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SEARCH RESULTS FOR: Gynecomastia

Clinical Findings of Androgen Deficiency

Yu, Yan - Androgen Deficiency - FINAL.pptx
Hypogonadism in Males:Clinical Findings of Androgen Deficiency? secretion volume from seminal vesicle and prostateAuthor:  Yan YuReviewers:Peter VetereGillian GoobieHanan Bassyouni** MD at time of publicationLegend:Published June 18, 2013 on www.thecalgaryguide.comMechanismPathophysiologySign/Symptom/Lab FindingComplications? effect of testosterone on the brain? Libido(sensitive, but less  specific)? [testosterone] : [estrogen] ratio at the male breast? ejaculate volume(a sensitive and specific sign)Gynecomastia (palpable breast tissue, not fat, directly under nipple)Fatigue,low mood, irrtabilityHot flashes, sweats(Can be nocturnal; occur only when hypogonadism is severe)Vasomotor neural response  of unknown causeFewer spontaneous erections (i.e. in the morning)Lack of androgens (i.e. testosterone, DHT) in men past the age of pubertyIn advanced stages of the disease, after years of hypogonadism:(thus, less commonly seen)Low Bone  Mass Density (BMD)Less testosterone to be converted into estrogen in bone? muscle bulk and strengthSmall, soft testicles(<4cm long on orchidometer)Lack of hormones to stimulate and maintain testicular hyperplasia/growthLoss of androgenic hair (on face, midline, and pubic area)Vertebral fracture (height loss), or other fragility fracturesIf sexual development is incomplete from puberty:Note: These clinical findings apply to many disorders, including:-Andropause-Hypopituitarism (suspect if other hormone abnormalities & Sx of mass lesion like visual field loss, diplopia, and headache exist)-Testicular Failure (if Hx of chemo, radiation, excess alcohol, and chronic liver disease)-Klinefelter's (if assoc. tall and eunuchoid stature, breast enlargement and cognitive deficiency - XXY)-Kallman's (if assoc. anosmia, and tall/eunuchoid stature)-Drugs (e.g. ketoconazole, anabolic steroids, spironolactone, digoxin, marijuana)Testosterone's inhibitory effect on estrogen is not enough to prevent breast growthDeficiency in  testosterone during puberty delays fusion of epiphysesTall, eunuchoid statureNote: any disease involving an increase in aromatase activity (hyperthyroidism, cirrhosis, HCG-secreting tumors) will also cause relative estrogen excess  & subsequent gynecomastia.
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Viral-Hepatitis

Viral Hepatitis: Pathogenesis and clinical findings Infection with a virus that targets the
Authors: Sean Spence Tyler Anker Yan Yu Reviewers: Dean Percy Crystal Liu Sam Lee* * MD at time of publication
  liver, e.g. HAV, HBV, HCV, HDV, HEV
Hepatocytes are invaded & damaged
Foreign particles and tissue damage activate immune systemàliver inflammation
Lysis (bursting) of hepatocytes
Infection with chronic viruses (HBV and HCV) persist over time and additional symptoms may develop
RUQ pain/tenderness
If infection is prolonged or severe, inflammation becomes systemic
Release of hepatocyte’s cellular contents into the bloodstream
Infection with acute viruses (HAV and HEV) resolve over time, and the symptoms above normalize
Notes:
• HDV can only infect people with concomitant HBV infection
• HAV and HBV vaccines are the only ones that currently exist
• Not all patients with viral hepatitis will develop each of these symptoms. The presentations vary.
Fever, nausea, vomiting ↑ serum ALT, AST
                         ↓ Hepatic metabolic activity (e.g. reduction of gluconeogenesis)           ↓Serum Glucose
↓ Synthesis of plasma proteins (albumin, clotting factors, etc)         ↓ Albumin, ↑ INR
Abbreviations:
• HAV - Hepatitis A Virus
• HBV - Hepatitis B Virus
• HCV - Hepatitis C Virus
• HEV - Hepatitis E Virus
• RUQ - Right Upper Quadrant
• ALT - Alanine Aminotransferase
• AST - Aspartate Aminotransferase
• INR - International Normalized Ratio
 ↓ Bilirubin clearance from blood, bilirubin ends up under the skin         Jaundice Portal Hypertension
Encephalopathy, Splenomegaly, Esophageal Varices, Ascites, Caput Medusae, Edema
Encephalopathy, Muscle Wasting, Metabolic Bone Disease, Terry’s Nails, Ascites, Bruising, Clubbing, Edema
Spider Nevi, Altered Hair Patterns, Testicular Atrophy, Gynecomastia, Palmar Erythema
      Progressive deterioration in liver function, possibly ending up in cirrhosis. (See slide on “Cirrhosis: pathogenesis and complications” for more details on mechanisms and full explanations.)
Hepatic Insufficiency Hyperestrogenism
        Legend:
 Pathophysiology
 Mechanism
Sign/Symptom/Lab Finding
  Complications
Re-Published January 12, 2020 on www.thecalgaryguide.com

Potassium-Sparing-Diuretics-Mechanism-of-Action-and-Side-Effects

Potassium-Sparing Diuretics: Mechanism of Action and Side Effects Potassium-Sparing Diuretics
Authors: Samin Dolatabadi, Yan Yu* Reviewers: Jessica Krahn, Timothy Fu, Juliya Hemmett* * MD at time of publication
    Epithelium Sodium Channel Blockers (Amiloride and Triamterene) Inhibit Na+ channels (involved in Na+ reabsorption) in the luminal membrane of the principal cells in the cortical collecting duct
Aldosterone Antagonists (Spironolactone and Eplerenone) Competitively blocks mineralocorticoid receptors and ↓ aldosterone effect in the renal tubules and throughout the body
    ↓ aldosterone effectà↓ expression of basolateral Na+/K+ pumps & luminal epithelium Na+ channels on the principal cells of cortical collecting duct
Spironolactone’s molecular structure is similar to that of steroid
hormonesàspironolactone can also block androgen receptors
Anti-androgenic effects
(due to ↓ androgen function in reproductive organs, skin, and on brain centers)
        Triamterene can form triamterene crystals
and granular casts (unclear mechanism)
↓ Na+ reabsorption by principal cells
↓ in serum Na+ concentration: Hyponatremia
↓ K+ pumped out into the tubule by principal cells
               Crystals & casts obstruct tubular lumen → inflammation (unclear mechanism)
Triamterene crystals are
directly cytotoxic to tubular cells
Only ~2-5% of Na+ filtered by the glomerulus is normally reabsorbed in the
cortical collecting ductàthe ↑ in Na+ retained in cortical collecting duct is mild
Water follows Na+ to maintain a balanced osmotic pressureà↑ in water in cortical collecting duct available for excretion
↑ positive charges in lumen relative to surroundings generates an electropositive tubular lumen
Unfavorable electrical gradient ↓ secretion of positive charged ions into electropositive lumen
↓ libido
Menstrual abnormalities (in women)
↓ acne Gynecomastia
(in men)
              ↓ secretion of K+
↑ in serum K+ concentration:
Hyperkalemia
Cardiac Arrythmias (See relevant slide on Hyperkalemia: Clinical Findings)
  Interstitial inflammation and tubular injury
Drug-induced Nephrotoxicity
Mild Diuresis
↓ blood volume
↓ Blood pressure/ Hypotension
↓ secretion of H+
↑ in serum H+ concentration:
Metabolic Acidosis
             Legend:
 Pathophysiology
 Mechanism
Sign/Symptom/Lab Finding
  Complications
Published February 15, 2021 on www.thecalgaryguide.com

Gynecomastia

Gynecomastia: Pathogenesis
Authors:
Sara Cho Reviewers: Michelle J. Chen Samuel Fineblit* *MD at time of publication
        Physiologic causes
Puberty
Placenta transfers maternal estrogens to newborn male babies
Older age (>60 years)
Hyperthyroidism
Klinefelter Syndrome (males with > 1 X chromosome)
Liver cirrhosis
Certain tumors (e.g., germ cell, adrenal, Leydig cell, Sertoli cell)
Anabolic steroid usage (containing testosterone)
Finasteride (treatment for benign prostate hyperplasia and male pattern baldness)
Cimetidine - inhibits stomach acid production
Spironolactone (diuretic
used to treat high blood pressure and heart failure)
Ketoconazole (antifungal)
Cytotoxic agents (e.g. alkylating agents, vincristine, methotrexate)
Imbalance between estrogens and androgens
Estrogen stimulates breast tissue growth in newborn
Changes in metabolic rate ↑ fat production
Unclear mechanism
↑ Proinflammatory mediators and cytokines (e.g. prostaglandin E2, TNF⍺, IL-1, IL-6, cyclooxygenase-2)
Prostaglandin E2 and IL- 6 upregulate aromatase enzyme expression
Available estrogen is higher than available testosterone
↑ Aromatase enzyme activity, converting androgens to estrogen
↓ Testosterone release from the testes
        ↓ Testosterone
↑ Serum sex hormone binding globulin (SHBG)
SHBG binds estrogen with less affinity to testosterone
     Thyroid hormone stimulates liver to express more sex hormone binding globulin
Thyroid hormone stimulates aromatase activity
Overexpression of aromatase enzyme
Seminiferous tubules in the testes hyalinize and fibrose
Suppression of the hypothalamic pituitary thyroid axis through an unclear mechanism
Tumor may produce estradiol
Tumor produces β- human chorionic gonadotropin (β-HCG)
↑ serum testosterone
Inhibits 5-α reductase
Blocks binding of 5-DHT to androgen receptors
↓ 2-hydroxylation of estradiol
Mimics structures of testosterone
Inhibits 17,20 desmolase and 17α-hydroxylase
Damage to Leydig cells in testes
↑ Estrogen to androgen ratio
                    Pathological causes
Impaired spermatogenesis and testosterone production
↓ GnRH secretion from hypothalamus
↓ Testosterone
↓ Luteinizing hormone (LH) release from anterior pituitary
↓ 5-DHT and/or testosterone binding to androgen receptors in chest tissue
↓ inhibition of breast development
Normal or increased estrogen acts on estrogen receptor on chest tissue
Estrogen receptors stimulate breast development
          Estradiol negatively feedbacks on luteinizing hormone
β-HCG stimulates LH receptors on Leydig cells in the testes
Aromatase enzyme converts excess testosterone into estrogen and estradiol
↓ conversion of testosterone to 5- dihydrotestosterone (5-DHT), a more potent form of testosterone
Glandular proliferation in male breasts
Gynecomastia
(development of breast tissue in males)
                      Drug side- effects
↓ Metabolism of estradiol
Competitively binds to androgen receptors
↑ Serum estradiol levels
Exhibits physical attributes that do not align with gender identity
Psychological distress
In some cases, hormones stabilize
Involution and atrophy of ducts
Gynecomastia resolves
             ↓ Steroid synthesis
↓ Androstenedione produced (testosterone precursors)
↓ Serum testosterone levels
       ↓ Testosterone production
 Legend:
 Pathophysiology
 Mechanism
 Sign/Symptom/Lab Finding
 Complications
 Published Jun 9, 2024 on www.thecalgaryguide.com