HYPOGONADISM + MISC DISORDERS (PAGET'S) Flashcards
hypogonadism
occurs when gonads produce low levels ofhormones due to HPA gonadal disruption
- sex hormone release reg by hypothalamus, AP gland, and hormones they secrete
hypogonadism normal pathway
hypothalamus—GnRH—pituitary gland—FSH + LH —-gonads—sex specific hormones (reg via neg feedback)
estrogen
- primary v secondary traits
control development primary sex characteristics in females
- vagina, uterus, fallopian tubes, clitoris, cervix, bear children ability
- secondary: breasts + fat distribution
- other secondary controlled by androgens: pubic + axillary hair, libido
progesterone
prepares endometrium for potential of pregnancy aftr ovulation
- trigger lining to thicken to accept fertilized egg, dec muscle contractions in uterus that would reject egg
testosterone controls what
controls male physical features and promotes physical changes in puberty
- growth of penis + testes
- facial, pubic, body hair growth
- deeper voice
- muscle + bone development, taller
- sperm production
how do testosterone levels fluctuate
- when is highest/lowest
- what age highest
- change from hr to hr
- highest in morning, lowest at night
- highest age 20-30, start to decline slowly after 30-35
primary v. secondary hypogonadism causes
primary
- dysfunc of gonads–> low/no sex hormones
secondary
- dysfunc hypothalamus or pituitary—> low FSH + LH –> low/no sex hormones
primary hypogonadism
- what levels are high/low
- acquired v. congenital causes
no neg feedback to pit+hypothal = FSH+LH OVERPRODUCTION
acquired
- radiation, chemo, trauma, autoimmune ds, infx (mumps)
congenital
- genetic d/o (klinefelter or turner syndrome)
hypergonadotropic hypogonadism
secondary hypogonadism
- what levels are low/high
- acquired v. congenital causes
dysfunc hypothal or pit = LOW FSH + LH
acquired
- tumors of hypothal or pit, pit hemorrhage or necrosis (sheehan), head trauma
congenital
- panhypopituitarism (all pit hormones), kallman syndrome (GnRH def), chronic illness (CF, celiac)
hypogonadotropic hypogonadism
hypogonadism dx
- general testing
- primary v. secondary dx
check serum levels of sex hormones (testosterone, estradiol, LH, FSH)
primary
- high LH+FSH, low estradiol or testosterone
- karyotyping to r/o genetic conditions
secondary
- low LH+FSH, low estradiol or testosterone
- pit/brain MRI to assess underlying cause
hypogonadism tx
- male and female
- risks
- underlying cause tx
long term hormone replacement therapy (HRT)
- testosterone IM injx, patch, gel (inc risk edema, thomboemboli)
- estrogen + progesterone pills, skin patch (inc RBC and risk thromboemboli)
—-> estrogen w out prog = risk endometrial hyperplasia and ca
hypogonadism tx secondary only
chorionic gonadotropin and/or GnRH therapy (can help w fertility)
- HRT will induce puberty but not help w fertility
pagets ds (osteitis deformans)
- define
- osteoclast v osteoblast nl function
- osteoclasts nl absorb/break down bone
- osteoblasts make new bone
chronic bone d/o marked by disorganized remodeling of the bones
- osteoclasts more active than blasts (inc bone breakdown, lead to deformities + potential fractures)
pagets ds patho
- 3 phases
3 stages
- lytic phase: osteoclast hyperactive (inc bone breakdown rate)
- mixed (lytic-blastic): compensatory osteoblastic hyperactive, inc bone formation (disorganized)
- sclerotic phase: thick, sclerotic, disorg bone (woven), prone to fracture, HYPERVASC
burned out phase: inactive
pagets RFs + onset
- unclear cause
- can be triggered by infx (measles)
- linked to genetic mutations (SQSTM1, RANK genes)
- onset after age 55
pagets ds presentation
- intially v. overtime
initial- no sx
over time
- impinged nerves–> sensory losses (auditory and optic)
- skulll involvement–>lion like face (leontiasis)–> INC HAT size
- bone/joint pain w microfractures
- low linb weakness
- BOW LEGGINGS
can lead to osteosarcoma
pagets ds complications
- osteoarthritis
- HF
- neuro tissue compression
- malig transformation to sarcoma
pagets ds labs+ imaging dx
labs
- alk phos high
xray
- lytic lesions
- thickened bone (tunneling)
if these both pos—> baseline radionuclide bone scan to see extent/location of skeletal involvemtn
- bone bx (exclude osteosarcoma)
- dexa scan (osteoporosis)
pagets ds management/tx
- analgesia–>pain control, NSAID, APAP
- bisphosphonates (alendronate)–> monitr for GERD, ulcers, alph phos monitor to see success tx
- surgery to correct bone deform/decompress impinged nerves
- PT
- assistive devices based on Sx (walker, hearing aids)
