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diagnosis differential algorithm endocrinology pathophysiology causes amenorrhea clinical menstrualcycle obgyn primarycare signs symptoms video gynecology gynecomastia neurology ovariancycle primary fsh
Hypogonadism Differential Diagnosis Algorithm • Low testosterone, Normal or low LH, Normal or low FSH -
Algorithm • Low testosterone ... Normal or low FSH ... Normal LH, Normal FSH ... Normal LH, Elevated FSH ... Elevated LH, Elevated FSH
Inhibin < Hypothalamus < GnRH ④ Anterior pituitary FSH LH V Sertoli cells V Leydig cells Paracrine e e → #Testosterone
Anterior pituitary FSH ... Paracrine e e → #Testosterone
Feedback Loop: Prolactin (PRL) • PRL levels exhibit diurnal, menstrual, and age-related variation • TRH has
secretion -> Decr FSH ... females, Decr testosterone
#LH #Cholesterol t cholesterol desmolase (#thecal cells) V 3ß-hydroxysteroid dehydrogenase Pregnenolone Progesterone 17a-hydroxylase 17-Hydroxypregnenolone 17,20-lyase Dehydroepiandrosterone 3ß-hydroxysteroid dehydrogenase #Androstenedione 17B-hydroxysteroid dehydrogenase FSH V #Testosterone Đ #aromatase (granulosa cells) V #Estradiol
dehydrogenase FSH ... V #Testosterone
Glucocorticoid-Induced Osteoporosis: Pathogenesis and Clinical Findings • Negative feedback on hypothalamus/pituitary, Decreasing ACTH -> Decr Sex
Hormones (LH, FSH ... , Testosterone,
ACTH LH Cholesterol cholesterol desmolase Pregnenolone 17a-hydroxylase 17 Hydroxyregnenolone 17,20-lyase 3B-hydroxysteroid dehydrogenase 3B-hydroxysteroid dehydrogenase 17a-hydroxylase #Progesterone 17-Hydroxyprogesterone 17,20-lyase 21ß-hydroxylase 21ß-hydroxylase 11-Deoxycorticosterone 11-Deoxycortisol 11ß-hydroxylase 11ß-hydroxylase #Cortisol #Dehydroepiandrosterone #DHEA 3ß-hydroxysteroid dehydrogenase 个 #Androstenedione #17B-hydroxysteroid #dehydrogenase #Testosterone #aromatase #FSH #Estradiol #5a reductase #Corticosterone aldosterone synthase #Aldosterone Angiotensin || #Dihydrotestosterone (DHT)
dehydrogenase #Testosterone ... #aromatase #FSH
Bilateral Winged Scapula on Physical Exam - Seen in Facioscapulohumeral Muscular Dystrophy (FSH, FSHD) #Bilateral #Winged #Scapula
Muscular Dystrophy (FSH ... , FSHD) #Bilateral ... Muscular #Dystrophy #FSH ... #FSHD #clinical
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 Exogenous Testosterone Side Effects • Mood disorder, Depression, Aggression • ↑ Erythropoiesis • Hypogonadism +/-BPH, prostate
Exogenous Testosterone ... #Exogenous #Testosterone
Benign Prostatic Hyperplasia: Pathogenesis and Medications Aging -> Increased Testosterone -> Testosterone metabolized into DHT by type
-> Increased Testosterone ... -> Testosterone ... Conversion of testosterone ... pituitary -> Decr Testosterone
Causes of Female and Male Infertility - Differential Diagnosis Algorithm Causes of Female Infertility: • Uterus -
• Increased FSH ... • Decreased FSH ... • Decreased FSH ... hypogonadism) Low FSH ... problem) High FSH
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