-
LH stimulates
Leydig cells
-
FSH stimulates
sertoli cells
-
synthesized by the hypothalamus
regulates synthesis and release of hormones from the pituitary gland
GnRH
-
initiates spermatogenesis by binding to sertoli cells and increasing levels of androgen binding protein
FSH
-
Regulates production of testosterone
LH
-
Produced by sertoli cells under the influence of FSH, suppressing the release of FSH
Inhibin
-
Androgens
- testosterone
- dihydrotestosterone
- androstenedione
- promote metabolism and musculoskeletal growth
-
Most testosterone is converted to
DHT
-
precursor for testosterone
androstenedione
-
secreted by the leydig cells
testosterone
-
Hypogonadism clinical features
- fatigue
- depression
- decreased libido
-
Hypogonadism diagnosis
<300 ng/dl testosterone level
-
testicular failure
primary hypogonadism
-
lack of stimulation by gonadotropins
secondary hypogonadism
-
decreased or absent GnRH
tertiary hypogonadism
-
Testosterone replacement therapies
- long acting intramuscular preparations
- short acting intramuscular preparations
- scrotal patches
- Transdermal patches
- Transdermal gel
- Oral agents
-
Phosphodiesterase 5
degrades cGMP
-
Number of men affected by ED
18-30 million
-
Percentage of men in their 40s
5%
-
percentage of men with ED over 65
15-25%
-
Causes of ED
- organic
- physiologic
- endocrine
- psychogenic
-
Risk factors for ED
- diabetes
- cigarette smoking
- mental disorders
- vascular disease
- neurogenic disorders
-
Bloodwork/Labs for ED
- Testosterone
- Fasting Lipid panel
- Fasting glucose
- Thyroid
- Liver and kidney function
-
ED drug therapy
- Phosphodiesterase 5 inhibitors
- intracavernosal injections or suppositories
- testosterone if hypogonadism present
-
contraindicated in patients that are taking nitrates
Phosphodiesterase Inhibitors
-
Pharmacological treatment for priapism
- alpha adrenergic agonists
- beta adrenergic agonists
- guanylate cyclase inhinbitors
-
% of men that experience prostatitis in their lifetime
50%
-
recurrent infection and inflammation of the prostate and urinary tract
- chronic bacterial prostatitis
- chronic pelvic pain syndrome
-
risk factors for prostatitis
- bladder outlet obstruction
- diabetes mellitus
- suppressed immune system
- catheter
- STDs
-
treatemt for prostatitis
- antibiotics
- usually iv then oral
- therapy for weeks to months
-
BPH
- Benign prostatic hyperplasia (BPH)
- age related nonmalignant enlargement of the prostate gland
-
-
normal prostate physiology
- secrete fluids that make up 20-40% of ejaculate volume
- provides high zinc concentration
-
two types of prostate tissue
-
embeded with alpha 1 adrenergic receptors
stromal tissue
-
testosterone is converted to DHT by
5 alpha reductase
-
type 1 5 alpha reductase
hair follicles, sebaceouse glands in scalp, liver and skin
-
type II 5 alpha reductase
prostate genital tissue, scalp
-
stimulates growth of stromal tissue in the prostate
estrogen
-
ultimate mediator of prostatic hyperplasia
DHT
-
-
results in contraction of the prostate gland around the urethra and narrowing of the urethral lumen
Dynamic prostatic factor
-
Gives rise to symptoms such as weak urinary stream, post-void dribbling, frequency of urination and nocturia
Static prostatic factor
-
Surgery for BPH is necessary if
- urinary retention
- recurrent UTI
- hematuria
- bladder stones
- renal insufficiency
-
-
most potent and plentiful estrogen
estradiol
-
estrogen comes from
ovaries, adrenal glands and placenta
-
effects of progesterone
- development of breast tissue and endometrium
- competes with aldosterone
- increases body temp with ovulation
- smooth muscle relaxation during pregnancy
-
produced by the ovary after ovulation to prepare for implantation
progesterone
-
-
Primary amenorrhea
gonadal, congenital or hormone regulation disorder
-
Secondary amenorrhea
- body fat : muscle ratio important
- ovary, pituitary or hypothalamus dysfunction
-
treatment for amenorrhea
- correct underlying cause (prolactin, TSH)
- oral contraceptives
-
Primary Dismenorrhea
- associated with a physical abnormality or pathological process
- related to intrinsic factors
-
Secondary Dysmenorrhea
caused by specific conditions
-
Increases prostaglandins
progesterone
-
Afflics approximately 80% of women
PMS
-
Higher in luteal phase
increases sodium and water retention
prolactin
-
peaks in luteal phase
stimulates anxiety and nervous tension
estrogen
-
may produce depression
progesterone
-
aldosterone
increased fluid retention
-
candidiasis
20-25% of cases
-
-
bacterial vaginosis
30-35% of cases
-
Normal characteristics
- white/clear
- floccular
- high viscocity
- pH <4.5
-
Candidiasis characteristics
- white
- no odor
- floccular
- high viscosity curdlike
- pH 4-4.5
-
trichomoniasis
- yellow/green
- malodorous
- homogenous
- low viscosity/frothy
- pH 5-6
-
BV caracteristics
- white/gray
- fishy smell
- homogenous
- low viscosity
- pH > 4.5
-
may lead to pelvic inflammatory disease
BV
-
Treatment for candida albicans
antifungals
-
treatment for trich
- oral metronidazole
- all partners should be treated
-
treatment for BV
- clindamycin
- metronidazole
- treating partners not necessary
-
HPV 16 and 18
cause 70% of cervical cancer
-
Risk factors for cervical cancer
- early age of intercourse
- multiple partners
- promiscuous male partner
- smoking
- STIs
-
Gardasil
- 16, 18, 6, 11
- additional coverage for warts
- 0, 2 and 6 month
-
Cervarix
- 16 and 18
- 0, 1 and 6 months
-
Diagnosis of PID
- Lowerabdominal pain
- adnexal tenderness
- painful cervix on exam
-
treating PID
- 14 days of broad spectrum antibiotics
- treat partners for previous 60 days
-
complications of PID
- infertility
- ectopic pregnancy
-
% of women diagnosed with PCOS that are obese
50%
-
Causes of PCOS
- increased LH
- increased production of androgens
- increased prolactin
-
mechanism of insulin resistance that goes with PCOS
decreased levels of sex hormone binding globulin = increased free testosterone
-
Non-hormonal therapy for PCOS
- metformin
- Thiazolidinediones
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