Reproductive Endocrine Disorders And Short/Tall...
Transcript of Reproductive Endocrine Disorders And Short/Tall...
![Page 1: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/1.jpg)
ธต สนบบญ
อายรศาสตร แพทยศาสตร
14 ตลาคม 61
Reproductive Endocrine Disorders And
Short/Tall stature
![Page 2: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/2.jpg)
Amenorrhea/Hirsutism
Male Hypogonadism/Gynecomastia
Short/Tall Stature
Cases
![Page 3: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/3.jpg)
• Primary (14/16) or Secondary (3/6)
• Primary: 2o sex + pelvic exam/chromosome (XY)
- low E (XO)
• Secondary: hirsutism/hypo E/systemic illness/pregnancy
- Pituitary tumor/Ovarian failure
- Androgen excess
Amenorrhea
![Page 4: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/4.jpg)
Endocr Rev 2002; 23:120-140
![Page 5: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/5.jpg)
![Page 6: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/6.jpg)
![Page 7: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/7.jpg)
Turner syndrome: Physical signs
![Page 8: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/8.jpg)
Insulin resistance & DM type 2 AITD 22% thyroid Ab check thyroid Ab, TSH at 10 y; Ab+ve (TSH annually) Inflammatory bowel disease Hepatic disease Malignancy: gonadoblastoma (45,X/46,XY) Otological disorders: conductive & neurosensory hearing loss Horseshoe kidney
Turner syndrome
![Page 9: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/9.jpg)
HRT in Turner syndrome
![Page 10: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/10.jpg)
Follow up
![Page 11: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/11.jpg)
Approach as 2nd amenorrhea
Am Fam Physician 2006; 73: 1374-1382.
![Page 12: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/12.jpg)
Best Pract Res Clin Obstet Gynaecol 2003; 17: 75-92.
![Page 13: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/13.jpg)
Hirsutism
![Page 14: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/14.jpg)
Hirsutism
![Page 15: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/15.jpg)
Hatch R, et al. Am J Obstet Gynecol 1981; 140: 815-30.
Rosenfield RL. NEJM 2005; 352: 2578-88.
> 7
![Page 16: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/16.jpg)
Testing androgen levels in women when
1. Moderate or severe Hirsutism (Score >15) 2. Hirsutism with sudden onset, rapidly progressive 3. Hirsutism with Virilization Acne, Alopecia, Baldness Menstrual dysfunction and/or infertility Central obesity Acanthosis nigricans
Martin KA, et al. JCEM 2008; 93: 1105-1120.
![Page 17: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/17.jpg)
Step 1: Drug use, Severity: mild (8-15) Idiopathic hirsutism Rx
Step 2: Severity: moderate or more (>15)
Virilization, PCOS risk, Neoplasm risk, other endocrinopathy risk
Hirsutism
![Page 18: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/18.jpg)
Deepening of voice
Increased libido
Androgenic muscle development
Masculine habitus
Breast atrophy, Abnormal Menstruation
Clitoromegaly
Acne
Virilization
![Page 19: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/19.jpg)
![Page 20: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/20.jpg)
NIH criteria (1990) Hyperandrogenism/-emia
Oligo-ovulation
Exclusion of related disorders
ESHRE/ASRM criteria (2003)
Clinical and/or biochemical hyperandrogenism
Oligo- or anovulation
PCO
Exclusion of related disorders
![Page 21: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/21.jpg)
Testis: 1.5 x 1 cm both (2 ml, soft, no mass)
Length of penis 2.5 cm, No pubic/axillary hair
Eunuchoid appearance
High-pitched voice
M: 22-year-old, delayed puberty
![Page 22: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/22.jpg)
• Sexual development, Eunuchoidism • Reduced sexual desire (libido) • Decreased spontaneous erections • Low/zero sperm counts, Infertility • Loss of body (axillary, pubic) hair • Gynecomastia • Small testes (< 5 mL) • Male osteoporosis • Reduced muscle bulk and strength • Hot flashes, sweats
ประวต ตรวจรางกาย
![Page 23: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/23.jpg)
Secondary sexual characteristics
Testicular examination: size and consistency
Body mass index (BMI)/Waist circumference
Body proportions (e.g. female fat distribution)
Pubic hair (density, distribution)/Penis (size)/Scrotum (pigmentation)
Gynecomastia
Smell test, Midline defect, Teeth, CNS, Kidney
Young J. JCEM 2012; 97: 707-718.
![Page 24: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/24.jpg)
![Page 25: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/25.jpg)
Endocrine Society 2008
![Page 26: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/26.jpg)
Endocrine Society 2010
![Page 27: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/27.jpg)
FSH 0.22 IU/L (1-8.4)
LH 3.0 IU/L (1-10.5)
Testosterone 2.5 (<10 nmol/L)
FT4 1.29 ng/dL (0.8-1.8)
TSH 0.55 uU/mL (0.3-4.1)
Morning cortisol 8.3 ug%
IGF-1 213 ng/mL (47-318)
![Page 28: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/28.jpg)
Genital defects
Neurological defects Somatic defect
Microphallus
Cryptorchidism
ANOSMIA/HYPOSMIA
Nystagmus
SNHL
Cerebellar ataxia
Spastic paraplegia
Leaning disability
Color blindness
Synkinesia
Seizures
Cleft lip
Cleft palate
High arch palate
Dental agenesis
Renal agenesis
Horseshoe kidney
Pes cavus
Kallmann syndrome
![Page 29: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/29.jpg)
CORONAL T1W and T2W
Olfactory sulci
Olfactory bulbs/tracts
![Page 30: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/30.jpg)
![Page 31: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/31.jpg)
![Page 32: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/32.jpg)
• ออนเพลย 6 เดอน ปรกษาแพทยเรอง ชายวยทอง
• T: 8.2, 7.9 nmol/L, FSH: 9.7 IU/L (1.0-8.4), LH: 4.7 IU/L (1.0-10.5)
• วนจฉย andropause andriol 80 mg/d
• อาการดขน แตยงรสกมไข รอนวบวาบ andriol 240 mg/d
• T: 13.2 nmol/L
• ปรกษาเรองการเลอกใชยา
• BT 38.2oc น าหนก 78 64 กโลกรม
• Infective endocarditis
• T: 16.7 nmol/L
M: 46-year-old, fatigue
![Page 33: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/33.jpg)
Male hormone
![Page 34: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/34.jpg)
Gooren LG, et al. Drugs 2004; 64: 1861-1891.
T levels in different forms
![Page 35: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/35.jpg)
Endocr Pract 2002
Management
![Page 36: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/36.jpg)
Gynecomastia ชาย 20 ป เรองเตานมโต
![Page 37: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/37.jpg)
Breast mass
Lipomastia Breast cancer
Metastasis
Onset (1 ป)
Tenderness
Unilateral/Bilateral
Discharge/Galactorrhea
Axillary lymph node
Cancer risks
![Page 38: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/38.jpg)
2 cm Nipple-Areloar Complex
Bilateral 50%
Macrogynecomastia
![Page 39: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/39.jpg)
NEJM 2007
![Page 40: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/40.jpg)
J Plast Reconst & Aesthet Surg 2008; 61: 41-49
![Page 41: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/41.jpg)
Progesterone
![Page 42: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/42.jpg)
Gynecomastia
Physiology Pathology
Neonatal
Puberty
Elderly
Drugs (20-25%)
Systemic diseases
Estrogen excess
Hypogonadism
Idiopathic
(25%)
![Page 43: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/43.jpg)
NEJM 2007
![Page 44: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/44.jpg)
Expert Opin Drug Saf 2012
![Page 45: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/45.jpg)
Systemic diseases
• Endocrine disease: GH, Cortisol, Thyroid (10-40%), Prl • Failure: Liver (8%), Renal (1%) • Neurological diseases: Myotonic dystrophy, Kennedy syndrome • HIV • Starvation, Refeeding • NF-1, PJS • Prostatic cancer
![Page 46: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/46.jpg)
Laboratory assessment
b-hCG USG testis
Testosterone, Estrogen Prolactin
hypogonadism FSH, LH
hyperestrogenemia Testis or Adrenal or Aromatase
Thyroid function test
Liver or Renal failure
![Page 47: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/47.jpg)
ชาย 20 ป เตานมโตทง 2 ขาง บตร คนเดยว แรกเกด 2,600 g พฒนาการปกต
เตานมโตตงแตอายประมาณ 14 ป ไมเจบ ไมมน านมไหล
ไมดมสรา/ยาเสพตด
morning erection 2-3 ครง/สปดาห ยงไมเคยมเพศสมพนธ
170 cm (expected height 167 cm), arm span 171 cm, 60 kg
Testes 3 cm in diameter, 2nd sex characteristics: well-developed
Public hair: male pattern Tanner IV
![Page 48: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/48.jpg)
Prolactin: 6.0 ng/mL < 2-25> FSH: 2.7 IU/L <1.0-8.4> LH: 4.7 IU/L <1.0-10.5> Testosterone: 26.1 nmol/L <5.9-24.7> Estradiol: 155.5 pmol/L <0-130> Free androgen index: 32.4% <40-90>
![Page 49: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/49.jpg)
Pseudogynecomastia หรอ Obvious causative drugs/conditions
Provide assurance, Remove/Treat cause, Provide periodic follow-up
Palpable Scrotal mass Testicular US
ประวตและตรวจรางกาย
Gynecomastia
Suspect breast mass
(hard, eccentric) USG หรอ Mammography และ Biopsy
Liver หรอ Renal หรอ Thyroid disease
LFTs, Renal function, and TSH assays
Treat underlying disease
Hormone testing ( total and bioavailable T,E2 , prolactin, LH , hCG assays)
T T ↑hCG
Hypogonadism
Androgen resistance
Testicular US
↑Prolactin
MRI pituitary
Germ cell tumor
Normal
Extragonadal hCG-secreting tumors
(bronchogenic, hepatic)
Pituitary disease
↑E2
Testicular US
Mass (Leydig หรอ
Sertoli cell tumor)
Normal
CT abdomen
Adrenal neoplasm
Normal
Increased aromatase activity
Exogenous estrogens
Negative work-up
Idiopathic
gynecomastia
![Page 50: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/50.jpg)
15 CAG
52 CAG
31 CAG
Sequencing : CAG repeats of the AR gene
“คณ ตา (73 ป) และ นา (35 ป)” เตานมโต และเดนไมคอยคลอง
![Page 51: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/51.jpg)
Kennedy syndrome • Spinal and Bulbar Muscular Atrophy (SBMA)
• CAG triplet (repeats) or polyglutamine disease : Huntington’s disease, dentatorubral-pallidoluysian atroph, spinocerebellar ataxia (5 subtypes)
• X-linked), female carriers (muscle cramps)
• Androgen receptor, exon 1, Positive correlation with severity
• Onset: ages 18-64, the 4th- 5th decade
• Time to diagnosis: 3 years
• Progress slowly, Normal life span
• 1-2/100,000, limited awareness
J Neurol Neurosurg Psychiatry 2018;
![Page 52: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/52.jpg)
Neurological manifestations • Tremor, cramping, proximal/distal muscle weakness and atrophy
lower motor neuron degeneration, primary muscle atrophy
• Bulbar muscle involvement dysarthria, dysphagia, hypernasality, decreased range of pitch and loudness, perioral fasciculation
• Temporalis/Masseter muscles weakness chewing, jaw drop
• A loss of sensation in the lower extremities (DRA)
• EMG/NCV: Low sensory nerve amplitudes, Decreased compound motor action potentials, Diffuse denervation. Motor unit nerve estimation (MUNE) is reduced to about half of healthy control values.
• Muscle biopsy: neurogenic/myogenic atrophy J Neurol Neurosurg Psychiatry 2018;
![Page 53: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/53.jpg)
ชาย 40 ป กอนทเตานมขวามา 3 เดอน
กอนโตเรว ไมเจบ ไมมน านมไหล
กนยาแกไขเปนประจ า
ไมดมสรา หรอ ใชยาเสพตด
morning erection ปกต
โรคประจ าตว NHL remission (3 ป)
![Page 54: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/54.jpg)
4(6) cm (macrogynecomastia)/Tanner III >1 year
Breast cancer Patient prefer
Surgery
![Page 55: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/55.jpg)
Short/Tall Stature
![Page 56: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/56.jpg)
ขอมลทตองการ
1. Height, Weight, Arm span, Nutritional status
2. Height velocity: Growth chart
3. Mid parental height: Expected height
4. Body proportion: Proportionate, Disproportionate
5. Bone age
![Page 57: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/57.jpg)
ประวต
• Child heath, Maternal health, IUGR
• Development
• Illness or chronic diseases, psychological stress
• Puberty
• Family history
• Growth curves: height age, weight age
![Page 58: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/58.jpg)
การตรวจรางกาย
• Upper/Lower ratio
• Arm span
• Weight
• Head circumferences
• Secondary sex characteristics
![Page 59: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/59.jpg)
ธนน สหกจรงเรอง
![Page 60: Reproductive Endocrine Disorders And Short/Tall staturereviews.berlinpharm.com/20181013/Reproductive_Endocrine...2018/10/13 · Otological disorders: conductive & neurosensory hearing](https://reader034.fdocuments.net/reader034/viewer/2022050416/5f8c61b87eb4d70c087706e6/html5/thumbnails/60.jpg)