ANATOMY &

INTRODUCTION PHYSIOLOGY

CLINICAL REFERENCES
CORRELATIONS
The endocrine system is a chemical
messenger system consisting of hormones,
the group of glands of an organism that
secrete those hormones directly into the
circulatory system to regulate the function of
distant target organs, and the feedback loops
which modulate hormone release so that
homeostasis is maintained.
Paki lagyan to guys
Categorize if major or
minor disease
 https://www.emedicinehealth.com/anatomy_of_the_endocrine_system/article_em.htm
 https://rarediseases.org/rare-diseases/precocious-puberty/
 Precocious puberty means an abnormally early onset of
puberty. A sequence of events occurs during which a child
develops into a young adult beginning at an unexpectedly
early age. Glands that secrete growth and sex hormones
begin to function abnormally early in life resulting in this
condition. Often, the exact cause of precocious puberty is
not known.
 Two types of Precocious puberty:
1) Central precocious puberty
2) Peripheral precocious puberty
 A tumor in the brain or spinal cord (central nervous system)
 A defect in the brain present at birth, such as excess fluid buildup
(hydrocephalus) or a noncancerous tumor (hamartoma)
 Radiation to the brain or spinal cord
 Injury to the brain or spinal cord
 McCune-Albright syndrome — a rare genetic disease that affects
bones and skin color and causes hormonal problems
 Congenital adrenal hyperplasia — a group of genetic disorders
involving abnormal hormone production by the adrenal glands
 Hypothyroidism — a condition in which the thyroid gland doesn't
produce enough hormones
Breast growth and first period in girls
Enlarged testicles and penis, facial hair and
deepening voice in boys
Pubic or underarm hair
Rapid growth
Acne
Adult body odor
 Breast Cancer
 Testicular tumor (males)
Ovarian or adrenal malignancy (females)
 Short height. Children with precocious puberty may grow quickly at
first and be tall, compared with their peers. But, because their bones
mature more quickly than normal, they often stop growing earlier than
usual. This can cause them to be shorter than average as adults. Early
treatment of precocious puberty, especially when it occurs in very
young children, can help them grow taller than they would without
treatment.
 Social and emotional problems. Girls and boys who begin puberty
long before their peers may be extremely self-conscious about the
changes occurring in their bodies. This may affect self-esteem and
Keeping your child away from external
sources of estrogen and testosterone — such
as prescription medications for adults in the
house or dietary supplements containing
estrogen or testosterone.
Encouraging your child to maintain a
healthy weight.
 OVARY TESTES

Follicular Gameto-
Development Lutinization Testosterone
genisis
Gonadotropin-releasing hormone (GnRH) stimulation test.
Magnetic resonance imaging (MRI). Checks brain
abnormalities that causes the early start of puberty.
Thyroid testing. The doctor may also test your child's thyroid if
he or she shows any signs of slow thyroid function
(hypothyroidism), such as fatigue, sluggishness, increased
sensitivity to cold, constipation, a drop in school performance
or pale, dry skin.
 In untreated patients, a mean adult height ranging from 151-155
cm (59.5 to 61.0 inches) has been reported. Treatment with
gonadotropin-releasing hormone (GnRH) agonists improves the
adult height of children with rapidly progressing puberty, based
on a calculation of a predicted adult height, particularly in
younger children (less than 6 years old). There is only minimally
convincing evidence of an improvement in adult height in girls 6-
8 years old; and in those between 8-10 years old, GnRH agonists
have shown no benefit in adult height. There are few results of
adult height benefit in boys. Gonadotropin secretion
recommences approximately 3-4 months after stoppage of
treatment, with normal pubertal progress and fertility.
GnRH analogue therapy, a monthly injection of a
medication, such as:
a. leuprolide acetate (Lupron Depot)
b. triptorelin (Trelstar, Triptodur Kit) which delays further
development.
Histrelin implant (Vantas)-> lasts for up to a year
Calcium supplementation to preserve bone mass
during GnRH agonist therapy
Chronic low self-esteem
Disturbed body image
Ineffective coping
Allow the patient to verbalize feelings and concerns,
especially related to body image and self-esteem; provide
emotional support.
Point out positive aspects about self and body.
Encourage the patient to participate in decision making and
aspects of care as appropriate.
Assist the patient in identifying positive coping strategies.
Administer medications as ordered; give leuprolide
intramuscularly (I.M.) or subcutaneously, nafarelin
intranasally and give medroxyprogesterone I.M.
Precocious Puberty has an incidence of 1 in 5-
10,000 children with a female to male ratio of
about 20:1 although this ratio is debated. Eighty to
ninety percent of girls with true PP have idiopathic
CPP whereas over 50% of boys have an
identifiable etiology for true PP.
Male hypogonadism is a condition in which the
body doesn't produce enough testosterone —
the hormone that plays a key role in masculine
growth and development during puberty — or
has an impaired ability to produce sperm or
both.
 Primary Hypogonadism:
o Congenital disorder such as Klinefelter's syndrome
Acquired as a result of radiation treatment
o Chemotherapy
o Mumps
o Tumors or trauma to the testes.
  Secondary Hypogonadism:
Malnutrition
Systemic illness
Stress
Side effects of medication
Liver cirrhosis
Toxins (alcohol and heavy metals)
Obesity
Depressed mood enlargement
Lethargy Hot flashes
Sleep disturbances Sweating
Decreased muscle mass Poor concentration and
and strength decreased energy
Loss of body hair (pubic,
axillary, facial)
Increased body fat
Breast discomfort and
Infertility
Erectile dysfunction
Fatigue
Osteoporosis
Muscle weakness
There are no known ways to prevent low
testosterone that is caused by genetic
conditions or damage to the testes or pituitary
gland. A healthy lifestyle that includes good
nutrition, exercise, weight management, and
that avoids excessive use of alcohol and
drugs can help keep testosterone levels
normal.
Two categories of male hypogonadism have been described—primary and
secondary. Hypergonadotropic hypogonadism or primary hypogonadism results from disease of the
testes, which can be congenital or acquired. In primary hypogonadism, sperm production is more
significantly affected than testosterone production due to extensive damage to the seminiferous
tubules.
The most common form of congenital primary hypogonadism is Klinefelter’s syndrome. This genetic
disorder occurs when a male is born with an additional X chromosome, and it is seen in an
estimated 1 in 1,000 male births. Abnormalities that can occur with Klinefelter’s syndrome include
damage to the seminiferous tubules and Leydig cells, resulting in decreased size of the testes as well
as low sperm counts and testosterone levels. In addition to infertility caused by testosterone
deficiency, men born with this disorder frequently have increased length of their long bones,
including those in the arms, legs, and hands. Many other complications exist independent of the
testosterone deficiency seen with these patients, including predisposition to developing respiratory
conditions, carcinomas, and many other comorbidities, which are not preventable with testosterone
replacement.
Acquired primary hypogonadism occurs when a patient is exposed to a substance, experiences
trauma, or contracts a disease or infection that results in decreased sperm and testosterone
production, often leading to infertility. Common medication causes resulting in this disorder include
glucocorticoids, ketoconazole, and alkylating/neoplastic agents
Physical examination
Serum testosterone test
MRI or CT scan
Genetic studies
 Many men with permanent causes of hypogonadism
genetic causes, testicular damage, pituitary injury.
require lifelong therapy. Men with hypogonadism
related to critical illness or medication use recover after
resolution of the illness or discontinuation of the
medication that causes low testosterone such as
opiates, glucocorticoids. Marked weight loss in men with
obesity (with bariatric surgery) may lead to recovery of
eugonadal state.
Testosterone replacement therapy (TRT)
Injection. Testosterone injections
(testosterone cypionate, testosterone
enanthate)
 Patch. (Androderm)
Gel.
Gum and cheek (buccal cavity).
Nasal. Testosterone
Implantable pellets.
Sexual dysfunction
Disturbed body image
Altered sleeping pattern
 In Transdermal patch, Place 1-2 of 5 mg patch applied each night to your
patient on his/her back, abdomen, upper arm or thigh avoiding pressure areas.
 Educate patient regarding the patch is rotated in different areas to decrease
occurrence of redness or irritation.
 When patient is in Nasal testosterone medication, Apply into nostrils 3 times
daily.
 Advised patient to avoid bathing every after gel application of testosterone to
assure absorption.
 In testosterone Injection administer at 75-100 mg IM weekly or 150-200 mg IM
every other week.
 Advised that pain on site of IM injection can occur.
 On administering on buccal cavity 30 mg is needed. Twice daily q12h. Advised
that gum irritation can occur.
 Advised to avoid alcohol, mouthwashes and others causing gum irritation.
Hypogonadism affects an estimated 4 to 5
million men in the United States, and although it
may occur in men at any age, low testosterone
levels are especially common in older males.
That study reported that 5.6% of men aged 30–
79 years of age were testosterone deficient.
Prevalence of testosterone deficiency increases
in men aged over 50, of whom about 20% are
testosterone deficient.