﻊ‬)‫ﻋﻘد‬‫اﻟﻠؤﻟ‬‫ؤ‬(
•‫اﻟﺗﺻﻧﻊ‬ ‫ﻣﻔرطﺔ‬ ‫اﻟﻣﺑﯾض‬ ‫ﻟﺣﻣﺔ‬
‫ﺣو‬‫ا‬‫ﻟ‬‫ﻲ‬20%‫اﻟﻧﺳﺎء‬ ‫ﻣن‬‫ھورﻣوﻧﯾ‬ ‫اﻟطﺑﯾﻌﯾﺎت‬‫ﺎ‬
‫ﯾ‬ ‫ﻗد‬‫وﺟد‬‫ﻋﻧدھ‬‫ن‬‫ﻣﺑﯾﺿ‬‫ﯾن‬‫ﻣﺗﻌدد‬ ‫ﺑﻣظﮭر‬
‫اﻟﻛﯾﺳﺎت‬
Figure 32-3 Transvaginal ultrasound in a woman with
PCO disease. The multiple subcapsular cysts, with their
"string of pearls" appearance (arrows), are common in
this syndrome.

5/2/2019
•‫زﯾﺎدة‬‫إﻓراز‬GnRH
•‫ﻟـ‬ ‫اﻟﻧﺧﺎﻣﺔ‬ ‫ّﺎﺳﯾﺔ‬‫ﺳ‬‫ﺣ‬ ‫زﯾﺎدة‬GnRH.
‫اﻟﻣرﯾﺿﺎت‬ ‫ﺗﺑدي‬‫زﯾﺎدة‬‫ﻓﻲ‬‫ﺗواﺗر‬‫ﻧﺑﺿ‬‫ﺎت‬‫اﻟـ‬LHLH

5/2/2019
LHAD and T‫رة‬ّ‫اﻟﻣﺗطو‬ ‫اﻷﺟرﺑﺔ‬ ‫ﻣن‬ ‫اﻟﻛﺛﯾر‬ ‫رﺗﻖ‬‫و‬‫ﯾﻌرﻗل‬
‫اﻟﻣ‬ ‫ﻟﻠﺟراب‬ ‫اﻟطﺑﯾﻌﻲ‬ ‫اﻟﺗطور‬‫ﺳ‬‫ﯾ‬‫طر‬‫ﻓﻲ‬‫اﻷ‬ ‫ﻣﻌظم‬‫وﻗ‬‫ﺎ‬‫ت‬
‫إﻟﻰ‬ ‫ﻟﻼﻧدروﺟﯾن‬ ‫اﻟﺧﺎرﺟﻲ‬ ‫اﻟﺗﺣوﯾل‬‫إﺳﺗروﺟﯾن‬‫ﻣﺳﺗوﯾﺎت‬‫ﯾﺔ‬ّ‫ﻣﻘو‬‫ﻣن‬
‫اﻹﺳﺗروﺟﯾن‬‫إطﻼق‬ ‫ﺗﺛﺑط‬FSH‫دﻓﻘﺔ‬ ‫ﺣدوث‬ ‫ﻋدم‬LH‫ﻻ‬‫اﺑﺎﺿﺔ‬
‫ﺑﻌض‬‫اﻟ‬‫ﺑﺎﻹﺿ‬ ‫اﻟﻛظرﯾﺔ‬ ‫اﻟﻐدد‬ ‫ﻣن‬ ‫اﻻﻧدروﺟﯾن‬ ‫إﻧﺗﺎج‬ ‫ﻓﻲ‬ ‫زﯾﺎدة‬ ‫ﻋﻧدھن‬ ‫ﻣرﯾﺿﺎت‬‫ﺎﻓﺔ‬
‫اﻟﻣﺑﯾﺿﯾن‬ ‫إﻟﻰ‬

5/2/2019
‫ﺑﯾن‬ ‫ﺗراﻓﻖ‬ ‫ھﻧﺎك‬‫اﻟﺷﺎذ‬ ‫اﻻﻧدروﺟﯾن‬ ‫إﻧﺗﺎج‬‫و‬‫اﻷﻧﺳوﻟﯾن‬ ‫ﻣﻘﺎوﻣﺔ‬‫ﻣﻊ‬‫اﻷﻧﺳ‬ ‫ﻓرط‬‫وﻟﯾﻧﯾﺔ‬
‫اﻟﻣرﺗﻔﻌﺔ‬ ‫واﻻﻧﺳوﻟﯾن‬ ‫اﻻﻧدروﺟﯾن‬ ‫ﻣﺳﺗوﯾﺎت‬‫وإﻓراز‬ ‫إﻧﺗﺎج‬SHBG
‫اﻟﺣر‬ ‫اﻟﺗﺳﺗوﺳﺗﯾرون‬
‫اﻷﻧﺳوﻟﯾن‬ ‫ﻣﻘﺎوﻣﺔ‬‫اﻹﺳﺗﻘﻼ‬ ‫ﻟﻠﻣﺗﻼزﻣﺔ‬ ‫اﻟﺧطر‬‫ﺑﯾﺔ‬
‫اﻻﺳﺗروﺟﯾن‬‫اﻟﻣﻌﺎﻛس‬ ‫ﻏﯾر‬‫وﺳرطﺎن‬ ‫اﻟرﺣم‬ ‫ﺑطﺎﻧﺔ‬ ‫ﻓﻲ‬ ‫ﺗﺻﻧﻊ‬ ‫ﻓرط‬ ‫ﯾﺳﺑب‬ ‫ﻗد‬‫ﺑطﺎﻧﺔ‬
‫اﻷﺣﯾﺎن‬ ‫ﺑﻌض‬ ‫ﻓﻲ‬ ‫اﻟرﺣم‬.

5/2/2019
•‫ﻣﺎ‬ ‫ﺣد‬ ‫إﻟﻰ‬ ‫ﻟﻠﺟدل‬ ‫ﻣﺛﯾر‬.
•‫ﺑﺎﻟﻧﻔﻲ‬ ‫ﺗﺷﺧﯾص‬ ‫ھو‬.
•‫وھوأﯾﺿﺎ‬‫ﻣﺗﻼزﻣﺔ‬
•‫ﺗﻌ‬‫ﺗﺑر‬‫ا‬ ‫وﻋﻠم‬ ‫ﻟﻠﺧﺻوﺑﺔ‬ ‫اﻷوروﺑﯾﺔ‬ ‫اﻟﺟﻣﻌﯾﺔ‬‫ﻷﺟﻧﺔ‬
‫اﻟـ‬PCOS‫ﻣوﺟودا‬ ‫ﯾﻛون‬ ‫أﻧﮫ‬‫وﺟود‬ ‫ﻋﻧد‬:
•‫ﺷﺎذة‬ ‫اﺑﺎﺿﺔ‬)‫واﺿﺣﺔ‬ ‫طﻣث‬ ‫ﻧدرة‬ ‫ﻣﻊ‬ ‫ﻋﺎدة‬
‫ﺳرﯾرﯾﺎ‬(
•‫اﻷﻧدروﺟﯾن‬ ‫ﻓرط‬ ‫ﻋﻼﻣﺎت‬.
•‫اﻟﻛﯾﺳﺎت‬ ‫ﻣﺗﻌددة‬ ‫ﻣﺑﺎﯾض‬.
•‫اﻟﻌﻼﻣﺎت‬ ‫ﻟﮭذه‬ ‫اﻷﺧرى‬ ‫اﻷﺳﺑﺎب‬ ‫ﻧﻔﻲ‬ ‫ﺑﻌد‬
‫ﺗﺷﺧﯾص‬
‫اﻟـ‬PCOS

5/2/2019
Ovarian Neoplasms
‫اﻟﺣدوث‬1/500
‫ﻣﺻﺎﺑﺔ‬ ‫إﻣرأة‬
‫ﺑﺎﻟﺷﻌراﻧﯾﺔ‬
‫اﻟﻣﺑﯾض‬ ‫أورام‬‫اﻟﻣﻧﺗﺟﺔ‬
‫ﺟدا‬ ‫ﻧﺎدرة‬ ‫ﻟﻸﻧدروﺟﯾن‬

5/2/2019
IDIOPATHICHIRSUTISM
(constitutional hirsutism)
‫ﺧﻔﯾﻔﺔ‬ ‫ﺷﻌراﻧﯾﺔ‬‫إﻟﻰ‬‫ﻣﻌﺗد‬‫ﻟﺔ‬
‫ﻓﻲ‬ ‫ارﺗﻔﺎع‬ ‫ﺑدون‬‫ا‬‫ﻷﻧدروﺟﯾ‬‫ن‬
‫أو‬‫ﺷﺎذة‬ ‫إﺑﺎﺿﺔ‬
‫ﻟز‬ ‫ﻛﻧﺗﯾﺟﺔ‬‫ﯾ‬‫ﺎد‬‫ا‬ ‫ة‬‫ﻟﺗﺣول‬
‫اﻟﻧﺳﯾﺟﻲ‬‫ﻟﻠﺗﯾﺳﺗوﺳﺗﯾر‬‫إﻟﻰ‬ ‫ون‬
DHT
‫اﻟﺷﻌراﻧﯾ‬ ‫ﺗﻛون‬ ‫أن‬ ‫اﻟﻧﺎدر‬ ‫ﻣن‬‫ﺔ‬
‫اﻟﺣﻘﯾﻘﯾﺔ‬True‫و‬ ‫ﺑﻧﯾوﯾﺔ‬
‫ﺗﻘرﯾﺑﺎ‬ ‫داﺋم‬ ‫ﺑﺷﻛل‬ ‫ﺗﺷﯾر‬‫إﻟﻰ‬
‫ﺗﺣﺗﻲ‬ ‫وﺟﯾﻧﻲ‬ ‫أﻧدر‬ ‫اﺿطراب‬
‫ﻋﻧد‬‫اﻟﻧﺳﺎء‬.

5/2/2019
Disorder Notable Diagnostic
Findings
Examples Notable Clinical Features
Amenorrhea/Oligomenorrhea with Breast Development and Normal Müllerian Structures
Pregnancy Positive pregnancy test
Uterine defects Intrauterine scarring on
hysterosalpingogram
Asherman's syndrome Fertility problems
Hypoestrogenism Low serum estrogen levels
Hypopituitary dysfunction Low FSH, LH, and prolactin;
other hormone deficiencies
should be ruled out
Excessive exercise (runner's
amenorrhea); anorexia
nervosa
Lean body mass; anorexia
nervosa is primarily a
psychiatric disorder with
significant mortality
Premature ovarian failure Elevated serum FSH, low
serum estrogen, karyotype
indicated if age < 30 yr
Autoimmune premature
ovarian failure
Age <40 yr
Hyperprolactinemia Elevated serum prolactin Pituitary adenoma; empty
sella syndrome;
hypothyroidism; drugs;
others (see Box 32-2)
Galactorrhea
Normal estrogen and
amenorrhea
Normal hormone levels Mild hypothalamic
amenorrhea; exercise,
nutrition, stress,
hypothyroidism
Hyperandrogenism Elevated androgens
(variable)
Congenital adrenal
hyperplasia; polycystic ovary
syndrome; HAIR-AN
syndrome; others (see Box
32-2)
Hirsutism, acne, insulin
resistance, virilization

5/2/2019
HISTORY
‫اﻟوظﯾﻔﯾﺔ‬ ‫اﻻﺿطراﺑﺎت‬‫اﻟوظﯾﻔﯾﺔ‬ ‫اﻻﺿطراﺑﺎت‬
‫ﻣرة‬ ‫ﻷول‬ ‫ﺗظﮭر‬ ‫ﻣﺎ‬ ‫ﻏﺎﻟﺑﺎ‬
‫اﻟﺑﻠوغ‬ ‫ﻓﺗرة‬ ‫ﺧﻼل‬
‫ﺗﻣﯾل‬‫ﺑﺑط‬ ‫اﻟﺗطور‬ ‫إﻟﻰ‬‫ء‬
‫زﯾﺎدة‬ ‫ﻋﻼﻣﺎت‬ ‫ﺗﺗطور‬
‫ﻣدى‬ ‫ﻋﻠﻰ‬ ‫اﻻﻧدروﺟﯾن‬
‫ﺳﻧوات‬ ‫ﻋدة‬
‫اﻟورﻣﯾﺔ‬ ‫اﻹﺿطراﺑﺎت‬
‫وﻗت‬ ‫أي‬ ‫ﻓﻲ‬ ‫ﺗﺣدث‬ ‫أن‬ ‫ﯾﻣﻛن‬
‫ﻓﻲ‬ ‫ﺗﻧﺷﺄ‬‫اﻟﺣﺎﻻت‬ ‫ﻣﻌظم‬‫ﺑﻌ‬‫د‬
‫ﺑﺳﻧوات‬ ‫اﻟﺑﻠوغ‬
‫ﺗظﮭر‬‫ﻋﻼﻣﺎﺗﮭﺎ‬‫ﻓﺟﺄة‬
‫اﻟ‬‫ﺳرﯾﻊ‬ ‫ﺗطور‬
‫اﻷﺣﯾﺎن‬ ‫ﻣن‬ ‫ﻛﺛﯾر‬ ‫ﻓﻲ‬ ‫ﯾراﺟﻌن‬
‫اﻟﺑدء‬ ‫ﺣدﯾث‬ ‫اﺳﺗرﺟﺎل‬ ‫ﻣﻊ‬

5/2/2019
PHYSICAL EXAMINATION
‫درﺟﺔ‬ ‫ﺗﻘﯾﯾم‬ ‫ﯾﺟب‬
‫اﻟﺷ‬ ّ‫ﺣب‬ ، ‫اﻟﺷﻌراﻧﯾﺔ‬‫ﺑﺎب‬
‫ّﻌﻠﺑﺔ‬‫ﺛ‬‫اﻟ‬ ‫أو‬ ،
‫اﻻﻧدروﺟﯾﻧﯾﺔ‬
‫ّﯾﺔ‬‫ﻗ‬‫اﻟدر‬ ‫ّة‬‫د‬‫اﻟﻐ‬ ‫ﺟس‬
‫ﻟﻠﺿﺧﺎﻣﺔ‬
‫اﻟﻣرﯾﺿﺎت‬ ‫ﺳؤال‬ ‫ﯾﺟب‬
‫اﻟ‬ ‫اﻟوﺟﮫ‬ ‫ﺷﻌر‬ ‫ﻋن‬‫ز‬‫اﺋ‬‫د‬
‫واﺿﺢ‬ ‫ﺑﺷﻛل‬
‫ﻣﻼﺣظﺔ‬ ‫ﯾﺟب‬‫ﻋﻼﻣﺎت‬
‫ﻛوﺷﯾﻧﻎ‬
‫اﻻﺳود‬ ‫اﻟﺷواك‬
Acanthosis
nigricans
‫اﻟﻣس‬ ‫ﯾﻛﺷف‬ ‫ﻗد‬
‫ﺑﺎﻟﺟس‬ ‫اﻟﻣﺷرك‬
‫ﺿﺧﺎﻣﺔ‬ ‫ﻟﻠﺣوض‬
‫ﻣﺑﯾﺿﯾﺔ‬

5/2/2019
‫اﻟﻣﺧﺑري‬ ‫اﻟﺗﻘﯾﯾم‬ ‫ﯾﮭدف‬
‫إﻟﻰ‬ ‫ﻣﺑدﺋﯾﺎ‬‫اﺳﺗﺑﻌﺎد‬
‫اﻟﺧطرة‬ ‫اﻻﺿطراﺑﺎت‬
CAH
17-OH.P<ng / mL2
‫ﻋﯾﺎر‬17-OH.P‫اﺧﺗﺑﺎر‬ ‫ﺑﻌد‬
‫ﺑـ‬ ‫اﻟﺗﺣرﯾض‬ACTH
Cushing's
syndrome
‫ﺑ‬ ‫ﻓﻲ‬ ‫اﻟﺣر‬ ‫اﻟﻛورﺗﯾزول‬ ‫ﻋﯾﺎر‬‫ول‬
24‫ﺳﺎﻋﺔ‬
‫اﺧﺗﺑﺎر‬ ‫إﺟراء‬
overnight
dexamethasone
suppression

5/2/2019
•Prolactin and TSH ‫ﺑد‬ ‫أو‬ ‫ﻣﻊ‬ ‫اﻟﺑروﻻﻛﺗﯾن‬ ‫ارﺗﻔﺎع‬‫ون‬
‫ّﻲ‬‫ﻗ‬‫در‬ ‫وظﯾﻔﻲ‬ ‫ﺧﻠل‬
•‫ﻋﯾﺎر‬‫ﻣﺳﺗوﯾﺎت‬‫واﻟﺣر‬ ّ‫ﻲ‬‫اﻟﻛﻠ‬ ‫اﻟﺗﯾﺳﺗوﺳﺗﯾرون‬‫و‬DHEA-S‫اﻟﻣﺻل‬ ‫ﻓﻲ‬.
•DHEA-S<7000 ng/mL‫أو‬ّ‫ﻲ‬‫اﻟﻛﻠ‬ ‫اﻟﺗﯾﺳﺗوﺳﺗﯾرون‬<200
ng/dL‫ﺑ‬ ‫ﻛﺑﯾر‬ ‫ﺑﺷﻛل‬ ‫اﻟﺷك‬ ‫ﺗﺛﯾر‬‫ﻣﻧﺗﺞ‬ ‫ﻣﺑﯾﺿﻲ‬ ‫أو‬ ‫ﻛظري‬ ‫ورم‬
‫ﻟﻸﻧدروﺟﯾن‬.
•‫أﻓﺿل‬‫ھو‬ ، ‫ﻟﻸﻧدروﺟﯾن‬ ‫اﻟﻣﻔرز‬ ‫ﻟﻠورم‬ ‫ﻣﻧﺑﺊ‬‫اﻟﺳرﯾرﯾﺔ‬ ‫اﻟﺻورة‬.
•‫ﺗوﺟد‬‫ﻓﻲ‬ ‫اﻻﺳﺗرﺟﺎل‬ ‫ﻋﻼﻣﺎت‬98%‫اﻷورام‬ ‫ﻣرﯾﺿﺎت‬ ‫ﻣن‬
‫ﻟﻔرط‬ ‫واﺿﺣﺔ‬ ‫ﻏﯾر‬ ‫ﻋﻼﻣﺎت‬
‫اﻻﻧدروﺟﯾن‬

‫ﻋﻧد‬ ‫ﺣوض‬ ‫إﯾﻛو‬ ‫إﺟراء‬ ‫ﯾﺟب‬‫اﻟﺧطورة‬ ‫ﻋﺎﻟﯾﯨﺔ‬ ‫ﻋﻼﻣﺎت‬ ‫وﺟود‬‫اﻟﻣﺑﯾﺿﯾﺔ‬ ‫اﻷورام‬ ‫ﻟﻧﻔﻲ‬
‫ﻣﺣوري‬ ‫طﺑﻘﻲ‬ ‫أو‬ ‫ﻣرﻧﺎن‬ ‫إﺟراء‬ ‫ﯾﻣﻛن‬
‫اﻧﺗﻘﺎﺋﯾﺔ‬ ‫ورﯾدﯾﺔ‬ ‫ﻗﺛطرة‬
•‫اﻟﺻﯾﺎﻣﻲ‬ ‫اﻟﺳﻛر‬ ‫ﻣﺳﺗوﯾﺎت‬
•‫اﻟﻔﻣوي‬ ‫اﻟﺳﻛر‬ ‫ﺗﺣﻣل‬ ‫اﺧﺗﺑﺎر‬–2‫ﺳﺎﻋﺔ‬
•‫اﻟﺷﺣوم‬ ‫ﻣﺳﺗوﯾﺎت‬
PCOS :
5/2/2019

‫اﻟورم‬ ‫اﺳﺗﺋﺻﺎل‬ ‫ﯾﺳﺗطب‬
‫اﻟ‬‫ﻣﺑﯾﺿﻲ‬‫أو‬‫اﻟ‬‫ﺟراﺣﯾﺎ‬ ‫ﻛظري‬
‫ﻣﺗﻼزﻣﺔ‬Cushing
‫ﻟ‬ ‫ﺟراﺣﻲ‬ ‫اﺳﺗﺋﺻﺎل‬‫ﻠ‬‫ورم‬
‫اﻟ‬‫أو‬ ‫ﻛظري‬‫اﻟ‬‫ﻧﺧﺎﻣﻲ‬.
5/2/2019
PCOS
‫اﻟﺷﻌراﻧﯾﺔ‬ ‫ﻋﻼج‬‫ھو‬‫اﻟﻣﺑﯾ‬ ‫ﺗﺛﺑﯾط‬‫ض‬
)‫ﻣرﻛب‬ ‫ﺣﻣل‬ ‫ﻣﺎﻧﻊ‬(
‫اﻟﻣﻔرط‬ ‫اﻹﻧﺗﺎج‬ ‫ﺗراﺟﻊ‬
‫ﻟ‬‫ـ‬T‫و‬A‫ﻓﻲ‬‫اﻟﻣﺑﯾض‬
‫ّز‬‫ﻔ‬‫ﯾﺣ‬Estrogen
‫إﻧﺗﺎج‬SHBG
‫اﻟﺗﺳﺗوﺳﺗﯾرون‬
‫اﻟﺣر‬

5/2/2019
‫ﻣﺎ‬ ‫أﻓﺿل‬ ‫اﻟﺷﻌراﻧﯾﺔ‬ ‫ﻋﻼج‬‫ﯾ‬‫ﺑﺈﺿﺎﻓﺔ‬ ‫ﺗﺣﻘﻖ‬‫ﻟﻸﻧدر‬ ‫ﺣﺎﺻر‬‫وﺟﯾن‬
•Spironolactone
•‫اﻷﻟدوﺳﺗﯾرون‬ ‫ﻣﺿﺎدات‬Aldosterone antagonist
•‫ﻟﻠﺗﺳﺗوﺳﺗﯾرون‬ ‫اﻟراﺑطﺔ‬ ‫اﻟﻣواﻗﻊ‬ ‫ﯾﻧﺎﻓس‬‫ﻟﻸﻧدروﺟﯾن‬ ‫ﻣﺿﺎد‬ ‫ﻣﺑﺎﺷر‬ ‫ﺗﺄﺛﯾر‬ ‫ﯾﻣﺎرس‬.
•‫إﻧﺗﺎج‬ ‫وﯾﻧﻘص‬ ‫اﻟﺳﺗﯾروﺋﯾدات‬ ‫إﻧزﯾﻣﺎت‬ ‫ﻓﻲ‬ ‫ّل‬‫ﺧ‬‫ﯾﺗد‬‫اﻟ‬‫ﺗﺳﺗوﺳﺗﯾرون‬
•‫ﯾﺟب‬‫ﻣ‬‫راﻗﺑ‬‫ﺔ‬‫اﻟﻣﺻل‬ ‫ﺑوﺗﺎﺳﯾوم‬ ‫ﻣﺳﺗوﯾﺎت‬
•Flutamide and cyproterone acetate
•Finasteride
‫ﯾﺳﺗﻐرق‬ ‫ﻗد‬‫اﻟﻌﻼج‬6‫أ‬‫اﻟﺗﺄﺛ‬ ‫ﯾرى‬ ‫ﻻ‬ ‫ﻗد‬ ‫و‬ ، ‫اﻟﺷﻌراﻧﯾﺔ‬ ‫ﻓﻲ‬ ‫اﻟﺟﻣﺎﻟﻲ‬ ‫اﻟﺗﺣﺳن‬ ‫ﺑﻣﻼﺣظﺔ‬ ‫ﻟﻠﺑدء‬ ‫ﺷﮭر‬‫ﯾر‬
‫ﺣﺗﻰ‬ ‫ﺗﺻل‬ ‫ﻟﻣدة‬ ‫اﻷﻋظﻣﻲ‬‫اﻟ‬‫ﺳﻧﺗ‬‫ﯾ‬‫ن‬.

5/2/2019
ّ‫ذ‬‫اﻟﺷﺎ‬ ‫اﻷﻧدروﺟﯾن‬ ‫أوﻋﻣل‬ ‫إﻧﺗﺎج‬ ‫ﺗﺛﺑﯾط‬‫ﻋ‬ ‫ﯾوﻗف‬‫ﻣوﻣﺎ‬
‫اﻟﻣﺳﺗﻘﺑﻠﻲ‬ ‫اﻟﺷﻌر‬ ‫ﻧﻣو‬‫اﻹﺧﺗﻔﺎ‬ ‫ّب‬‫ﺑ‬‫ﯾﺳ‬ ‫ﻻ‬ ‫ﻟﻛن‬‫اﻟﻔوري‬ ‫ء‬
‫اﻟﻣوﺟودة‬ ‫ﻟﻼﺷﻌﺎر‬
‫ﺟﯾدة‬ ‫ﺗﺟﻣﯾﻠﯾﺔ‬ ‫ﻧﺗﺎﺋﺞ‬ ‫ﻋﻠﻰ‬ ‫ﻟﻠﺣﺻول‬،‫ا‬ ‫إزاﻟﺔ‬ ‫ﯾﺟب‬‫ﻟﺷﻌر‬
‫ﻋﺎدة‬ ‫اﻟﻣوﺿﻌﻲ‬‫اﻟﻛﯾﻣﯾﺎوﯾ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫إﻟﻰ‬ ‫ﺑﺎﻹﺿﺎﻓﺔ‬‫ﺔ‬
‫اﻟﺣﯾوﯾﺔ‬

5/2/2019
‫ﻣرﯾﺿﺎت‬ ‫ﻋﻧد‬ ‫اﻟﺗﺣﺗﯾﺔ‬ ‫اﻷﻧدروﺟﯾن‬ ‫وﻓرط‬ ‫اﻷﻧﺳﯾوﻟﯾن‬ ‫ﻟﻣﻘﺎوﻣﺔ‬ ‫إن‬PCOSّ‫م‬‫ﺗﺄﺛﯾرھﺎ‬
‫ﺧطورﺗﮭ‬ ‫ﻋﻠﻰ‬‫ن‬‫اﻟﻣﺣﺗﻣﻠﺔ‬ ‫اﻟوﻋﺎﺋﯾﺔ‬ ‫اﻟﻘﻠﺑﯾﺔ‬ ‫واﻟﻣراﺿﺔ‬ ‫ّري‬‫ﻛ‬‫اﻟﺳ‬ ‫ﻟﻠداء‬
‫ﻣﻊ‬ ‫اﻟﻧﺳﺎء‬PCOS‫إﻟﻰ‬ ‫أﯾﺿﺎ‬ ‫ﯾﻣﻠن‬ ‫اﻷﻧدروﺟﯾن‬ ‫وﻓرط‬‫زﯾﺎدة‬‫ﻣﺳﺗوﯾﺎت‬( LDL
cholesterol )‫وإﻧﺧﻔﺎض‬‫ﻣﺳﺗوﯾﺎت‬(HDL cholesterol)
‫اﻟﺷرﯾﺎﻧﻲ‬ ‫اﻟﺗوﺗر‬ ‫ارﺗﻔﺎع‬ ‫ﻟﺣدوث‬ ‫ﻋﺎﻟﯾﺔ‬ ‫ﺧطورة‬ ‫ﻋﻧدھن‬.

5/2/2019
CAH
‫اﻟﻘﺷرﯾﺔ‬ ‫اﻟﺳﺗﯾروﺋﯾدات‬)‫اﻟدﻛﺳﺎﻣﯾﺗﺎزو‬‫ن‬(
‫ﺣﻣل‬ ‫ﻣواﻧﻊ‬
‫ﻓﻣوﯾﺔ‬
‫أﻧدروﺟﯾﻧﯾﺔ‬ ‫ﻣﺿﺎدات‬

32 amenorrhea, oligomenorrhea, and hyperandrogenic disorders dr.hisham al hammami 2020 powerpoint

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to 32 amenorrhea, oligomenorrhea, and hyperandrogenic disorders dr.hisham al hammami 2020 powerpoint

Similar to 32 amenorrhea, oligomenorrhea, and hyperandrogenic disorders dr.hisham al hammami 2020 powerpoint (20)

More from Hisham Al-Hammami

More from Hisham Al-Hammami (20)

Recently uploaded

Recently uploaded (20)

32 amenorrhea, oligomenorrhea, and hyperandrogenic disorders dr.hisham al hammami 2020 powerpoint