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Jncyo3aiyvnrbwy7vwtvfwczh Neuroendocrinal syndromes in gynecology (Shikhane syndrome, hyperandrogeny, hyperprolactinemia). 1.Relevance Sheehan's syndrome, also known as postpartum pituitary gland necrosis, is hypopituitarism (decreased functioning of the pituitary gland), caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth In a study of 1,034 symptomatic adults, Sheehan’s syndrome was found to be the sixth-most frequent etiology of growth hormone deficiency, being responsible for 3.1% of cases (versus 53.9% due to a pituitary tumor). Hyperandrogenemia (HA) describes the condition of a patient with increased production of a group of steroid hormones known as androgens, from the Greek prefix “andro” meaning “man.” While these hormones play a central role in male physiology, they are also present to a lesser degree in females, with the most predominant androgens including testosterone, dihydrotestosterone (DHT), androstenedione, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S). The overall incidence of HA in women is approximately 5%–10%, with polycystic ovarian syndrome (PCOS) accounting for approximately 80% of cases. In general, HA may be caused by exogenous medications, endogenous neoplasms, or via the nonneoplastic overproduction of androgens. Clinical signs of HA include acne, abnormal hair growth (hirsutism), and male pattern baldness (alopecia). Other signs of HA may also be present, including irregular menstrual cycles, virilization (deepening voice, enlarging clitoris, breast atrophy), or insulin resistance. Excessive upper lip hair in a third of women ages 14-45 Hyperprolactinemia may result in hypogonadism, infertility, and galactorrhea, or it may remain asymptomatic Testing for hyperprolactinemia is straightforward, owing to the ease of ordering a serum prolactin measurement. Accordingly, an evidence-based, cost-effective approach to management of this relatively common endocrine disorder is required. Prolactin acts to induce and maintain lactation of the primed breast. Nonpuerperal hyperprolactinemia is caused by lactotroph adenomas (prolactinomas), which account for approximately 40% of all pituitary tumors.. Bone loss occurs secondary to hyperprolactinemia-mediated sex steroid attenuation. Spinal bone density is decreased by approximately 25% in women with hyperprolactinemia and is not necessarily restored with normalization of prolactin levels. Modern knowledge about neuroendocrinological syndroms of the female reproductive system function, role of hormones and biological active substances are at the heart of gynecology. 2. Objectives (are described in the terminology of professional activity, taking into account the system of classification of the objectives of the respective levels of cognitive, emotional and psychomotor spheres): -To analyze the results of main methods of functional diagnostics in gynecology -To explain The levels of regulation of woman`s genital functions -To suggest tactics of management of patients with neuroendocrinological syndroms. -To classify mestrual disordes (irregularities) -To interpret the results of laboratory and instrumental examinations of the cervix, endometrium, ovaries, depending with fazes of MC, the clinical and biochemical, hormonal studies of blood, results of colpocytologycal examination -To draw a diagram scheme of menstrual cycle --To make the analysis of the methods of functional diagnosis in gynecology -To make up the models of clinical cases with various hormanal pathology in women of reproductive and premenopausal age. 3. The basic level of expertise, skills, abilities, required for learning the topic (interdisciplinary integration ) The name of the previous Acquired skills disciplines Normal Anatomy Structure of female genital organs. Topography of abdominal organs and pelvic organs. Histology Histological structure of the cervix, vulva and endometrium in normal and in pathological conditions. Notmal Physiology Physiological changes occurring in the hypothalamic- pituitary-ovarian system of women and target organs of the sex hormones action at different ages. Pathological Physiology Hormonal changes in the body during the menstrual cycle and disorders of the microbiota of the female reproductive system. Pharmacology Groups of medications that affect the function of the hypothalamus, pituitary gland, ovaries, adrenal glands; mechanism of pharmacological action of hormonal, hemostatic, anti-inflammatory, antiviral drugs. 4. Tasks for independent work in preparation for the lesson and in class. 4.1. The list of the major terms, parameters, characteristics to be acquired by a student to be prepared for the lesson The term Definition Adrenogenital syndrome (AGS) is congenital adrenal hyperplasia, female hermaphroditism, or advanced sexual development of the heterosexual type develops as a result of necrotic changes in the hypophysis, which appeared Sheehan’s syndrome against the background of a spasm or intravascular blood coagulation in the vessels of the adenohypophysis after hemorrhages and septic shock during delivery or abortion Hyperprolactinemia . distinct clinical entity and resulted in distinguishing prolactin-secreting tumors from nonfunctioning adenomas Female Sex steroid hormones luteonizing hormone (LH) prolactin follicle-stimulating hormone (FSH) estrogens progesterone Replacement hormonal therapy (RHT) is aimed at the prevention and recovery of metabolic disorders of the climacteric period. Hirsutism Increased Terminal Hair male- patterned growth in women Alopecia Female-Patterned Hair Loss (central hair thinning) Acne Vulgaris is a long-term skin disease that occurs when dead skin cells and oil from the skin clog hair follicles.Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring 4.2 Theoretical questions for the lesson: 1. Regulations mechanisms of menstruation at different levels. 2. Biologic action of sex hormones, hypophysis hormones and releasing hormones. 3. Basic levels of menstruation regulation and physical stages of their establishment. 4. Pathogenesis of menstrual disorders. 5. Pathogenesis of adrenogenital syndrome 6. Clinic of adrenogenital syndrome 7. Management of adrenogenital syndrome 8. Pathogenesis of Sheehan`s syndrome 9. Clinic of Sheehan`s syndrome 10. Management of Sheehan`s syndrome 11. Pathogenesis of hyperprolactinemia 12. Clinic of hyperprolactinemia 13. Management of hyperprolactinemia 4.3 Practical activities (tasks) to be performed on the lesson: To Describe the proposed changes in organs of women during menstrual cycle. To Evaluate proposed by instructor menstrual cycle, amount of blood loss during normal and pathologic menstrual cycle (anovulatory cycle, luteine phase insuffi-ciency). To analyze the results of main methods of functional diagnostics in gynecology To suggest tactics of management of patients with hormonal imbalance of female reproductive system. To classify mestrual disordes (irregularities) To interpret the results of laboratory and instrumental examinations of the cervix, endometrium, ovaries, depending with fazes of MC, the clinical and biochemical, hormonal studies of blood, results of colpocytologycal examination To draw a diagram scheme of menstrual cycle and chart of basal temperature To make up the models of clinical cases with various hormanal pathology in women of reproductive and premenopausal age. Adrenogenital Syndrome Adrenogenital syndrome (AGS) is congenital adrenal hyperplasia, female hermaphroditism, or advanced sexual development of the heterosexual type. It should be noted that the adrenal glands synthesize 3 main groups of steroids of different biological action: 1) mineralocorticoids; 2) glucocorticoids; 3) reticular zone hormones – androgens (strong – testosterone, weak – дегідроепіандростерон, dehydroepiandrosterone sulfate, androstenedione), and estradiol with estrone, a small quantity of which is also formed here. Etiology and pathogenesis. AGS is a consequence of congenital genetically conditioned deficiency of enzyme systems, which take part in the synthesis of adrenal steroid hormones. At that, by the feedback principle there increases ACTH formation in the adenohypophysis and the synthesis of cortisol precursors, which form androgens due to enzyme deficit. Symptoms and Signs A. General appearance 1. Muscular male body habitus (e.g. Shoulder girdle) 2. Android Obesity B. Miscellaneous Changes 1. Deepening of voice 2. Clitorimegaly 3. Increased Libido C. Menstrual irregularity 1. Amenorrhea 2. Infertility D. Endocrine changes 1. Hypertension 2. Hyperlipidemia 3. Glucose Intolerance E. Skin changes Congenital Adrenogenital Syndrome Adrenal malfunction has an intrauterine onset, almost simultaneous with the beginning of adrenal glands functioning as an endocrine gland. The clinicodiagnostic criteria: - karyotype 46,ХХ; - the signs of external genitals virilization (clitoromegaly, fusion of the large lips of pudendum, and urogenital sinus persistence – fusion of the two lower thirds of the vagina and urethra, which opens under the enlarged clitoris); - the ovaries and uterus are developed correctly; - advanced sexual development of the heterosexual type; - hypertrichosis; - in consequence of the anabolic action of androgens there takes place the rapid lengthwise growth of tubular bones, distribution of the muscular and fatty tissue by the male type. In girls with congenital AGS the body length reaches 150–155 cm till the age of 10–12 years, children do not grow any
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