details of klinfelter syndrome, noonan syndrome and diseases of pitutary and diseases of hypogonadism and cause of hypogonadism and primary hypogonadism and secondary hypogonadism
Congenital Adrenal Hyperplasia (CAH)
For 5th Year Medical Students and Endocrinology Modules and Master and MD Degree Internal Medicine and Endocrinology
By Dr Usama Ragab Youssif
References: Oxford Handbook of Endocrinology & Diabetes
Male gonadal function and dysfunction (male hypogonadism). Emphasis where made on the causes, types of male hypogonadism, diagnosis and treatment methods.
details of klinfelter syndrome, noonan syndrome and diseases of pitutary and diseases of hypogonadism and cause of hypogonadism and primary hypogonadism and secondary hypogonadism
Congenital Adrenal Hyperplasia (CAH)
For 5th Year Medical Students and Endocrinology Modules and Master and MD Degree Internal Medicine and Endocrinology
By Dr Usama Ragab Youssif
References: Oxford Handbook of Endocrinology & Diabetes
Male gonadal function and dysfunction (male hypogonadism). Emphasis where made on the causes, types of male hypogonadism, diagnosis and treatment methods.
Hirsutism is a common endocrinological disorder in clinical practice. The causes vary from simple idiopathic hirsutism to most complicated malignant ovarian and adrenal tumors. Most common cause of hirsutism in endocrine clinic is due to a disorder known as PCOS (polycystic ovarian syndrome). Hirsutism poses embarrassment to the women. The purpose of this short review is to identify the common diseases associated with hirsutism, an approach to working through the differential diagnosis, investigations helping in diagnosis and the commonly available treatment modalities for the various forms of hirsutism. The review will provide the physician about the most efficient, cost effective and safe clinical approach to management of hirsutism.
Disorders of sex hormones are the disorders occurring due to problem in the areas endocrine system governing hormones related to reproductive system and the organs related to the same.
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).
Hirsutism is a common endocrinological disorder in clinical practice. The causes vary from simple idiopathic hirsutism to most complicated malignant ovarian and adrenal tumors. Most common cause of hirsutism in endocrine clinic is due to a disorder known as PCOS (polycystic ovarian syndrome). Hirsutism poses embarrassment to the women. The purpose of this short review is to identify the common diseases associated with hirsutism, an approach to working through the differential diagnosis, investigations helping in diagnosis and the commonly available treatment modalities for the various forms of hirsutism. The review will provide the physician about the most efficient, cost effective and safe clinical approach to management of hirsutism.
Disorders of sex hormones are the disorders occurring due to problem in the areas endocrine system governing hormones related to reproductive system and the organs related to the same.
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).
Hyperprolactinemia Quiz - Case PresentationUsama Ragab
Hyperprolactinemia Quiz - Hyperprolactinemia Workshop
In light of 3rd Annual Endo-ISMA Conference 2021
By Dr. Usama Ragab Youssif
Importance of History Taking and Hypothyroidism as a cause of hyperprolactinemia
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
DNA Sequencing - DNA sequencing is like reading the instructions inside a cellAmitSamadhiya1
DNA sequencing is like reading the instructions inside a cell. It's figuring out the exact order of the building blocks that make up our DNA, represented by the letters A, T, C, and G. This order is like a code that tells our bodies how to function and grow.
By reading this code, scientists can understand genes, diagnose diseases, and even trace our ancestry. There are different ways to sequence DNA, kind of like having a few different ways to read a book. These techniques are constantly improving, making it faster and easier to unlock the secrets hidden in our DNA.
CELL STRUCTURE, CELL ORGANELLES, CELL FUNCTIONS.
BRIEF IDEA ABOUT CELL STRUCTURE, CELL ORGANELLES AND THEIR FUNCTIONS, COMPARTMENTALIZATION INSIDE CELL
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. CASE SUMMARY –
16 year old girl presents with poor growth for four years. Her growth and
development were normal before this, and her appetite and food intake remain
satisfactory. At age 12, she was a passenger in a motor vehicle collision, where she
suffered a moderate traumatic brain injury ( GCS of 12 ), requiring hospitalization for
around a week. There were no intracranial hemorrhages and she did not require
neurosurgical intervention.
Her family history is unremarkable. Her performance at school satisfactory. She has
not attained menarche yet.
A complete blood count, metabolic panel, liver function tests and urinalysis and ESR
are also within normal limits.
Anthropometric mesurements :
Height – 130 cm (< 3rd percentile)
Weight - 40.5 kg (< 3rd percentile)
Calculated height velocity : 1 cm /year
Vital signs – stable
Heart, Lung, CNS – no abnormalities
3. General examination:
• No Dysmorphic feature.
• Tanner stage – 1(i.e. secondary sexual characteristics absent)
• One Scar in left parietal region, 2cm in length.
Endocrine profile –
TSH – 5.6 mcg/dl (5-12)
FT3 – 71 ng/dl (75-200)
CORTISOL – 1.82 mIU/ml (2-10)
FSH – 0.89 mcg/dl ( 5-23)
LH - 1.08 miu/ml (1-9)
Estradiol – 0.31 miu/ml (2-12)
DHEAS – 0.20 ng/dl (3.4 – 17)
Prolactin - 2.0 ng/ml (3-24)
IGF -1 – 1.45 ng/ml (3-24)
X-ray bilateral wrist –
Both wrists are compatible with a bone
age of ten years.
MRI Brain – T2 weighted axial section
demonstrated a slim pituitary gland
located posteriorly in the sella turcica.
Posterior hypophysis appears normal.
These findings are consistent with
partial empty sella syndrome.
4. (Left) An MRI shows an empty sella, (Right) An MRI with a normal sella.
5. Interpretation of biochemistry laboratory reports –
Hypothyroidism –
Hypothyroidism in patients who have pituitary or hypothalamic disease is the result
of thyrotropin (TSH) deficiency. The serum TSH concentration is usually not low,
except when the hypothyroidism is treated. Screening for hypothyroidism in patients
with pituitary or hypothalamic disease is performed by measuring TSH and free T4.
Gonadotropins (FSH, LH) - Workup varies with the gender of the patient.
Men — luteinizing hormone (LH) deficiency can best be detected by
measurement of the serum testosterone concentration. If it is repeatedly low at 8 to
10 AM and the LH concentration is not elevated, the patient has secondary
hypogonadism. If fertility is an issue, the sperm count should be determined.
Women — In a woman of premenopausal age who has pituitary or hypothalamic
disease but normal menses, no tests of LH or follicle-stimulating hormone (FSH)
secretion are needed because a normal menstrual cycle is a more sensitive indicator
of intact pituitary-gonadal function than any biochemical test.
6.
7. If the woman has oligomenorrhea or amenorrhea, serum LH or FSH should be measured. In
addition, the following two tests should be obtained:
• Measurement of serum estradiol
• Administration of medroxyprogesterone
10 mg daily for 10 days (to determine if vaginal bleeding occurs after the 10-day course)
A low serum estradiol concentration and/or absence of vaginal bleeding indicate estradiol
deficiency as a consequence of gonadotropin deficiency and warrant consideration of estrogen
treatment.
Normal results, in association with oligomenorrhea or amenorrhea, could indicate sufficient
gonadotropin secretion to maintain normal basal estradiol secretion but insufficient to cause
ovulation and normal progesterone secretion. This situation should prompt consideration of
intermittent progestin treatment.
The serum LH response to a single bolus dose of gonadotropin-releasing hormone (GnRH)
is not helpful in distinguishing secondary hypogonadism due to pituitary disease from that
due to hypothalamic disease, because patients who have hypogonadism due to pituitary
disease may have normal or subnormal serum LH responses to GnRH, as may those who
have hypothalamic disease.
8. Growth hormone –
Measurement of basal serum growth hormone concentration does not distinguish reliably
between normal and subnormal growth hormone secretion in adults.
Three other criteria, however, are useful:
•Deficiencies of multiple other pituitary hormones
•Serum insulin-like growth factor-1 (IGF-1)
•Provocative tests of growth hormone secretion
Either insulin-induced hypoglycemia or the combination of arginine and growth hormone-
releasing hormone (GHRH) is a potent stimulus of growth hormone release. Subnormal
increases in the serum growth hormone concentration (<5.1 ng/mL for the former and
<4.1ng/ml for latter) confirms the diagnosis of growth hormone deficiency.
PROLACTIN -
Women who have severe hypopituitarism due to hypothalamic or pituitary disease may, in the
postpartum period, have a serum prolactin concentration that is inappropriately low and not be
able to nurse.
•No commercially available prolactin preparation is available for these women.
•No data available about serum prolactin concentrations in women without known pituitary
disease who are unable to lactate.
•There is no standardized test of prolactin reserve.
9. Corticotropin (ACTH) –
Morning serum cortisol — To test basal ACTH secretion, morning serum cortisol (at 8 to 9 AM),
and the results should be interpreted as follows.
• A serum cortisol value of ≤3 mcg/dL (83 nmol/L, normal range 5 to 25, confirmed by a second
determination, is strong evidence of cortisol deficiency, which in a patient with a disorder
known to cause hypopituitarism is usually the result of that disorder.
•Indeterminate — A serum cortisol value >3 mcg/dL (83 nmol/L) but less than <18 mcg/dl is an
indication to evaluate ACTH reserve.
Metyrapone testing.
Cosyntropin stimulation test
The test has become less necessary because immunometric plasma ACTH assays in use are very
sensitive and specific.
10.
11.
12.
13. Discussion -
At a first glance, this 16 year old girl’s chief complaint appears to be a potential growth delay.
However a careful review of her history brings another important complaint to light : delayed
menarchy. This combination is most concerning.
Her calculated growth velocity, height and weight are all below the third percentile, while her
pubertal maturation is only Tanner stage 1. this confirms the growth delay is indeed present.
Chronic illnesses, malnutrition, endocrine, metabolic disorders or chromosomal anomalies are
characterized by proportionate short stature.
A question arises : why was not her slow growth velocity assessed until now ? unfortunately,
this can not be answered with the information currently at hand.
Plain radiographs of both wrists reveal that her bone age is markedly less than her
chronological age, strongly favoring an endocrine cause.
Consider the history of traumatic brain injury (TBI). Post traumatic hypopituitarism is a known
complication of moderate to severe TBI, typically first appearing months to years after the initial
insult.
A genetic etiology is made clinically less likely by the lack of dysmorphic features,
unremarkable neurological examination and negative family history. However this possibility
should be revisited if other conditions are excluded.
14. An endocrine profile demonstrates all anterior pituitary hormones to be below the normal
ranges while follow-up brain MRI reveals a partially empty sella. When considered along with
the clinical findings this is sufficient to diagnose post traumatic hypopituitarism.
Hypopituitarism is a rare disease, but may be significantly underdiagnosed in people with
previous traumatic brain injury.
Hormone repalcement therapy is the mainstay of treatment.
Corticosteriods should be replaced first so as to avoid precipitating an adrenal crisis due to
levothyroxine induced increased metabolism.
Serious consideration should also be given to contacting social services. As mentioned
earlier, it is concerning that her growth delay has been ignored for such a long period.
As there is no evidence of hereditary disorder, genetic counseling is not indicated.
Thank You