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Recent Advances in Gyne-Endocrinology
Dilip Kumar Dutta
1:
Neuroendocrine Control of Reproduction
INTRODUCTION
THE NEUROHORMONE CONCEPT AND HYPOTHALAMO HYPOPHYSEAL PORTAL SYSTEM
The HPO Axis (Hypothalamopituitary-Ovarian Axis)
HYPOTHALAMUS AND NEUROHORMONES
GnRH and its Role
Secretion
Control
Role
Dopamine
PITUITARY AND GONADOTROPINS
OVARY AND HORMONAL CONTROL
ROLE OF OPIOIDS AND PINEAL GLAND
SUMMARY: KEY POINTS
2:
Puberty and Endocrinology
ETIOLOGY OF PUBERTY
PHYSIOLOGY OF PUBERTY
The Biological Changes
Sex Steroid Production
HORMONAL CHANGES OF PUBERTY
Prepubertal Period
Gonadotropin-Releasing Hormone
Gonadotropins
GH, IGF-I AND INSULIN IN PUBERTY
Pubertal Sequence (Fig. 2.6)
INITIATION OF GONADARCHE
Physical Changes in Girls
Breast Development
Pubic Hair
Initiation of Adrenarche
MENSTRUATION AND FERTILITY
Menarche
Ovulation
Folliculogenesis and the ‘Follicular Phase’ (Fig. 2.10)
The LH Surge and Ovulation (Fig. 2.10)
Endometrial Development During the Menstrual Cycle and Early Pregnancy
Menstruation
Vagina, Uterus, Ovaries
Assessing Puberty
3:
Ovulation, Anovulation and Related Endocrinology
INTRODUCTION
THE OVARIAN CYCLE
Phases of Ovarian Cycle (Fig. 3.1)
Mechanism
ANOVULATION
CONCLUSION
4:
Luteal Phase Defect
INTRODUCTION
PREVALENCE
Normal Luteal Phase
Hormonal Events
PATHOGENESIS
DIAGNOSIS
Clinical
INVESTIGATIONS
HISTOPATHOLOGY
TREATMENT
5:
Thyroid in Reproduction
INTRODUCTION
PHYSIOLOGY OF THYROID AND REPRODUCTION
THYROID AND MENSTRUAL IRREGULARITY
THYROID DISORDER SCREENING IN PREGNANCY
THYROID IN INFERTILITY
AUTOIMMUNE THYROID DISEASE
CONCLUSION
6:
Hyperprolactinemia
INTRODUCTION
ETIOLOGY
Physiological Causes
Hypothalamic Disorder
Pituitary Disorder
Metabolic Causes
Drug Induced
Dopamine Receptor Blockers
Dopamine synthesis inhibitor
Catecholamine depletor
Opiates
H2 Antagonists
Imipramines
SSRI (Selective serotonin reuptake inhibitor)
Calcium channel blockers
Hormones
CLINICAL FEATURES
INVESTIGATIONS
Imaging Techniques
MANAGEMENT (FLOW CHART 6.1)
Expectant Management
Medical Management
Surgical Treatment
CONCLUSION
7:
Precocious Puberty
INTRODUCTION
TYPES1,2
ISOLATED PUBERTAL EVENTS
DIAGNOSIS OF PRECOCIOUS PUBERTY
Differential Diagnostic Steps
Physical Diagnosis
Laboratory Diagnosis
TREATMENT
MANAGEMENT
Central Precocious Puberty
Peripheral Precocious Puberty
Isolated Pubertal Events
FOLLOW-UP
CONCLUSION
SUMMARY
8:
Delayed Puberty
INTRODUCTION
DEFINITION
CAUSES OF DELAYED PUBERTY (FIG. 8.1)
Constitutional Delay
Hypogonadotropic Hypogonadism (Table 8.1)
Primary Gonadal Failure (Hypergonadotropic Hypogonadism) (Table 8.1)
Other Causes
DIAGNOSIS (FIG. 8.2)
MANAGEMENT (TABLE 8.3)
Constitutional Delay
Hypogonadotropic Hypogonadism
Primary Gonadal Failure
CONCLUSION
9:
Polycystic Ovarian Syndrome in Adolescent Girl
OVERVIEW
CLINICAL MANIFESTATION
PATHOPHYSIOLOGY
GENETIC FACTORS IN THE ETIOLOGY OF PCOS
DIAGNOSIS
History
Medical History
Family History
Social/Cultural History
Menstrual History
Drug History
CLINICAL FEATURES
INVESTIGATION
Laboratory Studies – Blood Profile
Endometrial Aspiration and Biopsy
Radiological Studies
DIFFERENTIAL DIAGNOSIS
SEQUELAE OF PCOS
THE NATURAL HISTORY OF PCO
COMPLICATION
Short-term Sequelae
Long-term Sequelae
Diabetic
Cardiovascular Disease
Cancer
Osteoporosis
PCO and Mortality
MANAGEMENT
Prime Importance of Treatment
Division of Treatment
Weight Reduction And Diet
Medical
Treatment of Acne and Hirsutism
Medical Management
Combined Oral Contraceptive Pill
Antiandrogens
Spironolactone
Flutamide
Finasteride
GnRH Agonists
Ketoconazole
Metformin
Other Therapy
Surgical
Wedge Resection of Ovary
Laparoscopic Ovarian Puncture
CONCLUSION
10:
Amenorrhea
INTRODUCTION
Definition
Hypergonadotropic Amenorrhea (Primary Hypogonadism; Gonadal Failure)
Genetic Alterations
Genetic Causes
Immunology of POF
THERAPIES IN PREMATURE OVARIAN FAILURE
Immunotherapy
Endocrine Therapy
Chronic Anovulation
Mechanism of Central Ovulatory Dysfunction
Anorexia Nervosa (Table 10.4)
TREATMENT
HYPERPROLACTINEMIA
Causes of Hyperprolactinemia
Mechanism of Hyperprolactinemia
Clinical Presentation of Hyperprolactinemia
HYPOPITUITARISM
POLYCYSTIC OVARY SYNDROME
Dual-Defect Hypothesis of PCOS15
INSULIN RESISTANCE AND OBESITY
Treatment
Chronic Anovulation due to Other Endocrine and Metabolic Disorders
Anatomical Defects
11:
Dysfunctional Uterine Bleeding
ABNORMAL UTERINE BLEEDING
THE BLOOD SUPPLY OF THE UTERUS
Endometrium Shedding and Repair
MECHANISMS OF NORMAL MENSTRUATION AND THE CONTROL OF BLOOD LOSS
Appendix
Hemostasis
Vasoconstriction
Endometrial Repair
Epithelium
Matrix
Menstrual Cycle
Regulation of Normal Menstrual Cycle
MECHANISM OF DYSFUNCTIONAL UTERINE BLEEDING
Ovulatory DUB
Definition
Pathophysiology
Anovulatory DUB
Definition
Mechanism of Anovulatory DUB
DIAGNOSTIC APPROACH OF ABNORMAL UTERINE BLEEDING
History
Investigations
MANAGEMENT OF DUB
Surgical Management
Dilatation and Curettage
Endometrial Destruction
Advantages of Endometrial Ablation
Hysterectomy
CONCLUSION
RECOMMENDATIONS
12:
Obesity and a Lifecycle of Risks
INFANCY, CHILDHOOD AND ADOLESCENCE
OBESITY AND WOMEN OF REPRODUCTIVE AGE
POLYCYSTIC OVARIAN SYNDROME (PCOS)
Fertility
Fertility Treatment
Miscarriage
Obstetric Risks
Gynecological Problems in the Middle Aged Women
The Perimenopausal Woman
Gynecological Cancers and Obesity
CONCLUSION
13:
Luteinized Unruptured Follicle Syndrome
INTRODUCTION
DEFINITION
INCIDENCE
PATHOPHYSIOLOGY
LUF Syndrome and Associated Infertility
Relation between LUFS and luteal Phase defect
LUFS AND POLYCYSTIC OVARIAN SYNDROME
Diagnosis of the LUF Syndrome
Treatment of the LUF Syndrome
14:
Hirsutism and Endocrinology
INDEX
TOC
Index
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