Sex hormone disorders pathophysiology

erectile dysfunction, gynacomastia, hypogonadism and PCOS

1. REPRODUCTIVE/SEXUAL
HORMONE DISORDERS

2. Introduction
•Reproductive hormones stimulate or control the sexual
organs and reproductive systems in both men and
women.
•In women, hormones including estrogen, progesterone
and follicle-stimulating hormone (FSH) are vital to
menstruation and pregnancy.
•In men, sexual hormones are called androgens.
• The main androgen is testosterone.

3. •Usually, endocrine glands keep reproductive hormones at
the right levels, but many factors can cause hormone
levels to be too high or too low.
•This can lead to problems with sexual development,
fertility and more.

4. Disorders
1.Erectile dysfunction
2.Gynacomastia
3.Hypogonadism
4.PCOS
5.Hirsutism

5. 1.Erectile dysfunction
•Definition
•“The consistent inability to achieve and/or maintain an
erection adequate for satisfactory sexual intercourse”
•Persistent or recurrent inability to attain, or to maintain
until completion of the sexual activity, an adequate
erection

6. •Penile erection is a neurovascular event modulated by
psychological factors and hormonal status.
• On sexual stimulation, there is increased flow of blood
into the lacunar network.
• Subsequent compression of the trabecular smooth
muscle causes a closure of the emissary veins and
accumulation of blood in the corpora. The corpora
becomes non- compressible and blood cannot escape.

7. Causes

8. Symptoms

•Erectile dysfunction symptoms might include persistent:
•Trouble getting an erection
•Trouble keeping an erection
•Reduced sexual desire

9. Pathogenesis

10. Risk Factors for ED
•Diabetes mellitus
•Cardiovascular disease
•Concurrence of other GU diseases
•Psychiatric or psychological disorders
•Chronic diseases
•Smoking Medications
•Hormonal factors also serve as well-defined risk factors

11. Diagnosis

•Physical exam
•Blood tests
•Urine tests (urinalysis)
•Ultrasound
•Psychological exam

12. Complications

•Complications resulting from erectile dysfunction can
include:
•An unsatisfactory sex life
•Stress or anxiety
•Embarrassment or low self-esteem
•Relationship problems

13. 2. Gynecomastia
•Gynecomastia is an increase in the amount of breast
gland tissue in boys or men, caused by an imbalance of
the hormones estrogen and testosterone.

14. Symptoms

•Signs and symptoms of gynecomastia include:
•Swollen breast tissue
•Breast tenderness

15. Causes

•Gynecomastia is triggered by a decrease in the amount of the
hormone testosterone compared with estrogen.
• The decrease can be caused by conditions that block the
effects of testosterone, reduce testosterone or increase
estrogen level.
•Most people think of estrogen as an exclusively female
hormone, but men also produce it — though normally in small
quantities.
• Male estrogen levels that are too high or are out of balance
with testosterone levels can cause gynecomastia.

16. Medications
1.Anti-androgens used to treat an enlarged prostate,
prostate cancer and other conditions.
2.Anabolic steroids and androgens, which are prescribed
by doctors for certain conditions or are sometimes used
illegally by athletes to build muscle and enhance
performance.
3.AIDS medications. Gynecomastia can develop in men
who are HIV-positive and receiving a treatment regimen
called highly active antiretroviral therapy.

17. •Anti-anxiety medications, such as diazepam (Valium).
•Tricyclic antidepressants.
•Antibiotics.
•Ulcer medications
•Cancer treatment.
•Heart medications (digoxin (Lanoxin) and calcium channel
blockers)
Drugs and alcohol
•Alcohol
•Amphetamines, used to treat attention-deficit/hyperactivity
disorder
•Marijuana
•Heroin
•Methadone (Methadose, Dolophine)

18. Health conditions
•Hypogonadism.
•Aging.
•Tumors.
•Hyperthyroidism
•Kidney failure
•Liver failure and cirrhosis
•Malnutrition and starvation

19. Risk factors

•Adolescence
•Older age
•Use of anabolic steroids or androgens to enhance athletic
performance
•Certain health conditions, including liver and kidney
disease, thyroid disease, hormonally active tumors, and
Klinefelter syndrome

20. Complications

•Gynecomastia has few physical complications, but it can
cause psychological or emotional problems caused by
appearance.

21. Diagnosis

•Blood tests
•Mammograms
•Computerized tomography (CT) scans
•Magnetic resonance imaging (MRI) scans
•Testicular ultrasounds
•Tissue biopsies

22. Medications

•Medications used to treat breast cancer and other
conditions may be helpful for some men with
gynecomastia. They include:
•Tamoxifen (Soltamox)
•Aromatase inhibitors, such as anastrozole (Arimidex)

23. 3. Hypogonadism
•“Hypogonadism occurs when sex glands produce little or no
sex hormones”
•The sex glands, also called gonads, are primarily the testes in
men and the ovaries in women.
•Sex hormones help control secondary sex characteristics, such
as breast development in women, testicular development in
men, and pubic hair growth.
• Sex hormones also play a role in the menstrual cycle and
sperm production.

24. Types of hypogonadism
•Primary hypogonadism
•Primary hypogonadism means that they don’t have
enough sex hormones in their body due to a problem in
gonads.
•Gonads are still receiving the message to produce
hormones from brain, but they aren’t able to produce
them.

•Central (secondary) hypogonadism
•In central hypogonadism, the problem lies in your brain.
Your hypothalamus and pituitary gland, which control your
gonads, aren’t working properly.

25. Causes of hypogonadism
•The causes of primary hypogonadism include:

•Autoimmune disorders, such as addison’s disease and
hypoparathyroidism
•Genetic disorders, such as turner syndrome and klinefelter
syndrome
•Severe infections, especially mumps involving your testicles
•Liver and kidney diseases
•Undescended testes
•Hemochromatosis, which happens when your body absorbs
too much iron
•Radiation exposure
•Surgery on your sexual organs

26. •Central hypogonadism may be due to:
•Genetic disorders, such as kallmann syndrome (abnormal
hypothalamic development)
•Infections, including HIV
•Pituitary disorders
•Inflammatory diseases, including sarcoidosis, tuberculosis, and
histiocytosis
•Obesity
•Rapid weight loss
•Nutritional deficiencies
•Use of steroids or opioids
•Brain surgery
•Radiation exposure
•Injury to your pituitary gland or hypothalamus
•A tumor in or near your pituitary gland

27. Symptoms of hypogonadism
•Symptoms that may appear in females include:
•lack of menstruation
•slow or absent breast growth
•hot flashes
•loss of body hair
•low or absent sex drive
•milky discharge from breasts

28. •Symptoms that may appear in males include:

•loss of body hair
•muscle loss
•abnormal breast growth
•reduced growth of penis and testicles
•erectile dysfunction
•osteoporosis
•low or absent sex drive
•infertility
•fatigue
•hot flashes
•difficulty concentrating

29. Pathogenesis

30. Risk factors

•Risk factors for hypogonadism include:
•HIV/AIDS
•Previous chemotherapy or radiation therapy
•Aging
•Obesity
•Malnutrition

31. Complications

•Abnormal genitalia
•Enlarged male breasts (gynecomastia)
•Infertility
•Erectile dysfunction
•Osteoporosis
•Poor self-image

32. Hypogonadism diagnosis
•Hormone tests
•Imaging tests
•Semen analysis
•Pituitary imaging
•Genetic studies
•Testicular biopsy

33. Treatment for female hypogonadism

•Female : increasing amount of female sex hormones
•First line treatment: estrogen therapy
•Low dse testosterones
•Menstrual irregularities or trouble conceiving: injections of
the hormone human choriogonadotropin or pills
•Tr0eatment of infertility due to hypogonadism

34. 4. Polycystic ovary syndrome

•Polcystic ovary syndrome is a condition in women
characterized by irregular or no menstrual periods, acne,
obesity, and excess hair growth.
• PCOS is a disorder of chronically abnormal ovarian
function and hyperandrogenism (abnormally elevated
androgen levels)

35. Causes

•Excess insulin. Insulin is the hormone produced in the pancreas that allows cells
to use sugar, body's primary energy supply. If cells become resistant to the action
of insulin, then blood sugar levels can rise and body might produce more insulin.
Excess insulin might increase androgen production, causing difficulty with
ovulation.
•Low-grade inflammation. This term is used to describe white blood cells'
production of substances to fight infection. Research has shown that women with
PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to
produce androgens, which can lead to heart and blood vessel problems.
•Heredity. Research suggests that certain genes might be linked to PCOS.
•Excess androgen. The ovaries produce abnormally high levels of androgen,
resulting in hirsutism and acne.

37. Symptoms

•Irregular periods. Infrequent, irregular or prolonged
menstrual cycles are the most common sign of PCOS.
•Excess androgen. Elevated levels of male hormone may
result in physical signs, such as excess facial and body
hair (hirsutism), and occasionally severe acne and male-
pattern baldness.
•Polycystic ovaries. Ovaries might be enlarged and
contain follicles that surround the eggs. As a result, the
ovaries might fail to function regularly.

38. Pathogenesis

39. Complications
•Infertility
•Gestational diabetes or pregnancy-induced high blood pressure
•Miscarriage or premature birth
•Nonalcoholic steatohepatitis — a severe liver inflammation caused by
fat accumulation in the liver
•Metabolic syndrome Type 2 diabetes or prediabetes
•Sleep apnea
•Depression, anxiety and eating disorders
•Abnormal uterine bleeding
•Cancer of the uterine lining (endometrial cancer)

40. Diagnosis

•Here's no test to definitively diagnose PCOS.
•A pelvic exam.
•Blood tests.
•Analyzed to measure hormone levels.
•Measure glucose tolerance and fasting cholesterol and triglyceride
levels.
•An ultrasound.

41. Treatment

•Lifestyle changes
•Medications
•Combination birth control pills. Pills that contain estrogen and
progestin decrease androgen production and regulate estrogen.
•Progestin therapy. Taking progestin for 10 to 14 days every one to
two months can regulate periods and protect against endometrial
cancer.
•Clomiphene (Clomid). This oral anti-estrogen medication is taken
during the first part of menstrual cycle
•Metformin