Gonadal function and dysfunction
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The document discusses male gonadal function and hypogonadism. It covers causes of primary and secondary hypogonadism, including Klinefelter's syndrome and Noonan's syndrome. Symptoms of hypogonadism before and after puberty are described. The challenges of diagnosing and treating hypogonadism in aging males are also covered, along with monitoring of testosterone replacement therapy and other treatment options.
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- MRI brain
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Pharmacotherapy of Male Sex hormones & Drugs use in Erectile dysfunction(ED)
This document provides information about androgens and anti-androgens. It discusses the sources and types of androgens like testosterone and their effects. It describes treatments for androgen excess like finasteride and ketoconazole which inhibit testosterone synthesis. It also discusses treatments for erectile dysfunction including phosphodiesterase-5 inhibitors like sildenafil, tadalafil and vardenafil which improve blood flow to the penis. The document outlines their dosages, onset of action, duration of effects and potential side effects.
Lect 2-polycystic ovarian syndrome
Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by increased androgen production and irregular menstrual cycles. PCOS is associated with infertility, hirsutism, insulin resistance, obesity, and increased risk of diabetes and heart disease. Diagnosis is based on hyperandrogenism, chronic anovulation or oligomenorrhea, and exclusion of other disorders. Treatment focuses on regulating menses, managing insulin resistance and weight loss, and addressing long-term health risks.
Amenorrhea
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.
Andropause
Andropause, also known as male menopause, is the gradual decline in testosterone levels that occurs in men as they age. Unlike female menopause which is sudden, andropause is a slow process resulting in more subtle symptoms. Low testosterone can negatively impact many organ systems and quality of life. Treatment options include lifestyle changes as well as hormone replacement therapy administered through oral, injectable, or transdermal methods. However, testosterone therapy may increase risks for certain health conditions like sleep apnea and prostate issues.
L6-8.Disorders of the reproductive system.pptx
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).
Sex hormones (Male)
Points:
Male Sex Hormone - Androgens (Mainly Testosterone)
Synthesis, Regulation & metabolism (By both Hypothalamus & Pituitory gland)
Various Action/ Physiological roles over:
1. Sex organs and secondary sex characters (Androgenic)
2. Testes
3. Skeleton and skeletal muscles (Anabolic)
4. Erythropoiesis
Anabolic Steroids & their uses
Antiandrogens (Classification, MOA & Uses)
Drugs for erectile dysfunction (MOA & Uses)
Main Male Sex Hormone is Testosterone which converts into its highly active form i.e. dihydrotestosteron (DHT).
Main Female Sex Hormones are Estrogen & Progesterone.
CLINICAL DIAGNOSIS AND MANAGEMENT OF AMENORRHOEA BY DR SHASHWAT JANI
This clinical document provides guidelines for evaluating and managing amenorrhea. It defines primary and secondary amenorrhea and outlines the pathophysiology. The evaluation involves assessing the patient's history, physical exam, ultrasound and hormonal levels. Common causes include polycystic ovary syndrome, premature ovarian failure, hypothalamic issues, weight-related causes, and structural issues. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues from estrogen deficiency.
Gonadal horomone disorders
This document discusses gonadal hormone disorders and abnormalities in both males and females. It covers topics like hypothalamic-pituitary-gonadal axis function in males, male reproductive abnormalities classified into 5 types, defects in androgen action, and female reproductive abnormalities including polycystic ovary syndrome, amenorrhea, precocious puberty, hirsutism, and virilization. Causes, features, and diagnostic evaluation of each condition are described in detail. Congenital adrenal hyperplasia is also explained as a common cause of female pseudohermaphroditism.
Hypogonadotropic Hypogonadism
Hypogonadism is characterized by impaired testicular function and can affect sperm production and testosterone synthesis. It has three main categories: primary hypogonadism due to testicular failure, secondary (hypogonadotropic) hypogonadism caused by insufficient gonadotropin secretion, and androgen insensitivity. Hypogonadotropic hypogonadism is rare and can be congenital or acquired. Kallmann syndrome results from GnRH deficiency due to failed embryonic migration and causes anosmia and azoospermia. Prader-Willi syndrome is caused by chromosome abnormalities and results in obesity, short stature, and cryptorchidism. Treatment of hypogonadotropic hyp
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Sexual dysfunction, infertility, contraception, male breast; climacteric changes
Sexual dysfunction, infertility, contraception, male breast; climacteric changes
Pharmacotherapy of Male Sex hormones & Drugs use in Erectile dysfunction(ED)
Pharmacotherapy of Male Sex hormones & Drugs use in Erectile dysfunction(ED)
CLINICAL DIAGNOSIS AND MANAGEMENT OF AMENORRHOEA BY DR SHASHWAT JANI
CLINICAL DIAGNOSIS AND MANAGEMENT OF AMENORRHOEA BY DR SHASHWAT JANI
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Gestational diabetes
Gestational diabetes (GDM) is glucose intolerance first identified during pregnancy. Risk factors include BMI over 30, previous large or diabetic baby, family history of diabetes. GDM is identified through a 75g oral glucose tolerance test. It is associated with risks like large baby, shoulder dystocia, preeclampsia. Treatment like insulin lowers risks. Other types of diabetes may present as GDM and require identification. Mild maternal hyperglycemia increases risks incrementally without a clear threshold.
Endocrine disease in pregnancy
This document discusses the management of various endocrine diseases in pregnancy, including hypothyroidism, hyperthyroidism, prolactinoma, and Addison's disease. It provides guidance on treatment, monitoring, risks of under-treatment, and complications for each condition. Case examples are presented and management strategies are outlined, emphasizing the importance of optimizing treatment to reduce risks while minimizing harm to the mother and fetus. Close monitoring is recommended for conditions like Graves' disease and prolactinoma.
Diabetes in pregnancy
This document discusses diabetes in pregnancy, including:
- Risks to the mother include acceleration of complications like eye and kidney disease, as well as risks of hypoglycemia, pre-eclampsia, and obstetric complications.
- Risks to the fetus include congenital malformations, macrosomia, stillbirth, neonatal death, and issues like hypoglycemia and jaundice after birth.
- Management involves tight glycemic control, aspirin, monitoring for complications, and delivery planning based on gestational age and fetal growth. Acute issues like hypoglycemia and diabetic ketoacidosis require prompt treatment.
Hypoglycaemia in older people
- Hypoglycemia is more common in older adults treated with insulin or sulphonylureas and can be difficult to recognize due to non-specific symptoms. Unexplained falls, unsteadiness, or nausea may indicate unrecognized hypoglycemia.
- Maintaining tight glycemic control with aggressive HbA1c targets increases hypoglycemia risk in older adults. Guidelines recommend less stringent HbA1c targets for older patients based on functional status and comorbidities.
- Glucose variability in addition to average blood sugar levels affects hypoglycemia risk. Measuring endogenous insulin levels may help identify patients at risk of hypoglycemia due to absolute insulin deficiency.
Diabetes in the elderly
This document discusses diabetes management in the elderly population. It highlights that life expectancy is lower for those with type 1 diabetes compared to those without. A study on elderly patients who received awards for long-term diabetes found identifiers of long survival included reasonable blood sugar control, normal weight, and being non-smokers. Guidelines recommend individualized care plans for elderly patients in care homes that are agreed upon by the patient, doctor, and home staff. An audit found that some care home staff lacked diabetes education and homes did not always have policies for treating low blood sugar. Management of diabetes in the elderly aims to avoid low blood sugar, control symptoms, and reduce risks of infection and hospitalization.
Primary hyperaldosteronism - arterial venous sampling cases
This document discusses three patient cases presenting with resistant hypertension. Case 1 involves a 49-year-old female with obesity and resistant hypertension who shows signs of primary aldosteronism based on blood tests. Case 2 is a 53-year-old female with a 10-year history of resistant hypertension, low potassium levels, and imaging showing a lesion on her left adrenal gland. Case 3 is a 55-year-old male with resistant hypertension and normal potassium who was confirmed to have primary aldosteronism based on salt loading tests, but no adrenal lesion was seen on imaging. All three patients underwent adrenal vein sampling to further evaluate their condition.
Calcium metabolism handout
This document summarizes the key components involved in vitamin D and calcium homeostasis, including the roles of vitamin D, parathyroid hormone (PTH), and calcitonin. It discusses how vitamin D is obtained from sunlight or diet and activated in the body. PTH and calcitonin work in opposition to regulate calcium levels - PTH increases calcium levels by acting on the kidneys and bone, while calcitonin decreases calcium levels by inhibiting bone resorption. PTH and vitamin D also interact, as vitamin D helps absorb calcium from the gut and PTH stimulates its production. Together this maintains appropriate calcium and phosphate levels in the blood and body.
Calcium metabolism handout
This document discusses calcium homeostasis and disorders, including hypercalcemia and hyperparathyroidism. It provides details on the roles of parathyroid hormone (PTH), vitamin D, and calcitonin in regulating calcium levels. It examines causes of hypercalcemia such as primary hyperparathyroidism, malignancy, and vitamin D toxicity. Guidelines for treatment of asymptomatic primary hyperparathyroidism with surgery or medication are reviewed based on calcium levels, bone mineral density, kidney stones, and age. Non-surgical treatments including vitamin D supplementation and cinacalcet are also discussed.
Kallmann syndrome
The document discusses delayed puberty, defined as the absence or incomplete development of secondary sex characteristics past a certain age. It then focuses on hypogonadotrophic hypogonadism, which affects about 1 in 10,000 male births and can be associated with loss of smell. Sixteen gene defects have been linked to Kallmann syndrome. Short term goals of treatment include attaining appropriate sexual development and growth, while long term goals include maintaining normal hormone levels and inducing fertility. Pretreatment with FSH before GnRH therapy has shown promise in inducing testicular growth and fertility in men with congenital hypogonadotropic hypogonadism and underdeveloped testes.
Kallmann syndrome
The document discusses delayed puberty, defined as the absence or incomplete development of secondary sex characteristics past a certain age. It then focuses on hypogonadotrophic hypogonadism, which affects about 1 in 10,000 male births and can be associated with loss of smell. Sixteen gene defects have been linked to Kallmann syndrome. Short term goals of treatment include attaining appropriate sexual development and growth, while long term goals include maintaining normal hormone levels and inducing fertility. Pretreatment with FSH before GnRH therapy has shown promise in inducing testicular growth and fertility in men with congenital hypogonadotropic hypogonadism and underdeveloped testes.
Hypogonadism and testosterone replacement part 2
The FDA is investigating the risks of stroke, heart attack, and death in men taking testosterone products due to two recent studies suggesting increased cardiovascular risks. While the FDA has not concluded testosterone treatment definitively increases these risks, they are reassessing the safety issue. The FDA advises patients to discuss concerns with their healthcare providers and for providers to consider if benefits outweigh potential risks. Testosterone is only approved to treat medical conditions causing low levels like testicular or hypothalamic-pituitary problems.
Erectile dysfunction in diabetes
Erectile dysfunction is common in men with diabetes and tends to be more severe than in non-diabetic men. Screening for ED should be conducted annually as part of diabetes reviews. Asking direct questions such as "Are your erections hard enough for penetration?" can help identify cases of ED. Phosphodiesterase type 5 inhibitors are usually first-line treatment but some men may require additional options or a dose change if initial treatment is not effective. Testosterone deficiency can also contribute to ED in diabetic men.
The role of the podiatrist
The podiatrist plays an important role in assessing risk and treating foot complications in patients with diabetes. Key responsibilities include performing vascular, neurological, and wound assessments; providing debridement and dressing of ulcers; addressing biomechanical issues; and ensuring proper offloading. The podiatrist works as part of a multidisciplinary team to educate patients, treat foot problems, and prevent amputations through a holistic approach to diabetic foot care.
The diabetic foot
This document discusses diabetic foot care and prevention of amputations. It notes that amputations due to diabetes account for significant NHS costs and resources. While up to 80% of amputations are preventable, amputation rates vary widely across the UK. The document examines factors contributing to high amputation rates in some areas like Devon, and opportunities to improve care through measures like the Ipswich Touch Test for inpatient foot screening and better coordination between primary and secondary care. Overall it emphasizes the importance of preventing foot complications in diabetes which can greatly reduce quality of life.
ADVANCE - Type 2 diabetes - vascular risk with intervention
This document summarizes a study that investigated the effects of intensive blood glucose control versus standard control in patients over age 55 with type 2 diabetes. Over 5 years of follow up, intensive control reduced the risk of major macrovascular and microvascular events by 10% compared to standard control. Intensive control also significantly reduced new or worsening nephropathy and new-onset microalbuminuria. However, it increased the risk of severe and minor hypoglycemia. The study found no difference in all-cause or cardiovascular mortality between the intensive and standard control groups.
DCCT/EDIC - Type 1 diabetes - cardiovascular risk with intervention
This document summarizes a study examining the effects of intensive versus conventional diabetes treatment on cardiovascular outcomes in patients with type 1 diabetes over 17 years of follow up. The study found that intensive diabetes treatment during the Diabetes Control and Complications Trial (DCCT) period resulted in lower HbA1c levels and was associated with a lower risk of cardiovascular events over the subsequent 17 years of follow up in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, even as HbA1c levels between the groups converged during EDIC. The "metabolic memory" of intensive control during DCCT appeared to continue protecting against cardiovascular risk long term.
DCCT - Hypoglycemia
The DCCT trial compared intensive versus conventional diabetes treatment in 1,441 patients with type 1 diabetes from 1983 to 1989. The intensive group aimed for tighter blood glucose control through multiple daily insulin injections or pump therapy and frequent self-monitoring. This led to significantly more frequent hypoglycemic events compared to the conventional group, who followed a less strict regimen. Over the course of the trial, the intensive group experienced over 3 times as many hypoglycemic events and over 3 times the risk of hypoglycemic coma or seizure. However, intensive control also demonstrated long-term benefits in reducing diabetes complications.
DCCT overview
This document summarizes a randomized controlled trial that studied the effects of intensive versus conventional diabetes therapy in 1441 patients with type 1 diabetes between 1983-1989. The trial had two arms - a primary prevention arm of patients with diabetes for 1-5 years and no complications, and a secondary prevention arm of patients with diabetes for 1-15 years and some retinopathy or nephropathy. The intensive therapy group achieved significantly lower average blood glucose and HbA1c levels. In both prevention arms, intensive therapy reduced the risk of retinopathy, nephropathy, and neuropathy compared to conventional therapy, with risk reductions ranging from 34-76%. However, intensive therapy also led to higher rates of hypoglycemia.
DCCT – intensive diabetes therapy and glomerular filtration
The DCCT trial compared intensive diabetes therapy to conventional therapy in patients with type 1 diabetes over 22 years. Intensive therapy aimed to achieve an HbA1c level below 6.05% using three or more daily insulin injections or an insulin pump. Conventional therapy aimed to prevent symptoms of hyper/hypoglycemia with one-two daily injections. The trial found intensive therapy reduced the risk of impaired glomerular filtration rate (GFR) by 50% and end-stage renal disease by 50% compared to conventional therapy. Intensive therapy also slowed later GFR decline and increased mean GFR levels. The benefits were fully explained by lower HbA1c and albumin excretion from intensive therapy.
UKPDS overview
The UK Prospective Diabetes Study was a 20-year multicenter randomized controlled trial that investigated the effects of intensive glucose control and tight blood pressure control on diabetes complications. Over 5,000 patients with newly diagnosed type 2 diabetes were recruited between 1977-1991 and followed for a median of 10 years. The study found that intensive glucose control reduced the risk of diabetes complications, particularly microvascular complications, by 10-25%. The blood pressure control study found that tight blood pressure control reduced the risk of diabetes-related endpoints by 24% and strokes by 44% compared to less tight control.
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Gonadal function and dysfunction
- 1. Gonadal function and dysfunction Dr Thomas Fox Endocrine SpR Derriford Hospital
- 8. Male hypogonadism with effects before and after puberty Normal body proportions Eunachoid stature Osteoporosis Delayed bone age Normal hair distribution but poor growth Decreased body and facial hair Central fat distribution Gynaecomastia Gynaecomastia Voice broken High pitched voice Normal penis length Penis <5cm Testes volume <145ml Testes volume <5ml After puberty Before puberty
- 24. Male androgens over time 60-70% testosterone bound to SHBG 30-40% testosterone bound to albumin
- 27. Effects of testosterone replacement in the aging male
- 28. Effects of testosterone replacement in the aging male