Hirsutism virilism, gynaecomastia, impotence Flashcards
What is hirsutism
Male pattern hair growth in females
Causes
Familial
Idiopathic
Inc androgen secretion by the ovary - PCOS, ovarian cancer, adrenal gland
Drugs - steroids
What does PCOS cause
Secondary oligo or amenorrhoae Infertility Obesity Acne Hirsutism
PCOS USS show
Bilateral polycystic ovaries
PCOS blood tests
Inc testosterone DEC sex-hormone binding globulin Inc LH:FSH ratio TSH Lipids
PCOS management
Con Healthy eating Optimise weight Shaving Laser hair removal Wax Cream Bleach Medical: COCP Yasmin; co-cyprindiol if CI or not worked refer to 2ndary care Metformin helps with insulin resistant Clomifene used for infertility
What is virilism
Amenorrhoea, clitoromegaly, deep voice, temporal hair recession and hirsutism
What causes virilism
Androgen secreting adrenal tumour
Ovarian tumour
What is gynaecomastia
Abnormal amount of breast tissue in men
May occur normally in puberty
Causes of gynaecosmastia
Oestrogen/androgen ratio inc
Hypogonadism
Liver cirrhosis - inc oestrogens
Hyperthyroidism
Tumours - oestrogen producing testicular, adrenal, HCG producing - testicular, bronchial
Drugs- oestrogens, spironolactone, digoxin, testosterone, marijuana, consider stopping the drug if possible, consider testosterone if hypogonadism +/- oestrogen (tamoxifen)
What is impotence
Erectile dysfunction
What causes erections
Neuronal release of nitric oxide(NO)
Which via cGMP and Ca2+ hyperpolarises thus relaxes the vascular and trabecular smooth muscle cells, allowing engorgement.
Epidemiology and causes of impotence
Common 50 years +
Multifactoral
Psychological facet is common - esp if happens when stressed or if morning erections are still present (can also occur with an organic cause)
Organic causes: smoking, alcohol, diabetes, (reduce NO +autonomic neuropathy)
Endocrine: hypogonadism, hyperthyroidism, nd prolactin,
Neurological : cord compression, MS, pelvic surgery
Radiotherapy, atheroma, renal or hepatic failure, prostatic hyperplasia,penile anomalies
Drugs: digoxin, bet blockers, diuretics, anti-psychotics, antidepressants, oestrogens, finesteride and narcotics
Impotence work up
Full sexual and psych hx U&E LFT Glucose TFT, LH, FSH, lipids, testosterone, prolactin +/- Doppler Penile arterial pressure enough for inflow Is the veno-occlusive mechanism working Sensation ? - CNS
Tx impotence
Tx any underlying causes Counselling Oral phosphodiesterase inhibitors - PDE5 Inc cGMP Sildenafil Use only once daily Vacuum aids Intracavernal injections Transurethral pellets Prostheses
CI PDE5 inhibitor
Concurrent use of nitrates BP high or systolic <90mmHg Arrhythmia Unstable angina Stroke MI <90 days ago Cautions - Angina Bleeding peptic ulcer Markers hepatic or renal impairment Peyronie Riskof priapism Comple anti-hypertensive regimes Dyspnoea on minimal effort
What is primary male hypogonadism
Testicular failure
From local trauma, test torsion, chemo, infection - mumps, chromosome abnormalities - klinefelters
What is male hypogonadism
Hypogonadism is the failure of the tests to produced testosterone sperm or both Small tests Dec libido Erectile dysfunction Loss of pubic hair Dec muscle bulk Inc fat Gynaecomastia Osteoporosisdec mood
What is secondary hypogonadism
Dec gonadotropin (LH and FSH)
From hypopituitarism mall as syndrome
Systemic illness
Prader Willi
What is hypopituitarism
Dec in secretion of pituitary hormones
GH then FSH and LH, then TSH and ACTH, PRL
What is hypopituitarism caused by
Pan all hormones
Irradiation surgery
Or pit tumour.
