Endokrinn syndromy v gynekologii

Endocrine syndromes in gynecologyKuera, E.

Menstrual cycleNormal menstrual cycle21 36 days interval between bleeding duration of bleeding is 2 8 days average is 5 daysblood loss doesn't exceed 80 mlOvulation occurs 10 14 days before bleeding

Menstrual cycleMenarcheunder control of the CNSgenetically determinedsocioeconomical influenceaffected by body massMenopausegenetically determinedsocioeconomical influenceControl of the menstrual cycleBrain cortexHypothalamusPituitary glandOvaryTarget tissues

Gonadotropin-releasing hormoneIsolated in 1971Decapeptide produced pulsatively in hypothalamusProduced in the area of nucleus arcuatus with terminals axons in the eminentia medianaPulsatile secretionthe reason is not yet knowncondition for physiological M-cyclescontinual release causes inhibition of the pituitary glandProlactinPolypeptid 198 amino acids molecular weight 23 000Produced by the lactotropic cells in anterior pituitary lobeHyperprolactinaemia stress, hypoglycemia, tactile stimulationLactational amenorrhea

Ovary - functionEndocrine

OogenesisGonadotropins - secretion Theca cellsproduction of androgens and progesterone Granulosa cells aromatase + estrogen production

Steroid biosynthetic pathway for mineralocorticoid, glucocorticoid, and sex steroid hormone production.

Sexual Differentiation : Normal and AbnormalDiamond, David Andrew, MD, Campbell-Walsh Urology, chapter 133, 3597-3628.e6

Copyright 2012 Copyright 2012, 2007, 2002, 1998, 1992, 1986, 1978, 1970, 1963, 1954 by Saunders, an imprint of Elsevier Inc.

Steroid hormones estrogens (C-18)Low in the early follicular phase Increase 1 week before gonadotropin release

Second increase during formation of corpus luteumSteroid hormones gestagens (C-21)During follicular phase on low levelProduction of progesteroneProliferative phase 2,5-5,4 mg/24 hour.,Luteal phase 22-43 mg/24 hour.

Corpus luteumMain function is secretion of progesterone and oestradiolLuteinization - granulosa lutein cellsLH essential for keeping CL in function14. 28. day of the luteal phase cycleMax. production of progesterone is the 10th day after ovulation

Steroid hormones androgens (C-19)

C 19 androstane coreDHEAS, androstendione, testosteroneDaily plasmatic production of testosterone 0,23-0,34 mg/24 hour.

Steroid hormones - androgensMixed production ovarial/extraovarialTestosterone 50% ovarialAndrostendione 60% ovarialDehydroepinadrosterone 20%Endocrine syndromes in gynecologyEvaluationMedical history / anamnesisFamily historyPersonal history( surgeries, infections )Gynecological historyObstetric / sexual historyWork environment, social statusAbusus

Clinical examinationGynecological examinationBlood test hormonal levelUS, MRIEndoscopy, biopsy

Hormonal disorders symptoms Irregular bleedingInfertilityHirsutismEarly menopausePathological galactorrhoea

amenorrhea

PrimarySecondary

PhysiologicalPathological

Progesteron positiveProgesteron negativeamenorrhea

Hypothalamic dysfunctionPituitary dysfunctionOvarian dysfunctionamenorrhea

Hypothalamic dysfunctionGnRH dysregulationGnRH supression

amenorrhea

Pituitary dysfunction

TumorNecrosisDysregulation ( hypothalamic pituitary )

amenorrhea

Ovarinan dysfunctionOvarian failureOvarian tumorOvarian dysgenesisanovulationHyper PRLPCO syHypothalamus ( CNS )irregular menstrual bleeding Hypothalamic dysregulationChronic anovulationStress Ovarian failure

hyperandrogenismAndrogen excessAcneVirilizationHirsutism

TreatmentHormonal substitutionInduction of ovulationHormonal supressionConclusionFrequent disordersImpact on womens healthDetailed hormonal ( medical ) analysisModern hormonal treatment