Physiology

Question 1

What is the root cause of gynecomastia and what are some pathologic causes?

Answer 1

Root cause increased estrogen or decreased testosterone

Endocrine/hyperthyroid: This increases binding of SHBG which then decreases free T, in addition thyroid hormones increase the production of aromatase and the conversion of testosterone to estrogen

Liver disease: decrease metabolism/clearance of estrogen

Neoplasm producing HCG (LH like) stimulate androgen production and peripheral conversion to estrogen like in PCOS. Where increased ration of LH/FSH

Other: marijuana, puberty, RX, klinefeiter syndrome (increase T and decreased E2) unresponsive sertoli cells.

Question 2

When thinking of PCOS in females what other diseases and conditions come to mind?

Answer 2

21 beta hydroxylase deficency
11 beta hydroxylase defiencency (androgen excess)

Decrease in GNRH leading to involution
Rx, or CNS lesions ect