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ODESA NATIONAL MEDICAL UNIVERSITY Department of Internal Medicine № 1 with the Course of Cardiovascular Diseases ODESA NATIONAL MEDICAL UNIVERSITY Department of Internal Medicine № 1 with the course of cardiovascular diseases METHODIC RECOMMENDATIONS FOR PRACTICAL CLASSES Topic "Disease of the hypothalamic-pituitary system. Diseases of the gonads " Course IV Faculty: international Specialty :222 -"Medicine" The lecture was discussed on the methodical meeting of the department 27.08.2020 Protocol № 1 Head of the department Prof, Yu.I. Karpenko Odesa I. Actuality of the topic. Acromegalyis a syndrome that results when the pituitary gland produces excess growth hormone (hGH) after epiphyseal plate closure at puberty. A number of disorders may increase the pituitary's GH output, although most commonly it involves a GH producing tumor called pituitary adenoma, derived from a distinct type of cell (somatotrophs). Acromegaly most commonly affects adults in middle age, and can result in severe disfigurement, serious complicating conditions, and premature death if unchecked. Because of its insidious pathogenesis and slow progression, the disease is hard to diagnose in the early stages and is frequently missed for many years, until changes in external features, especially of the face, become noticeable. Acromegaly is often also associated with gigantism. Diseases of the sexual glands are a consequence of chromosomal abnormalities, detected when other endocrine glands are affected. In diseases associated with violations of sexual differentiation, sex may be incorrectly defined, which requires its change in the future. II. The purpose of the lecture: 1. To study the method of determination of etiologic and pathogenic factors of diseases of the hypothalamic-pituitary system (HPS). 2. To familiarize students with classifications of diseases of HPS. 3. Determination of variants of clinical picture of HPS diseases. 4. Familiarization with the atypical clinical variants of diseases of HPS. 5. Familiarization of students with possible complications of diseases of HPS. 6. Working off the methodology of determination of basic diagnostic criteria of HPS diseases. 7. Planning of patients examination with the diseases of HPS. 8. Analyzing of results of laboratory and instrumental investigations that are used for diagnostics of HPS diseases. 9. Tactic of conducting differential diagnostics of HPS diseases. 10. Technology of grounding and formulation of diagnosis for HPS diseases. 11. Planning of treatment of patients with the HPS diseases. 12. Deontological and psychological features of curation of patients with the disease of HPS. 13. Spread diseases of the sexual glands among population in Ukraine and other countries 14. To be able to carry out a clinical examination of a patient with diseases of the sexual glands To realize the goal of study, basic knowledge is necessary: 1. Determination of concept of HPS diseases. 2. Epidemiology of HPS diseases. 3. Risk factors of HPS diseases. 4. Mechanism of hormonal and metabolic disorders at the diseases of HPS. 5. Etiology and pathogenesis of HPS diseases. 6. Classification of HPS diseases. 7. Clinical picture of HPS diseases. 8. Polyorganic complications of HPS diseases. 9. Diagnostic criteria of HPS diseases. 10. Choice of method of treatment of HPS diseases. 11. Etiology and pathogenesis of diseases of the sexual glands 12. To know clinical manifestations of diseases of the sexual glands 13. Laboratory methods of diagnostics in patients with diseases of the sexual glands 14. to know medical treatment of patients with diseases of the sexual glands This discipline needs basic knowledge: 1. Peculiarities of anatomy and physiology of endocrine system 2. Anamnesis of endocrine patients 3. Objective investigation 4. Methods of instrumental and laboratory diagnosis 5. Differential diagnosis of acromegaly 6. Treatment of acromegaly III. A task for the self-preparation of a student for a lesson Information for raising the level of basic knowledge can be found in the following textbooks: Training: . Davidson’s “Principles of Practice of Medicine” 22th edition, 2014. 2. Harrison’s “Principles of internal medicine”, 19th edition, 2015 Additional: American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly - © 2011 American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients – 2009 Update AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Menopause © 2011 AACE Medical Guidelines for the Clinical Practice for Evaluation and Treatment of Male Sexual Dysfunction: A Couple's Problem- 2013 Update AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male Patients- 2012 Update AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hyperandrogenic Disorders © 2011 IV. Questions: 1. Etiology of acromegaly 2. Clinical diagnosis of acromegaly 3. Laboratory and instrumental diagnosis of acromegaly 4. Treatment of acromegaly 5. Etiology and pathogenesis of different types of diseases of the sexual glands 6. Classification of diseases of the sexual glands 7. Clinical manifestations of different types of diseases of the sexual glands 8. Laboratory diagnosis of different types of diseases of the sexual glands 9. Diff. diagnosis of different types of diseases of the sexual glands 10. Treatment of diseases of the sexual glands V. Plan of self-study: # Consequence of actions Indications 1 Diagnosis of acromegaly Plan of patient examination 2 Basic clinical and instrumental laboratory data of Criterions of acromegaly acromegaly diagnosis, tests 3 Practical actions in clinics Clinical diagnosis, prescribe medicine 4 Know the diagnostic capabilities for detecting diseases Draw up a plan for examining of the sexual glands the patient 5 Know the basic clinical and instrumental and Write the criteria for diagnosis laboratory data for diseases of the sexual glands of diseases of the sexual glands. Solution of test tasks of final control 6 Be able to apply the knowledge acquired in a clinical Record the clinical diagnosis situation of the examined patient. Write prescriptions. Task for self-study: References, tables, schemes of treatment Acromegaly is a syndrome that results when the pituitary gland produces excess growth hormone (hGH) after epiphyseal plate closure at puberty. A number of disorders may increase the pituitary's GH output, although most commonly it involves a GH producing tumor called pituitary adenoma, derived from a distinct type of cell (somatotrophs). Acromegaly most commonly affects adults in middle age, and can result in severe disfigurement, serious complicating conditions, and premature death if unchecked. Because of its insidious pathogenesis and slow progression, the disease is hard to diagnose in the early stages and is frequently missed for many years, until changes in external features, especially of the face, become noticeable. Acromegaly is often also associated with gigantism. Signs and symptoms Features that result from high level of GH or expanding tumor include: - Soft tissue swelling visibly resulting in enlargement of the hands, feet, nose, lips and ears, and a general thickening of the skin. In particular the appearance of the hands can indicate to a knowledgeable person that a stranger may be developing acromegaly; there are documented instances of physicians warning strangers that they had acromegaly. - Soft tissue swelling of internal organs, notably the heart with attendant weakening of its muscularity, and the kidneys, also the vocal cords resulting in a characteristic thick, deep voice and slowing of speech - Generalized expansion of the skull at the fontanelle - Pronounced brow protrusion, often with ocular distension - Pronounced lower jaw protrusion with attendant macroglossia (enlargement of the tongue) and teeth gapping - Hypertrichosis, hyperpigmentation, and hyperhidrosis may occur in these patients. Causes Pituitary adenoma In over 90 percent of acromegaly patients, the overproduction of growth hormones is caused by a benign tumor of the pituitary gland, called an adenoma. These tumors produce excess growth hormones and, as they expand, compress surrounding brain tissues, such as the optic nerves. This expansion causes the headaches and visual disturbances that often accompany acromegaly. In addition, compression of the surrounding normal pituitary tissue can alter production of other hormones, leading to changes in menstruation and breast discharge in women and impotence in men because of reduced testosterone production. There is a marked variation in rates of GH production and the aggressiveness of the tumor. Some adenomas grow slowly and symptoms of growth hormone excess are often not noticed for many years. Other adenomas grow rapidly and invade surrounding brain areas or the sinuses, which are located near the pituitary. In general, younger patients tend to have more aggressive tumors. Most pituitary tumors arise spontaneously and are not genetically inherited. Many pituitary tumors arise from a genetic alteration in a single pituitary cell which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but is acquired during life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells; it permanently switches on the signal that tells the cell to divide and secrete growth hormones. The events within
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