PERIPHERAL PRECOCIOUS PUBERTY SECONDARY TO MCCUNE-AL BRIGHT SYNDROME
|
|
- Stephany Cole
- 5 years ago
- Views:
Transcription
1 CASE REPORT PERIPHERAL PRECOCIOUS PUBERTY SECONDARY TO MCCUNE-AL BRIGHT SYNDROME Suhaimi H 1, Fatimah Harun 2, Mohd Yazid Jalaluddin 2 1. Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia 2. Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia Abstract We report a rare case of McCune-Albright syndrome in an 8-month-old girl who presented with early breast development and cyclical vaginal bleeds. She was confirmed to have a peripheral type of precocious puberty based on her hormonal studies. We also highlighted the use of tamoxifen in the management of peripheral type of precocious puberty. Keywords: Peripheral Precocious Puberty, Mccune-al Bright Syndrome Corresponding Author: Dr. Suhaimi Hussain, Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia Tel: hsuhaimi@kb.usm.my Case Report NE was an 8-month-old girl, the first child in the family, ex-premature 24 weeks with birth weight of 700 g. She had a stormy neonatal period with respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH) grade 2, retinopathy of prematurity (ROP) grade 1 and was admitted for three months. She presented again at the age of six months with progressive breast development associated with per vaginal bleeding. The per vaginal bleed was followed by brownish discharge for 4-5 days that occurred monthly at six months and seven months of age. There was no similar problem in the family. Parents are non-consanguineous. The infant was on exclusive breast feeding and there was no exposure to any drugs or herbs that might lead to premature onset of puberty. Clinically, she was not dysmorphic. Both breasts were at Tanner stage 3 (Figure 1). Her vaginal mucosa was oestrogenised. She had a typical café-au-lait skin lesion at her right thigh that measured 4 x 5 cm with ragged edges (Figure 2). Her abdomen was soft and she had no other signs of precocious puberty.
2 Figure 1. Breast Tanner stage 3 Figure 2. Café-au-lait with coast of Maine
3 Hormonal study showed a peripheral type of precocious puberty with predominant follicle-stimulating hormone (FSH) rise compared to luteinizing hormone (LH) (Table 1). Her oestradiol level was very high and ultrasound pelvis revealed multiple ovarian cysts (Figure 3). Figure 3. Multiple ovarian cysts Table 1. There should be a title / description / legend of this table for e.g. hormonal profile of patient Hormonal study LH ( m IU/ml) 1.3 < FSH ( m IU/ml) Oestradiol ( pmol/l) Testosterone ( nmol/l) hcg (< 5 ml U/ml (0-10) - FT4 (10-24 pmol/l)/ / TSH ( m IU/L) Cortisol (nmol/l) DHEA-S (nmol/l) - < She was then started on tamoxifen 10 mg daily to block the effect of oestrogen on the breast and endometrium. After a few months of starting the treatment, her breast size regressed and there was no more per vaginal bleeding. Discussions This girl had a peripheral type of precocious puberty as she had prepubertal level of gonadotropins but with a pubertal level of oestradiol. Precocious puberty is the
4 appearance of secondary sexual characteristics before the age of 8 years in a girl and 9 years in a boy respectively. For central type or gonadotropin dependent precocious puberty, both LH and FSH are high and it should show predominantly LH rise compared to FSH. In a girl, LH binds to LH receptors on theca cells of ovaries and results in androgen production. The androgen is transferred to granulosa cells to produce oestrogen. FSH leads to follicular maturation. Under the influence of oestrogen, the endometrium of uterus thickens but without fertilization the endometrium is shed in the form of per vaginal bleeds. The source of high oestrogen in this girl was from the ovaries as ultrasound study showed multiple follicular cysts measuring cm (Figure 3). She had no other lesions in the ovaries and adrenal. McCune-Albright (MAS) syndrome is a rare condition in children and for a clinical diagnosis, a patient should have two out of three criterion. This girl had a typical caféau-lait and a peripheral type of precocious puberty or endocrine hyperfunction [1]. MAS is due to mutation in the alpha subunit of G protein. G protein is responsible for intracellular signaling. When a ligand/hormone binds to surface receptor, G protein becomes activated and in turn activates adenyl cyclase and increase camp. In MAS, the activated G protein remains activated and unable to be de-activated leading to endocrine hyperfunction [2,3]. Confirmation of diagnosis requires tissue biopsy to look for G protein mutation and it is in fact the best yield compared to leucocytes and skin biopsy [4,5]. The confirmation of the diagnosis based on the tissue biopsy was not done as we could not get any consent from the parents. The girl was treated with tamoxifen 10 mg daily and after 2-3 months she had no more cyclical per vaginal bleeds and her breast enlargement regressed to Tanner stage 1. Biochemically her oestradiol level was normalized to pre-pubertal level. Tamoxifen is an oestrogen blocker and it has been used for the treatment of breast cancer in adults. However its usage for the treatment of precocious puberty in children has not been as much since peripheral type of precocious puberty is such a rare condition. There were some reported cases of its usage worldwide [4,5]. Antioestrogen, blocks the effects of oestrogen on tissue, by binding and blocking oestrogen receptor on the cell surface. The precise mechanism is unknown. It does not interfere at all in the underlying process. It only blocks the effects of oestrogen on the tissues and its main effect is to stop per vaginal bleeding and rate of bone age advancement better than aromatase inhibitor (testolactone) and in fact it is relatively safe [4,5]. Even though, she was successfully treated with peripheral blocker/tamoxifen, she needs to have a long term endocrine follow up with annual screening to look for other endocrine hyperfunctions. References [1] Shenker A, Weinstein LS, Moran A, et al. Severe endocrine and nonendocrine manifestations of the McCune-Albright syndrome associated with activating mutations of stimulatory G protein GS. J Pediatr. Oct 1993;123(4):
5 [2] Weinstein LS, Shenker A, Gejman PV, et al. Activating mutations of the stimulatory G protein in the McCune-Albright syndrome. N Engl J Med. Dec ;325(24): [3] Spiegel AM. The molecular basis of disorders caused by defects in G proteins. Horm Res. 1997;47(3): [4] Eugster EA, Rubin SD, Reiter EO, et al. Tamoxifen treatment for precocious puberty in McCune- Albright syndrome: a multicenter trial. J Pediatr. 2003;143(1):60-6. [5] Eugster EA, Shankar R, Freezle LK, et al. Tamoxifen treatment of progressive precocious puberty in a patient with McCune-Albright syndrome. J Pediatr Endocrinol. 1999;12(5):681-6.
Laura Stewart, MD, FRCPC Clinical Associate Professor Division of Pediatric Endocrinology University of British Columbia
Precocious Puberty Laura Stewart, MD, FRCPC Clinical Associate Professor Division of Pediatric Endocrinology University of British Columbia Faculty Disclosure Faculty: Laura Stewart No relationships with
More informationPrecocious Puberty. Disclosures. No financial disclosures 2/28/2019
Precocious Puberty Bracha Goldsweig, MD Pediatric Endocrinologist Children s Hospital and Medical Center, Omaha, NE University of Nebraska Medical Center Disclosures No financial disclosures 1 Objectives
More information5yo girl with vaginal bleeding. Matthew Wise, MD Med Peds Endo January 26, 2012
5yo girl with vaginal bleeding Matthew Wise, MD Med Peds Endo January 26, 2012 HPI 5y 10m Caucasian girl 2mo prior: labial swelling 1mo prior: painless vaginal bleeding x5days, pads q4 6h breast buds noted
More informationReproductive Health and Pituitary Disease
Reproductive Health and Pituitary Disease Janet F. McLaren, MD Assistant Professor Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology jmclaren@uabmc.edu Objectives
More informationPaul Hofman. Professor. Paediatrician Endocrinologist Liggins Institute, The University of Auckland, Starship Children Hospital, Auckland
Professor Paul Hofman Paediatrician Endocrinologist Liggins Institute, The University of Auckland, Starship Children Hospital, Auckland 14:00-14:55 WS #108: Common pubertal variants how to distinguish
More informationFibrous Dysplasia in Children. Professor Nick Shaw Birmingham Children s Hospital, UK
Fibrous Dysplasia in Children Professor Nick Shaw Birmingham Children s Hospital, UK Overview What is Fibrous Dysplasia? Clinical Presentations Endocrine Problems Skeletal Problems Treatment Options Fibrous
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Puberty and Pubertal Disorders Part 2: Precocious Puberty. These podcasts are designed to give medical students an overview
More information3 year old boy with puberty. Katie Stanley, MD August 1, 2013
3 year old boy with puberty Katie Stanley, MD August 1, 2013 Initial presentation 3 and 11/12 year old boy with signs of puberty Presented to outside endocrinologist in 2002 with: Pubic hair since 2.5
More informationClinical Guideline ADRENARCHE MANAGEMENT OF CHILDREN PRESENTING WITH SIGNS OF EARLY ONSET PUBIC HAIR/BODY ODOUR/ACNE
Clinical Guideline ADRENARCHE MANAGEMENT OF CHILDREN PRESENTING WITH SIGNS OF EARLY ONSET PUBIC HAIR/BODY ODOUR/ACNE Includes guidance for the distinction between adrenarche, precocious puberty and other
More informationA Case of Atypical McCune-Albright Syndrome with Vaginal Bleeding
Case Report Iran J Pediatr Sep 2011; Vol 21 (No 3), Pp: 399-403 A Case of Atypical McCune-Albright Syndrome with Vaginal Bleeding Noushin Rostampour 1, MD; Mahin Hashemipour* 1,2, MD; Roya Kelishadi 1,2,
More information2.0 Synopsis. Lupron Depot M Clinical Study Report R&D/09/093. (For National Authority Use Only) to Part of Dossier: Name of Study Drug:
2.0 Synopsis Abbott Laboratories Individual Study Table Referring to Part of Dossier: Name of Study Drug: Volume: Abbott-43818 (ABT-818) leuprolide acetate for depot suspension (Lupron Depot ) Name of
More informationOBJECTIVES. Rebecca McEachern, MD. Puberty: Too early, Too Late or Just Right? Special Acknowledgements. Maryann Johnson M.Ed.
1 Puberty: Too early, Too Late or Just Right? Maryann Johnson M.Ed., BSN, RN Special Acknowledgements Rebecca McEachern, MD OBJECTIVES Illustrate basic endocrine system and hormonal pathways Define the
More informationVirilisation in siblings secondary to transdermal bioidentical testosterone exposure
doi:10.1111/jpc.13466 INSTRUCTIVE CASE Virilisation in siblings secondary to transdermal bioidentical testosterone exposure Tony Huynh 1,2 and Catherine I Stewart 3 1 Department of Endocrinology and Diabetes,
More informationPuberty and Pubertal Disorders. Lisa Swartz Topor, MD, MMSc Pediatric Endocrinology July 2018
Puberty and Pubertal Disorders Lisa Swartz Topor, MD, MMSc Pediatric Endocrinology July 2018 Objectives Review normal pubertal development Recognize common pubertal disorders Identify recent trends in
More information9.4 Regulating the Reproductive System
9.4 Regulating the Reproductive System The Reproductive System to unite a single reproductive cell from a female with a single reproductive cell from a male Both male and female reproductive systems include
More informationReproduction. AMH Anti-Müllerian Hormone. Analyte Information
Reproduction AMH Anti-Müllerian Hormone Analyte Information - 1-2011-01-11 AMH Anti-Müllerian Hormone Introduction Anti-Müllerian Hormone (AMH) is a glycoprotein dimer composed of two 72 kda monomers 1.
More informationPeripheralPrecociousPubertyCausesDiagnosisandManagement
: F Diseases Volume 7 Issue Version.0 Year 07 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Inc. (USA) Online ISSN: 49468 & Print ISSN: 09755888 Peripheral
More informationFemale Reproductive Physiology. Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF
Female Reproductive Physiology Dr Raelia Lew CREI, FRANZCOG, PhD, MMed, MBBS Fertility Specialist, Melbourne IVF REFERENCE Lew, R, Natural History of ovarian function including assessment of ovarian reserve
More informationReproductive physiology
Reproductive physiology Sex hormones: Androgens Estrogens Gestagens Learning objectives 86 (also 90) Sex Genetic sex Gonadal sex Phenotypic sex XY - XX chromosomes testes - ovaries external features Tha
More informationReproductive System. Testes. Accessory reproductive organs. gametogenesis hormones. Reproductive tract & Glands
Reproductive System Testes gametogenesis hormones Accessory reproductive organs Reproductive tract & Glands transport gametes provide nourishment for gametes Hormonal regulation in men Hypothalamus - puberty
More informationPrescribing Guidelines Prescribing arrangement for the management of patients transferring from Secondary Care to Primary Care
Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care
More informationPolycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018
Polycystic Ovary Syndrome HEATHER BURKS, MD OU PHYSICIANS REPRODUCTIVE MEDICINE SEPTEMBER 21, 2018 Learning Objectives At the conclusion of this lecture, learners should: 1) Know the various diagnostic
More information10.7 The Reproductive Hormones
10.7 The Reproductive Hormones December 10, 2013. Website survey?? QUESTION: Who is more complicated: men or women? The Female Reproductive System ovaries: produce gametes (eggs) produce estrogen (steroid
More information2-year-old girl with premature thelarche. Endorama February 5, 2015 Carmen Mironovici, M.D.
2-year-old girl with premature thelarche Endorama February 5, 2015 Carmen Mironovici, M.D. Chief complaint Premature thelarche first noted at 21 months of age Patient referred to Endocrinology Clinic for
More informationManagement of Pediatric Fibrous Dysplasia/McCune-Albright Syndrome
Management of Pediatric Fibrous Dysplasia/McCune-Albright Syndrome Alison Boyce, MD 3 rd Meeting of the FD/MAS International Consortium Leiden University Medical Center, Leiden, The Netherlands Fibrous
More informationPrimary Neonatal and paediatric Consultant Dr M Gnanabalan Operating Paediatric Surgeon Dr P Balamourugane Paediatric Pathologist Dr Seetha lakshmi
Dr C K Janaki Raman DNB Pediatrics Trainee Department of Pediatrics Mehta Childrens Hospital Primary Neonatal and paediatric Consultant Dr M Gnanabalan Operating Paediatric Surgeon Dr P Balamourugane Paediatric
More informationThe menstrual cycle. François Pralong
The menstrual cycle François Pralong Services d Endocrinologie, Diabétologie et Métabolisme, Hôpitaux Universitaires de Genève et Lausanne Centre des Maladies CardioVasculaires et Métaboliques, Lausanne
More informationThe menstrual Cycle. François Pralong
The menstrual Cycle François Pralong Services d Endocrinologie, Diabétologie et Métabolisme, Hôpitaux Universitaires de Genève et Lausanne Centre des Maladies CardioVasculaires et Métaboliques, Lausanne
More informationHyperandrogenism. Dr Jack Biko. MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany)
Hyperandrogenism Dr Jack Biko MB. BCh (Wits), MMED O & G (Pret), FCOG (SA), Dip Advanced Endoscopic Surgery(Kiel, Germany) 2012 Hyperandrogenism Excessive production of androgens Adrenal glands main source
More informationHormonal Control of Human Reproduction
Hormonal Control of Human Reproduction Bởi: OpenStaxCollege The human male and female reproductive cycles are controlled by the interaction of hormones from the hypothalamus and anterior pituitary with
More informationEndocrine: Precocious Puberty Health care guidelines for Spina Bifida
Endocrine: Precocious Puberty Health care guidelines for Spina Bifida Precocious Puberty Primary outcome: Timely assessment, identification, appropriate referral, and management of precocious puberty.
More informationPUBERTY. Preetha Krishnamoorthy. Division of Pediatric Endocrinology
PUBERTY Preetha Krishnamoorthy Division of Pediatric Endocrinology Case 1 8-year-old girl referred for breast development noted by mom What do you want to know? Normal or abnormal? What if this was an
More informationReproduction and Development. Female Reproductive System
Reproduction and Development Female Reproductive System Outcomes 5. Identify the structures in the human female reproductive system and describe their functions. Ovaries, Fallopian tubes, Uterus, Endometrium,
More informationReproductive FSH. Analyte Information
Reproductive FSH Analyte Information 1 Follicle-stimulating hormone Introduction Follicle-stimulating hormone (FSH, also known as follitropin) is a glycoprotein hormone secreted by the anterior pituitary
More informationEndocrinology of the Female Reproductive Axis
Endocrinology of the Female Reproductive Axis girlontheriver.com Geralyn Lambert-Messerlian, PhD, FACB Professor Women and Infants Hospital Alpert Medical School at Brown University Women & Infants BROWN
More informationDr Stella Milsom. Endocrinologist Fertility Associates Auckland. 12:30-12:40 When Puberty is PCO
Dr Stella Milsom Endocrinologist Fertility Associates Auckland 12:30-12:40 When Puberty is PCO Puberty or Polycystic Ovary Syndrome? Stella Milsom Endocrinologist Auckland DHB, University of Auckland,
More informationReproductive System (Hormone Function) Physiology Department Medical School, University of Sumatera Utara
Reproductive System (Hormone Function) Physiology Department Medical School, University of Sumatera Utara 1 Endocrine Control: Three Levels of Integration Hormones of the hypothalamic-anterior pituitary
More informationBiology of Reproduction- Zool 346 Exam 2
Biology of Reproduction- Zool 346 Exam 2 ANSWER ALL THE QUESTIONS ON THE ANSWER SHEET. THE ANSWER ON THE ANSWER SHEET IS YOUR OFFICIAL ANSWER. Some critical words are boldfaced. This exam is 7 pages long.
More informationIdiopathic central precocious puberty associated with an enlarged pituitary gland
Idiopathic central precocious puberty associated with an enlarged pituitary gland Idiopathic central precocious puberty associated with an enlarged pituitary gland S Pathmanathan 1, Navoda Atapattu 2,
More informationPolycystic Ovary Syndrome
What is the polycystic ovary syndrome? Polycystic Ovary Syndrome The polycystic ovary syndrome (PCOS) is a clinical diagnosis characterized by the presence of two or more of the following features: irregular
More informationChapter 14 Reproduction Review Assignment
Date: Mark: _/45 Chapter 14 Reproduction Review Assignment Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Use the diagram above to answer the next question.
More informationWhy is my body not changing? Conflicts of interest. Overview 11/9/2015. None
Why is my body not changing? Murthy Korada Pediatrician, Pediatric Endocrinologist Ridge Meadows Hospital Surrey Memorial Hospital None Conflicts of interest Overview Overview of normal pubertal timing
More informationThe beginning of puberty is marked by the progressive increase in the production of sex hormones.
Puberty is characterized by the changes that prepare the human body for the ability to reproduce. This stage generally occurs between the ages of 10 and 14 years old. The beginning of puberty is marked
More informationA single sample GnRHa stimulation test in the diagnosis of precocious puberty
Yazdani et al. International Journal of Pediatric Endocrinology 212, 212:23 RESEARCH Open Access A single sample GnRHa stimulation test in the diagnosis of precocious puberty Parvin Yazdani 1*, Yuezhen
More informationCASE 41. What is the pathophysiologic cause of her amenorrhea? Which cells in the ovary secrete estrogen?
CASE 41 A 19-year-old woman presents to her gynecologist with complaints of not having had a period for 6 months. She reports having normal periods since menarche at age 12. She denies sexual activity,
More informationSCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY & MOLECULAR BIOLOGY
1 SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY & MOLECULAR BIOLOGY PBL SEMINAR: SEX HORMONES PART 1 An Overview What are steroid hormones? Steroid
More informationPhysiology of Male Reproductive System
Physiology of Male Reproductive System the anterior pituitary gland serves as the primary control of reproductive function at puberty Ant Pituitary secretes FSH & large amounts of LH (ICSH) FSH & LH cause
More informationAMH and measuring Ovarian reserve
AMH and measuring Ovarian reserve Professor W Hamish Wallace Consultant Paediatric Oncologist Edinburgh Scotland UK hamish.wallace@nhs.net Ovarian Reserve? The Wallace-Kelsey Model (Five parameter asymmetric
More informationFLASH CARDS. Kalat s Book Chapter 11 Alphabetical
FLASH CARDS www.biologicalpsych.com Kalat s Book Chapter 11 Alphabetical alpha-fetoprotein alpha-fetoprotein Alpha-Fetal Protein (AFP) or alpha-1- fetoprotein. During a prenatal sensitive period, estradiol
More informationPolyostotic Fibrous Dysplasia in a Young Female with McCune Albright Syndrome
Philippine Journal of Internal Medicine Case Report Polyostotic Fibrous Dysplasia in a Young Female with McCune Albright Syndrome Marbert John T. Cardino, M.D., 1 Ceryl Cindy Tan, M.D. 2 and Cecilia Jimeno,
More informationDr. Nermine Salah El-Din Prof of Pediatrics
Dr. Nermine Salah El-Din Prof of Pediatrics Diabetes Endocrine Metabolism Pediatric Unit (DEMPU) Children Hospital, Faculty of Medicine Cairo University Congenital adrenal hyperplasia is a common inherited
More informationFemale Reproductive System. Lesson 10
Female Reproductive System Lesson 10 Learning Goals 1. What are the five hormones involved in the female reproductive system? 2. Understand the four phases of the menstrual cycle. Human Reproductive System
More informationReproductive physiology. About this Chapter. Case introduction. The brain directs reproduction 2010/6/29. The Male Reproductive System
Section Ⅻ Reproductive physiology Ming-jie Wang E-Mail: mjwang@shmu.edu.cn About this Chapter The reproductive organs and how they work the major endocrine functions of sexual glands actions of sex hormones
More informationPrinciples of Ovarian Stimulation
Principles of Ovarian Stimulation Dr Genia Rozen Gynaecologist and Fertility Specialist Royal Women s Hospital and Melbourne IVF Learning objectives Why ovarian stimulation Recap physiology Ovarian cycle
More informationResult ID Reporting Name Type Unit LOINC. Z1886 Cortisol Alphanumeric ug/dl Z0226 Deoxycorticosterone (DOC) Alphanumeric ng/dl
Reporting Title: CAH Profile 6 Performing Location: Esoterix Endocrinol Specimen Requirements: Draw blood in a plain, red-top tube(s). Spin down and separate within 1 hour of collection and send 3.5 ml
More informationROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU)
ROLE OF HORMONAL ASSAY IN DIAGNOSING PCOD DR GAANA SREENIVAS (JSS,MYSURU) In 1935, Stein and Leventhal described 7 women with bilateral enlarged PCO, amenorrhea or irregular menses, infertility and masculinizing
More informationDisclosure. Session Objectives. I have no actual or potential conflict of interest in relation to this program/presentation.
46, XY Female: A Case of Complete Androgen Insensitivity Syndrome (CAIS) MICHELLE MCLOUGHLINMSN, CRNP, CPNP-AC THE CHILDREN S HOSPITAL OF PHILADELPHIA DIVISION OF ENDOCRINOLOGY AND DIABETES Disclosure
More informationPrecocious Puberty. Objectives After completing this article, readers should be able to:
Article endocrine Precocious Puberty Andrew Muir, MD* Author Disclosure Dr Muir did not disclose any financial relationships relevant to this article. Objectives After completing this article, readers
More informationWhen testes make no testosterone: Identifying a rare cause of 46, XY female phenotype in adulthood
When testes make no testosterone: Identifying a rare cause of 46, XY female phenotype in adulthood Gardner DG, Shoback D. Greenspan's Basic & Clinical Endocrinology, 10e; 2017 Sira Korpaisarn, MD Endocrinology
More informationLow AMH and natural conception. Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013
Low AMH and natural conception Dr. Phil Boyle Galway, Ireland IIRRM Annual Meeting, 7 th August 2013 Anti Mullerian Hormone AMH levels are commonly measured in fertility clinics to assess ovarian reserve
More informationREPRODUCTIVE ENDOCRINOLOGY
Overview REPRODUCTIVE ENDOCRINOLOGY Specialist Portfolio Seminar 23 rd June 2014 Katie Jones Sandwell and West Birmingham Hospitals NHS Trust Hypothalamic pituitary gonadal axis Females Males Overview
More informationREPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings
REPRODUCCIÓN La idea fija How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development, birth
More informationREPRODUCTION & GENETICS. Hormones
REPRODUCTION & GENETICS Hormones http://www.youtube.com/watch?v=np0wfu_mgzo Objectives 2 Define what hormones are; Compare and contrast the male and female hormones; Explain what each hormone in the mail
More informationChapter 27 The Reproductive System. MDufilho
Chapter 27 The Reproductive System 1 Figure 27.19 Events of oogenesis. Before birth Meiotic events 2n Oogonium (stem cell) Mitosis Follicle development in ovary Follicle cells Oocyte 2n Primary oocyte
More informationReproductive Progesterone
Reproductive Progesterone Analyte Information 1 Progesterone Introduction Progesterone is a natural gestagen belonging to the C 21 steroid group. It is also known as P4 (or pregn-4-ene-3,20-dione, or 4-pregnene-3,20-dione).
More informationEndometriosis and Infertility - FAQs
Published on: 8 Apr 2013 Endometriosis and Infertility - FAQs Introduction The inner lining of the uterus is called the endometrium and it responds to changes that take place during a woman's monthly menstrual
More informationSHARED CARE PRESCRIBING GUIDELINE Triptorelin (Gonapeptyl Depot 3.75 mg TM, Decapeptyl SR mg TM ) for precocious puberty
WORKING IN PARTNERSHIP WITH SHARED CARE PRESCRIBING GUIDELINE Triptorelin (Gonapeptyl Depot 3.75 mg TM, Decapeptyl SR 11.25 mg TM ) for precocious puberty NHS Surrey s Medicines Management Committee classification:
More informationLH activity administration during the
LH activity administration during the luteal-follicular transition Richard Fleming On behalf of the Luveris Pre-treatment group University of Glasgow Scotland Androgens have a Paracrine action in the Early
More informationIndex. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Acquired hypogonadism, prevalence of, 165 167 primary, 165 secondary, 167 Adipose tissue, as an organ, 240 241 Adrenal hyperplasia, congenital,
More informationMULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure.
Chapter 27 Exam Due NLT Thursday, July 31, 2015 Name MULTIPLE CHOICE: match the term(s) or description with the appropriate letter of the structure. Figure 27.1 Using Figure 27.1, match the following:
More informationWhen menarche does not occur a pediatric view
Peter Bang, MD, PhD, MSci Div of Pediatrics Dept of Clinical and Experimental Medicine Faculty of Health Sciences Linköping University peter.bang@liu.se Mobile +46708226491 Svensk Förening för Obstetrik
More information06-Mar-17. Premature menopause. Menopause. Premature menopause. Menstrual cycle oestradiol. Premature menopause. Prevalence ~1% Higher incidence:
Menopause Dr Sonia Davison MBBS FRACP PhD Endocrinologist and Clinical Fellow, Jean Hailes for Women s Health Women s Health Research Program, Monash University = the last natural menstrual period depletion
More informationReproduction. Inhibin B. Analyte Information
Reproduction Inhibin B Analyte Information - 1-2011-01-11 Inhibin B Introduction Inhibins are polypeptides belonging to the transforming growth factor-β (TGF-β) superfamily which also includes TGF-β, activin
More informationMRCPUK SEND Exam. Volume: 200 Questions
Volume: 200 Questions Question No : 1 A 24-year-old woman was referred with an 18-month history of worsening hirsutism, primarily on her face, but also new hair growth on her chest. She was shaving weekly.
More informationLab Guide Endocrine Section Lab Guide
Lab Guide - 2019 Endocrine Section Lab Guide Estradiol Estradiol, Cerner Name: Estradiol Competitive test principle using a polyclonal antibody specifically directed against 17βestradiol in Roche Cobas
More informationReproductive. Estradiol Analyte Information
Reproductive Estradiol Analyte Information - 1 - Estradiol Introduction Estradiol (E2 or 17β-estradiol) is the major estrogen in humans. Although it is often called the "female" hormone, it is also present
More informationApproach to ovulation induction and superovulation in women with a history of infertility. Anatte E. Karmon, MD
Approach to ovulation induction and superovulation in women with a history of infertility Anatte E. Karmon, MD Disclosures- Anatte Karmon, MD No financial relationships to disclose 2 Objectives At the
More informationCynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital
Cynthia Morris DO, FACOOG, FACOS Medical Director, Women s Wellness Center Fayette County Memorial Hospital Touchdown to CME Eighth District Academy of Osteopathic Medicine & Surgery October 8. 2017 Goals
More informationGrowth hormone therapy in a girl with Turner syndrome showing a large increase over the initially predicted ht of 4 5
Disorders of Growth and Puberty: How to Recognize the Normal Variants vs Patients Who Need to be Evaluated Paul Kaplowitz, M.D Pediatric Endocrinology. VCU School of Medicine Interpretation of Growth Charts
More informationEXCEPTIONAL DIAGNOSTICS FOR REPRODUCTIVE DISEASE STATE MANAGEMENT. Anti-Müllerian Hormone (AMH)
EXCEPTIONAL DIAGNOSTICS FOR REPRODUCTIVE DISEASE STATE MANAGEMENT Anti-Müllerian Hormone (AMH) Table of Contents» Introduction... 3» Biosynthesis... 3» Physiological Function... 4 Fetal Stage... 4 Postnatal
More informationHCG (human chorionic gonadotropin); Novarel Pregnyl (chorionic gonadotropin); Ovidrel (choriogonadotropin alfa)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.08.09 Subject: HCG Page: 1 of 5 Last Review Date: June 19, 2015 HCG Powder, Novarel, Pregnyl, Ovidrel
More informationImaging in Pediatric and Adolescent Gynecology
Background and Tools Sultan C (ed): Pediatric and Adolescent Gynecology. Evidence-Based Clinical Practice. Endocr Dev. Basel, Karger, 2004, vol 7, pp 9 22 Imaging in Pediatric and Adolescent Gynecology
More informationThe reproductive lifespan
The reproductive lifespan Reproductive potential Ovarian cycles Pregnancy Lactation Male Female Puberty Menopause Age Menstruation is an external indicator of ovarian events controlled by the hypothalamicpituitary
More informationPERIMENOPAUSE. Objectives. Disclosure. The Perimenopause Perimenopause Menopause. Definitions of Menopausal Transition: STRAW.
PERIMENOPAUSE Patricia J. Sulak, MD Founder, Living WELL Aware LLC Author, Should I Fire My Doctor? Author, Living WELL Aware: Eleven Essential Elements to Health and Happiness Endowed Professor Texas
More informationCase Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation
Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine
More informationEndocrine Glands System. Agha Zohaib Khan
Endocrine Glands System Agha Zohaib Khan Introduction Endocrine means secreting internally. Indeed, the endocrine system is made up of glands whose secretions enter the blood stream. Hence these glands
More informationPrecocious Puberty (Complete, Partial)
The Prepubertal Girl Sultan C (ed): Pediatric and Adolescent Gynecology. Evidence-Based Clinical Practice. Endocr Dev. Basel, Karger, 2004, vol 7, pp 57 65 Precocious Puberty (Complete, Partial) R. Stanhope,
More informationFemale Reproductive Endocrinology
Female Reproductive Endocrinology Dr. Channa Jayasena PhD MRCP FRCPath Clinical Senior Lecturer & Consultant Endocrinologist Department of Gynaecology, Hammersmith Hospital Anovulation is a common cause
More informationSISTEMA REPRODUCTOR (LA IDEA FIJA) Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings
SISTEMA REPRODUCTOR (LA IDEA FIJA) How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development,
More informationBreast Cancer Risk in Patients Using Hormonal Contraception
Breast Cancer Risk in Patients Using Hormonal Contraception Bradley L. Smith, Pharm.D. Smith.bradley1@mayo.edu Pharmacy Ground Rounds Mayo Clinic Rochester April 3 rd, 2018 2017 MFMER slide-1 Presentation
More informationEndocrine Features of Fibrous Dysplasia/McCune-Albright Syndrome
Endocrine Features of Fibrous Dysplasia/McCune-Albright Syndrome Alison Boyce, MD Sec@on on Skeletal Disorders and Mineral Homeostasis, NIDCR, NIH FD Founda@on Pa@ent and Family Conference 2017 Fibrous
More informationAnimal and Veterinary Science Department University of Idaho. REGULATION OF REPRODUCTION AVS 222 (Instructor: Dr. Amin Ahmadzadeh) Chapter 5
Animal and Veterinary Science Department University of Idaho REGULATION OF REPRODUCTION AVS 222 (Instructor: Dr. Amin Ahmadzadeh) Chapter 5 I. DEFINITIONS A. Endocrine Gland B. Hormone Chemical messenger
More information2-Hypertrichosis:- Hypertrichosis is the
Hirsutism And Virilization Hirsutism:- Is the development of androgen-dependent dependent terminal body hair in a woman in places in which terminal hair is normally not found, terminal body hairs are the
More informationStudy Guide Answer Key Reproductive System
Biology 12 Human Biology Textbook: BC Biology 12 Study Guide Answer Key Reproductive System 1. Distinguish between a gamete and a gonad using specific examples from the male and female systems. Gonads
More informationFertility assessment and assisted conception
Fertility assessment and assisted conception Dr Geetha Venkat MD FRCOG Director Pulse Learning Women s health 14 September 2016 Disclosure statement Dr Venkat is a director of Harley Street Fertility Clinic.
More informationGrowing up. W Worksheet 3.1: Percentile growth charts
3.1 W WWorksheet 3.1: Percentile growth charts Growing up From the day we are conceived, each and every one of us follows a life cycle. The human life cycle can be divided into stages such as baby, child,
More informationAction of reproductive hormones through the life span 9/22/99
Action of reproductive hormones through the life span Do reproductive hormones affect the life span? One hypothesis about the rate of aging asserts that there is selective pressure for either high rate
More informationPrimary and secondary amenorrhoea
BRITISH MEDICAL JOURNAL VOLUME 294 28 MARCH 1987 815 Clinical Aalgorithms Primary and secondary amenorrhoea S FRANKS Amenorrhoea, which is usually defined as no periods for six months or more, occurs in
More informationDOES INSULIN RESISTANCE CAUSE HYPERANDROGENEMIA OR HYPERANDROGENEMIA CAUSES INSULIN RESISTANCE IN PCOS
DOES INSULIN RESISTANCE CAUSE HYPERANDROGENEMIA OR HYPERANDROGENEMIA CAUSES INSULIN RESISTANCE IN PCOS D R. G A N A P A T H I. B D E P T. O F E N D O C R I N O L O G Y S T. J O H N S M E D I C A L C O
More informationRobert Wadlow and his father
Robert Wadlow and his father 1 Robert Wadlow Wadlow reached 8 ft 11.1 in (2.72 m) in height and weighed 485 lb (220 kg) at his death at age 22. Born in Illinois. His great size and his continued growth
More information