Reproductive system

Reproductive system diseases

physiology
In male Testes
LH---leydig cell---testosterone
FSH---sertoli cell---spermatogenesis
Negative feedback (testosterone and inhibin)
In female
FSH---development of ovarian follicle in 1st 2ws
Estradiol production from granulosa cell—decrease FSH
Marked LH secretion surge—ovulation
Ovum differentiate to corpus leutum—progesterone
Progesterone withdrawel---mensturation

Presenting problems

Hormone excess
-Primary
Polycystic ovary
Granulosa cell tumor
Leydig cell tumor
Teratoma
-Secondary
Pitutary tumor
gonadotrophinoma


Hormone deficiency
-Primary
Menopause
Hypogonadism
Turner syndrome
Klinfilters syndrome
-Secondary
Hypopitutarism
Kallmans syndrome(isolated GnRH def.)
Sever systemic illness(include anorexia nervosa)

Hormone hypersensitivity

Idiopathic hirsutism
Hormone resistance
Androgen resistance syndrome
5-alpha reductase def.
Nonfunctioning tumors
Ovarian cyst
Carcinoma
Teratoma
seminoma


Causes of delayed puberty and hypogonadism
Constitutional
Hypogonadotropic hypogonadism
-structural hypothalamic/pitutary disease
-Functional gonadotrophin deficiency
Chronic systemic illness (e.g. asthma, malabsorption, coeliac disease, cystic fibrosis, renal failure)
Psychological stress
Anorexia nervosa
Excessive physical exercise
Hyperprolactinaemia
Other endocrine disease (e.g. Cushing's syndrome, primary hypothyroidism)

Hypergonadotrophic hypogonadism

Chemotherapy/radiotherapy to gonads
Trauma/surgery to gonads
Autoimmune gonadal failure
Mumps
Tuberculosis
Haemochromatosis
Steroid biosynthetic defects
Anorchidism/cryptorchidism in males(undescended)
Klinefelter's syndrome (47XXY, male phenotype)
Turner's syndrome (45XO, female phenotype)


MALE HYPOGONADISM
The clinical features of both hypo- and hypergonadotrophic hypogonadism include
loss of libido
lethargy with muscle weakness
decreased frequency of shaving.
gynaecomastia
infertility
delayed puberty and/or anaemia of chronic disease
Male hypogonadism is confirmed by
demonstrating a low serum testosterone level.
The distinction between hypo- and hypergonadotrophic hypogonadism is by measurement of random LH and FSH.

CAUSES OF GYNAECOMASTIA

Idiopathic
Physiological ;puberty,old childhood
Drug-induced ;Cimetidine, Digoxin, Anti-androgens, e.g. cyproterone acetate, spironolactone, Some exogenous anabolic steroids, e.g. diethylstilbestrol
Hypogonadism
Androgen resistance syndromes
Oestrogen excess
Liver failure (impaired steroid metabolism)
Oestrogen-secreting tumour, e.g. of testis
hCG-secreting tumour, e.g. of testis or lung


Causes of hiurutism
Polycystic ovary
Congenital adrenal hyperplasia
Exogenous androgen (athelets, virilisation)
Androgen secreting tumors
Cushing syndrome