Other Endocrine Problems

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 (­oestrogens) 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, ­PRL, cirrhosis, cancer