Other Endocrine Problems
·
Hirsutism: Male pattern of hair
in a female. Common (10%). If normal menstruation then no increased
testosterone production Þ benign. If abnormal menstruation then ?polycystic ovary syndrome with
androgen hypersecretion or late onset congenital adrenal hyperplasia with
deficiency of 21-hydroxylase enzyme
·
Virilism: Male secondary sex
characteristics in a woman. Rare. Amenorrhoea, deep voice, temporal hair
recession, hirsutism. Refer for androgen secreting adrenal and ovarian tumours
·
Galactorrhoea: may come with
thyroid failure (primary or secondary), with a raised prolactin (prolactinoma,
pituitary stalk section and especially drugs) and occasionally with acromegaly
·
Gynaecomastia. Abnormal amount of
breast tissue in males. May occur in normal puberty. Due to an  in the
oestrogen : androgen ratio. May result from liver disease (¯metabolism
of oestrogen) or testicular tumours (Âoestrogens) or with
hyperthyroidism. Commonest causes are drugs: eg spironolactone, cimitidine,
digoxin
·
Hypogonadism: Due to hypopituitarism,
post-orchitis (eg from mumps), chemotherapy, irradiation, cirrhosis, alcohol
(toxic to Leydig cells), various syndromes
·
Impotence: Common in old age. Psychological causes are common (eg if clear
stressor, or if morning
·
erections still occur). Major
causes: diabetes, drugs (diuretics, b-blockers, major tranquillisers,
alcohol, antidepressants, cimetidine), hyperthyroidism, hypogonadism, ÂPRL,
cirrhosis, cancer
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