Endocrinology.reproductive-Endocrinology

Front 1

List the six main categories of erectile dysfunction.

Back 1

E: * Hormonal: hypogonadism (primary or secondary), hyperprolactinemia (with resultant hypogonadism), hyperthyroidism or hypothyroidism, and diabetes. Less common: adrenal insufficiency and Cushing's syndrome.
* Pharmacologic: long list of implicated medications: antihypertensives (clonidine, beta blockers, vasodilators, thiazide diuretics, spironolactoneView drug information); antidepressants (selective serotonin reuptake inhibitors [SSRIs], tetracyclic antidepressants), antipsychotics, anxiolytics, cimetidine, phenytoinView drug information, carbamazepineView drug information, ketoconazole, metoclopramide, digoxinView drug information. Alcohol is a major culprit. Illicit drugs include marijuana, cocaine, and heroin.
* Systemic disease: any severe illness can cause ED and hypogonadotrophic hypogonadism.
* Vascular: diabetes, peripheral vascular disease.
* Neurologic: diabetes, spinal cord injury, neuropathy.
* Psychogenic: uncommon in isolation, but contributes to most cases due to other etiologies. It is a diagnosis of exclusion.
A: hormonal,drugs,vascular, systemic, neurologic, psychogenic

Front 2

Describe the evaluation of a patient with erectile dysfunction.

Back 2

E: A typical initial evaluation includes history (with particular attention to medications), physical exam, and laboratory testing to rule out endocrine abnormalities. Start by checking TSH, prolactin, and testosteroneView drug information and ruling out systemic disease with urinalysis, complete chemistry panel and blood count, and HbA1c level in patients with diabetes. Carefully review the patient's medication list and ascertain alcohol consumption to assess possible etiologies for ED. Nocturnal penile tumescence testing is available to assess erectile function.
A: meds

Front 3

SSRIs can cause erectile dysfunction but can also help by?

Back 3

E: Delaying premature ejaculation.
A: premat

Front 4

What are the prostaglandins helpful in erectile dysfunction?

Back 4

E: Drugs useful in ED include * Alpha2-adrenergic receptor blocker: yohimbine (oral).
* Phosphodiesterase 5 inhibitors: sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis). All three are administered orally, but none should be used in combination with nitrates.
* Intracavernosal injections of vasodilating medications: alprostadilView drug information (Caverject), prostaglandin E1, papaverine, phentolamine.
* Transurethral alprostadilView drug information suppositories (MUSE)
A: alpra,E1

Front 5

What causes (categories) pathologic gynecomastia?

Back 5

athologic gynecomastia is typically due to estrogen excess from either overproduction or peripheral aromatization. Categories include:

* Drugs: any drug that increases estrogen activity or production or reduces testosteroneView drug information activity or production. Main mechanisms: estrogen-like properties, stimulation of estrogen production, increase in estrogen precursor molecules, reduction of testosteroneView drug information levels.
* Tumors: examples of tumors with increased human chorionic gonadotropin (hCG) or estrogen production include testicular tumors (Leydig cell, Sertoli cell, germ cell, granulosa cell), choriocarcinoma, or adrenal tumors. Male breast cancer is an uncommon cause.
* Decreased androgens or androgen resistance (hypogonadism due to any cause, Klinefelter's syndrome, Kallmann's syndrome).
* Increased aromatase activity (obesity, hyperthyroidism, genetic mutations).
* Displacement of estrogens from sex hormone-binding globulin.
* Others: end-stage liver disease, renal disease, HIV infection, familial syndrome, starvation refeeding.
A: drugs, aromat, displ, hormon,hepatic, renal, HIV

Front 6

What is the commonest presentation of hypogonadism in men?

Back 6

E: Erectile dysfunction, decreased libido
A: erect, libid

Front 7

What is the commonest presentation of hypogonadism in men?

Back 7

E: amenorrhea, infertility
A: amen, infert

Front 8

What are the causes (categories) of primary ovarian failure?

Back 8

E: In primary ovarian failure (hypergonadotrophic hypogonadism) levels of LH and FSH are generally high. Congenital causes include genetic alterations (Turner's syndrome [XO], enzyme deficiencies, LH or FSH receptor or postreceptor defects). Acquired causes include autoimmune destruction and physical insults (e.g., radiation, chemotherapy, viral infection, surgery).
A: Congenital, acqui

Front 9

Summarize the causes of secondary ovarian failure.

Back 9

E: Secondary ovarian failure (hypogonadotropic hypogonadism) is associated with low level of FSH and LH and induces chronic anovulation. Most causes in this category are acquired and include hypothalamic dysfunction (induced by exercise or eating disorders), pituitary dysfunction (tumors, hypopituitarism), and androgen excess (adrenal tumors, polycystic ovarian syndrome, tumors with high human choriogonadotropin, congenital adrenal hyperplasia). Other causes include hyperthyroidism and hypothyroidism, liver disease, renal disease, obesity, and adrenal dysfunction.

Front 10

What are the three features of PCOS?

Back 10

E: Anovulation or oligo-ovulation, hyperandrogenism, ovarian cysts
A: ovul, andro, cyst

Front 11

Women with polycystic ovarian syndrome are susceptible to cancer. Which one?

Back 11

E: Women typically present with menstrual dysfunction, hirsutism, and insulin resistance. Long-term consequences of PCOS include increased risk of developing type 2 diabetes, hyperlipidemia, and endometrial cancer.
A: endomet

Front 12

Which antidiabetic drugs are useful in PCOS?

Back 12

E: Management is aimed at correcting the underlying metabolic disorder and addressing cosmetic concerns related to hirsutism. Weight loss and treatment of insulin resistance (thiozolidenediones, metformin) are recommended. Oral contraceptives are used to regulate menstrual cycles and suppress hyperandrogenism. Since most patients have impaired ovulation, fertility must also be addressed. Most women can be treated with the ovulation induction drug, clomiphene citrateView drug information, either alone or in combination with insulin-sensitizing medication. Hirsutism is treated by suppressing androgen production (oral contraceptives, androgen receptor blockers, or 5-alpha-reductase inhibitors) and appropriate cosmetic treatments.
A: metfor, thiaz

Front 13

According to the USPTF(2005), there is good evidence that the use of estrogen in post-menopausal women results in a reduction of fractures. True/False?

Back 13

E: True
A: T

Front 14

According to the USPTF(2005), the use of combine estrogen and progestins in post-menopausal women results in a reduction of colorectal cancer. True/False

Back 14

E: True
A: T

Front 15

According to the USPTF(2005), the harmful effects of combined estrogen/progestins in postmenopausal women include the follwoing:

Back 15

E: The USPSTF found good evidence that the use of combined estrogen and progestin results in both benefits and harms. Benefits include reduced risk for fracture (good evidence) and colorectal cancer (fair evidence). Combined estrogen and progestin has no beneficial effect on coronary heart disease and may even pose an increased risk (good evidence). Other harms include increased risk for breast cancer (good evidence), venous thromboembolism (good evidence), stroke (fair evidence), cholecystitis (fair evidence), dementia (fair evidence), and lower global cognitive function (fair evidence).
A: breast, dementia, cholecy,CAD