#azospermia

[herbalsolutionayurveda]

Erectile Dysfunction

From Infertility to Erectile Dysfunction- "Bedroom Issues" you must know about

Topics like sex and anything around it are generally hush-hush in our country. In today's internet era and free access to information, these topics are still not discussed openly, especially issues related to "bedroom problems." Issues such as erectile dysfunction, premature ejaculation, and infertility that men face are considered as a blemish on the "macho man." It is seen as something that questions a man's manhood and, hence, is kept under wraps. In an attempt to understand these issues, we take you through one of the issues here.

What is erectile dysfunction?

Erectile dysfunction is the inability to get or maintain an erection. Having trouble with erections occasionally should not be a cause for concern. However, if it is a recurring problem, it is essential to understand what causes it and seek treatment.

What are the main causes of erectile dysfunction?

The underlying causes of ED can be varied- from physiological to physical. Neurological disorders and vascular diseases are leading biological causes that affect the nerves and blood supply to the penis, which results in no erection.

Psychological states such as depression, anxiety, lowered self-esteem and trauma (recent or from childhood) also lead to ED.

Is erectile dysfunction treatable?

The treatment for ED depends on what causes it. Medical intervention and psychological counseling are the best way to treat ED. With more awareness about Ayurveda and its ability to treat sexual problems, people are now gravitating toward more healthy and organic medicines that are just as effective.

www.herbalsolutionayurveda.com

www.erectiledysfunction.co.in

[ayricalikli]

Themurism - Mega+

Kişisel yaşam, temizlik daha doğrusu sağlık konusu insan hayatı için her zaman ilk kıstas olarak bilinir. Themurism.com internet sitesi sizlere sağlığınız konusunda en iyi şartları, en güvenilir ve en temiz ortamı sağlayarak tüm sağlık problemlerinizde yanınızda olmaktan yana oluyor. İlgili doktor kadrosu, düzenli tedavi, günlük muayene ve uzaktan muayene imkanlarıyla themurism.com internet sitenizi tercih etmeniz doğru bir karar olacaktır. Özellikle erkek kişiliği, hamilelik, gebe kalamamak, çocuk isteği, tüp bebek ve kısırlık tedavisi için themurism.com internet sitesine girerek çok daha faydalı, çok daha geniş ve özel bilgiye ulaşabilirsiniz. Bu tür konularda sağlıksal yardıma ihtiyacınız varsa themurism.com internet sitesinde size özel sağlık hizmetlerinin bulunduğunu söylemek daha doğru olacaktır.

Aynı zamanda azospermia, test tube baby ve benzeri konularda da themurism.com internet sitesinden yardım alabilirsiniz. İnternet sitesi üzerinden randevu alabilir, randevu saatinizde profesyonel bir şekilde sağlık hizmetlerinden faydalanabilirsiniz. İsterseniz WhatsApp üzerinden iletişime geçebilir isterseniz site üzerinden randevularınızı oluşturarak daha hızlı sağlık imkanlarından faydalanabilirsiniz. Gebelik hakkında, gebelik sürecinizi daha iyi ve daha kontrollü bir şekilde sürdürebilmek için themurism.com tüm bu süreçte sizlerin yanında olacaktır. Kendiniz ve bebeğiniz için şimdi hemen themurism.com internet sitesiyle tanışmanızı önermekteyiz.

[amiasfitaccw]

Can too much sex cause sperm death?

کیا بہت زیادہ سیکس سے سپرمز ختم یا مردہ ہوجاتے ہیں؟

Can too much sex cause sperm death?

اس کا جواب یہ ہے کہ پہلے تو بہت زیادہ یا بہت کم سیکس کی کوئی تعریف یا پیمانہ مقرر نہیں ہے۔ لوگ روزانہ سے لیکر ہفتے یا مہینے میں چند دفعہ تک سیکس کر سکتے ہیں۔ البتہ جیسے کہ پہلے بتایا گیا، سپرمز کی پیدائش اور پختگی کا ایک سائیکل 70 سے 80 دنوں میں مکمل ہوتا ہے۔ اس لیے اگر بہت جلدی جلدی سیکس کیا جائے تو امکان ہے کہ سپرمز نا پختہ حالت میں ہی آنا شروع ہو جائیں۔ اس سے کچھ اور فرق تو نہیں پڑتا البتہ شادی شدہ اور اولاد کے خواہش مند افراد کے لیے حمل ٹھہرنے کے امکانات کچھ کم ہو سکتے ہیں ۔باقی یاد رکھیں بہت زیادہ سیکس یا مشتزنی سے سپرمز مردہ بالکل نہیں ہوتے،اور نہ ہی کوئی جسمانی بیماری ہوتی ہے ، لیکن سیمن ٹیسٹ میں sperm count کم ہو سکتا ہے، اس لیے سیمن ٹیسٹ کے لیے ڈاکٹر 3 سے 5 دن سیکس گیپ کا کہتے ہیں۔

(یاد رکھیں مشتزنی سے بھی کوئی مردانہ کمزوری ، بانجھ پن ، کوئی جسمانی بیماری یا نفس کا اصل میں پتلا یا چھوٹا ہونا ، یہ سب بلکل نہیں ہوتا ، ہاں باقی کچھ لوگوں کو سٹریس ، تناؤ یا ہارمونز کی وجہ سے جنسی خواہش کی کمی، ہو سکتی ہے جس سے نفس میں مکمل تنائو نہیں آتا ،اور اس کا علاج بھی ہو سکتا ہے ، باقی ٹائمنگ کی کمی کو بھی مردانہ کمزوری نہیں کہا جا سکتا چاہے ٹائمنگ کچھ سیکنڈ کیوں نہ ہو ، اور نہ ہی منی کے پتلا ہونے سے مردانہ کمزوری یا بانجھ پن ہوتا ہے۔

باقی ابھی تک مارکیٹ میں کوئی ایسی میڈیسن ،طلہ ، پھکی نہیں آئی جو عضو تناسل کو بڑا کر سکے ، جیسے 5 آنچ کو 6 یا 7 انچ کر سکے، لہذا عضو تناسل کو بڑا کرنے کی بے وقوفی کرنا چھوڑ دو ، باقی 3 انچ کے سائز سے بھی حمل ،اولاد ہو سکتی ہے اور عضو تناسل کا ایوریج م سائز تقریباً 5 انچ ہوتا ہے)

باقی سپرمز مردہ ہونے کی درجنوں وجوہات اور بیماریاں ہوتی ہیں، جو مردانہ بانجھ پن کا سبب بنتی ہیں ، اگر کسی کو شادی کے ایک سال بعد بھی حمل نہ ہو رہا ہو تو پھر مردانہ بانجھ پن کی تشخیص اور علاج کےلئے ڈاکٹر سے رجوع کرے۔

مردانہ بانجھ پن کی وجوہات: جیسے کہ کروموسوم کی خرابی کا ہونا, وراثتی بانجھ پن کا مسلئہ ہونا، ہارمونز کا مسلئہ ہونا ، کن پیڑے , سوزاک,ذیابیطس, آتشک , شنگرف ,سینکھیا اور تانبہ کا استعمال کرنا , گردوں میں سوزش کا ہونا, varicocele کا ہونا ، ہائی پوٹینسی ادویات کا غلط استعمال کرنا ، مزید سگریٹ نوشی اور شراب بھی وجہ بن سکتی ہے اور تھرائڈ کا مسلئہ بھی اسکا سب بن سکتا ہے۔

سپرمز کی نشو ونما کی بے قاعدگیاں:

(Sperm abnormalities)

1:اولیگو سپرمیا: (Oligospermia)

اس میں سپرمز کاؤنٹ 20 ملین سے بھی کم ہو جاتے ہیں ، جو نارمل 40 ملین سے زیادہ ہوتے ہیں، اولیگو سپرمیا کا علاج آسانی سے کیا جا سکتا ہے۔

2:۔Pyospermia or leucocytospermia

اس کا مطلب سیمن ٹیسٹ میں پس ( pus cell) زیادہ ہوتی ہے، اسکی عموماً وجہ کوئی انفیکشنز ہو سکتا ہے۔

نارمل پس سیلز عموماً 2 سے 4 تک ہو سکتے ہیں۔ اس کا بھی میڈیکل علاج کیا جا سکتا ہے۔ ( اگر کسی مریض کے پس سیلز زیادہ ہوں جیسے 20 اور میڈیسن سے فائدا نہ ہو رہا ہو تو پھر semen culture and sensitivity test کیا جا سکتا ہے، کچھ مریضوں میں پس سیلز کا علاج مشکل بھی ہو سکتا ہے)

۔3:Asthenospermia یعنی سپرمز کی حرکت کرنے کی صلاحیت (motility) کم ہونا۔ نارمل سپرم موٹیلیٹی تقریباً 60 پرسنٹ سے زیادہ ہوتی ہے۔

اس کا بھی علاج ممکن ہے۔اس میں مریض کو سپرمز کو تقویت پہنچانے والی ادویہ استعمال کروائی جاتی ہیں۔وٹامنز سپلیمنٹ بھی استعمال کیے جا سکتے ہیں۔

۔Teratozoospermia:4 ایک ایسی حالت ہے جس کی خصوصیت غیر معمولی سپرم مورفولوجی سے ہوتی ہے۔ جیسے بہت زیادہ سپرم کا سائز، شکل یا ساخت غلط ہو سکتی ہے۔ سپرم سیل کے سر، مڈ پیس، یا دم میں خرابی شامل ہوسکتی ہے۔ اس کی نارمل تعداد 4 پرسنٹ سے زیادہ ہوتی ہے۔ اسکا علاج بھی مشکل ہو سکتا ہے۔

5:ایزو سپرمیا: (Azospermia)

اس میں سپرمز بالکل نہیں بنتے۔ علاج بہت مشکل ہے۔ ڈاکٹر محض چانس لے کر علاج شروع کراتے ہیں۔لیکن بدقسمتی سے Azospermia کا علاج کافی مشکل ہوتا ہے۔ایسے مریضوں کے لیے زیادہ تر ڈاکٹرز IVF یعنی In vitro fertilization جیسے پروسیجر کے ذریعے حمل ہونے کا کہتے ہیں.

آخری ہدایت یہ ہے کہ جنسیات سے متعلق کسی بھی مسلے کی صورت میں خود سے کوئی دوائی استعمال نہ کریں، کیونکہ سیلف میڈیکیشن کرنے کے فائدے کی بجائے بہت سے سائیڈ ایفیکٹ ہو سکتے ہیں۔ بلکہ تشخیص اور علاج کےلئے کسی ڈاکٹر سے رجوع کریں۔لہذا ٹوٹکوں اور سیلف میڈیکیشن سے پرہیز کریں۔کیونکہ میڈیکل علاج ہر مریض میں مختلف ہوتا ہے۔

سب سے پہلے خرابی کو سمجھیں !!

لیبارٹری ٹسٹ کروائیں۔کہ مسلہ کیا ہے

سپرمز کی کمی ہے،یا بن نہی رہے یا کمزور ہیں،یا بیمار ہیں یا بن کے مر رہے ہیں۔باقی Urologist یا Endocrinologist ڈاکٹر اس فیلڈ کے ماہر ہوتے ہیں۔

[brahmhomeo]

Azoospermia treatment

AZOSPERMIA TREATMENT IN HOMEOPATHY

Semen that is ejaculated during orgasm contains sperms. This sperms help in fertilisation of ova, and because of healthy sperm and healthy ova pregnancy occurs.

[chaitanyaclinic]

What are the top Specialists of Sexology clinic in Pune/Maharashtra/India?

Sexology Clinics in Pune/Maharashtra/India can provide Sex Counselling Services, Sex Therapy, assessment. We provide also known as sexual disorder. The Best Sexology Clinics in Pune/Maharashtra/India for Sexology Treatment is those that offer both traditional and modern treatment methods to their patients. We have a team of trained Sexologists who are well versed with the latest trends in Sexology.Dr. Nanal provide Consult with our staff we provide best solution for our patients marital and premarital Counselling we treated all sexual Male and Female

Dr. Nanal Sexology Clinics in Pune/Maharashtra/India or sexologist is a Medical Doctor who specializes in the diagnosis, prevention, and treatment of Male Sexual Problems, Diabetes Induced Erectile Dysfunction, Male Infertility Treatment, Treatment of Erectile Dysfunction Infertility Evaluation Treatment, Syphilis Treatment, premature ejaculation Low Libido Pre-Marital Counselling Etc.,Sexology Clinics in Pune/Maharashtra/India can provide Sex Counselling Services, Sex therapy, assessment. We provide also known as sexual disorder. The Best Sexology Clinics in Pune/Maharashtra/India for Sexology is those that offer both traditional and modern treatment methods to their patients. We have a team of trained Sexologists who are well versed with the latest trends in Sexology treatments.

Our Services:

Sexology Clinics in Pune, Sexology Clinics in Pune/Maharashtra/India, Sexology Clinics in Pune, Bund-garden,Deccan,Hadapsar,Karve Nagar,Koregao Park,Kothrud,Pune Station Road,Yerwada, we provide Pre-Marital Counselling About Contraception, Erectile Dysfunction Treatment, Sex Treatment & Masturbation Addiction, Low Sperm Count Treatment, Premature/Early Ejaculation, Male Hypoactive, Low/Loss of Libido Treatment, Sexual Desire Disorder Treatment, Low/Loss of Libido Treatment, Marital Therapy, Fertility, Treatment of Impotency, Treatment of Sexual Weakness in Male, Sex Therapy for Couples, Pre-Marital Counselling About Contraception. is a medical facility which provides Sexology Services, Sexology Clinics, female sexual problems such as Infertility, PCOD, Veganism’s, low Sex drive, Vaginal itching/tightening, loss of libido, typically to Erectile dysfunction, Nightfall, climax, over masturbation, premature ejaculation, Male infertility and other Sexology problems. Low Sex Desire, Erectile Dysfunction ,Premature Ejaculation,Delayed Ejaculation, Sexual Performance Fear,Veganism’s, Sex Education, Puberty and Sex Related all Issues, Sex Education, Low Testosterone,Low Sperm Count Treatment,Azospermia,oligospermi,Low Sperm Motility, Chlamydia, Genital herpes Treatment,Genital wartTreatment, Gonorrhoea, Cancroid, Genital Ulcers.

Dr. Nanal: Sexology Clinics in Pune/Maharashtra/India Services:

Best sex health services at the best prices.

Diet, lifestyle and stress Management sessions

Both premarital and post-marital Sexology Clinics in Sexology Clinics in Pune/Maharashtra/India.

Providing solutions on a variety of male sexual problems such as erectile dysfunction, Nightfall, climax, over masturbation, premature ejaculation, male infertility.

Offer treatment on female Sexual problems such as infertility, PCOD, Vaginismus, low Sex Drive, vaginal itching/tightening, loss of libido, etc.

Proper consultation and therapies on hyper sexual or sexual behaviour therapy, puberty, sex addiction counselling, sensate focus therapy, analytical as well as relational therapy

Diet and nutrition planning for weight loss and sex enhancement.

Best Sex Specialist Doctor in Pune who provide treatment for all age group.

One-to-one counselling session for everyone that helps to solve every kind of sexual issue.

Counselling sessions include Interaction between the doctors and couples with confidentiality.

Provides World-class Sex Education in Pune which is ideal for all age group.

[muhammetbas]

#azospermi #azospermitedavisi #azospermia #azosperm #anneadayı #anneadyaları #kısırlık #annebebek #ssvd #ssvddestekleyendoktorlar #kısırlık #keşfet https://www.instagram.com/p/CMM2JGCBMSf/?igshid=1xc7wl12nophx

[jinekologercankose-blog]

Dr.Ercan Köse #iyibayramlarolsun #hayirlibayramlarherkese #ivf #spermiyografi #sperm #hamilelik #bebekozlemi #genitalestetik #evlat #jinekolog #kadinsagligi #kisirlik #azospermia

[kicbengaluru]

How do I know if my husband is infertile?

It has been established that a lack of pregnancy can be due to both male and female partners. However, none of you would be able to know for certain whether your partner is infertile unless tests are conducted for specific reasons.

Sure, you may understand that something is wrong with your husband’s reproductive system if he has trouble with maintaining an erection or ejaculation.

However, there are a number of other reasons that contribute to male infertility as well.Both of you may visit a fertility clinic such as KIC, Bengaluru (https://kicbengaluru.com/) in order to know the truth and get treated.

1) The doctor would recommend a semen analysis to find out more about the size, shape, quantity and movement of his sperm. 2) There might be blood tests necessary as well 3) Hormonal therapy can help to regulate the hormonal levels 4) Testicular biopsy would be conducted to examine the tissue from his testes for finding out more about the causes of infertility in case of azospermia

[advicetomoms-blog]

What Is Azoospermia, How Is It Treated?

What Is Azoospermia, How Is It Treated? In this article, we answered all the questions about azoospermia, which is one of the causes of infertility in men, how does it occur, and whether there is a cure?

What is azoospermia?

Azoospermia (zero sperm) is the name given to the fact that there is no sperm in the semen. In this case, although there is unprotected sexual intercourse, pregnancy does not occur because there is no sperm in the semen to fertilize an egg. Azospermia accounts for approximately 10-15% of the infertility problem in men .

What are the causes of azoospermia?

Azospermia is a congenital problem due to genetic factors. But it can also appear later in a previously healthy man. Among the reasons; Obstruction in the sperm conduction channels (In this case, sperm is produced but cannot be ejected due to obstruction.),Genetic disorders ( such as cystic fibrosis- CFTR mutation),Testicular disorders ( such as undescended testicle ),Advanced age,Psychological problems,Stress,Poor quality nutrition,Hormone imbalances,There are situations such as the presence of antibodies that eliminate sperm in the body.

What are the symptoms of azoospermia?

This problem rarely manifests itself with physical symptoms. The most important symptom is not having children despite 1 year of unprotected intercourse. When a specialist is consulted with this complaint, necessary examinations are made and the problem arises. Apart from this, occasional changes such as the color and structure of the semen and its smelling may be a sign of azoospermia.

What are the symptoms of azoospermia?

How is azoospermia treated?

When you refer to a specialist with a complaint of infertility, your doctor will ask you for some tests from you and your partner. While you are having an analysis of the ovaries and the uterus, from your husband; Spermiogram ie semen analysis,Hormone tests,Tests such as testicle ultrasound are requested. What is distinctive here are the results of semen analysis. Sperms are examined 2 or 3 times with an interval of 2 weeks and if no sperm cells are seen in this examination, azoospermia is diagnosed. After the diagnosis, the characteristics of the situation are examined and it tries to find out what the problem is caused by. Then, the appropriate method is determined for the treatment of azoospermia. If the problem of azoospermia is caused by obstruction in the sperm ducts, this obstruction is removed by a surgical operation and sperms are easily released. Those who are treated with such azoospermia can usually have children naturally after the recovery period. If azoospermia did not occur due to obstruction, there may be a production problem. In this case, surgical methods are used. The methods used in azoospermia surgery are: PESA (Percutaneous Epididymal Sperm Aspiration): In this method, a needle is inserted through the testicles and sperms are drawn inside. If sperm is not obtained with this method, other methods are applied.PTSA (Percutaneous Testicular Sperm Aspiration): In this method, testicular tissue is taken with a needle from the testicles again.TESE (Testicular Sperm Extraction): The skin on the testicle is opened and a small tissue is taken from the inside.Micro TESE (Microscopic Testicular Sperm Extraction): In Mikro TESE, which is one of the latest developments in the treatment of azoospermia, the testicular tissue is opened and the ovaries are examined microscopically. Afterwards, samples are taken from the regions where sperm can be found and examined again. If sperm is found, it is immediately frozen and the process of insertion into the mother's womb, namely IVF, is applied. If sperm is not found, some azoospermia medications are given, and after a while the process is repeated. It is worth mentioning that; micro injection method does not completely eliminate the problem of azoospermia. Despite this problem alone, it provides pregnancy development. “ Are there people with azoospermia and children? "If you are asking, we can say that it is possible recently thanks to this method. Some experts think that freezing and thawing sperm cells, which are already problematic, will damage their structure more. So their advice is to be able to use fresh sperm as much as possible!

Are there any herbal treatment methods for azoospermia?

No, unfortunately, it is not possible to treat azoospermia with a herbal treatment. But there are some nutritional advice to improve sperm quality. Read the full article

[promilahcn-blog]

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[kibristupbebek]

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[garden-of-everything]

ABIM: Endocrinology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Adrenal Disorders

Primary aldosteronism and mineralocorticoid excess:   - Sx: HYPERNATREMIA, hypokalemia, metabolic alkalosis, HTN - Dx: aldosterone:renin >20 (aldosterone >15 with low renin levels), salt challenge fails to decrease aldosterone levels --> get CT scan  - Tx: thiazide for BP control, spironolactone for hyperplasia, surgery for adenoma Adrenal insufficiency:   - Addison’s = primary: tan, orthostatic HTN, hyponatremia, hyperkalemia, hypoglycemia, prolonged QTc - Dx: morning cortisol levels --> cosyntropin stimulation test <18mcg/dL = adrenal insufficiency --> check morning ACTH levels (if decreased ACTH, MRI brain; if increased ACTH, CT adrenals) - acute Tx: dexamethasone - chronic Tx: hydrocortisone +/- fludrocortisone only if primary - x2-10 dose of steroids during stress Pheochromocytoma:   - associated with MENIIa and IIb (increased calcitonin/medullary thyroid cancer is also associated with both MENII’s; if IIa: hypercalcemia/parathyroid, if IIb: Marfan’s/neuromas) - Dx: serum or 24 hour urine metanephrines --> MRI/CT ab --> if negative: T-MIBG Tx:  surgery: - pre-op BP control with phenoxybenzamine/doxazosin/nicardipine - intra-op HTN crisis: nitroprusside or phentolamine Incidentaloma: - if <4cm, f/u CT; if >6cm, surgery - Dx with 1mg overnight dex suppression test (Cushings) + urine metanephrines (PCC) +/i if hypertensive: aldosterone:renin ratio (hyperaldosteronism if elevated)

Thyroid Disorders

Hyperthyroidism: - Grave’s: anti-TSHR Ab - associated with vitiligo - Tx: Methimazole (AE: sore throat/agranulocytosis, hepatotoxicity) > PTU (for first trimester; AE: hepatotoxicity) Hypothyroidism: - Hashimoto’s: anti-TPO antibodies - associated with primary thyroid lymphoma - Tx if TSH>10 or planning pregnancy or symptomatic *FYI: increase Synthroid dose in pregnancy and in CELIAC DISEASE Thyroiditis: 1.  subacute/DeQuervain’s: PAINFUL, Tx with NSAIDs only 2.  Peripartum: painless, autoimmune 3.  amiodarone-induced *subclinical presentation (decreased TSH, normal T4): repeat TFT in 4-6mo Thyroid nodules: - if <1cm and doesn’t look cancerous, repeat US in 3-6 months - if >1cm, FNA > Sx Euthyroid sick syndrome: transient and mild, weird TSH/T3/T4 levels during illness without prior thyroid issues; usually T3 is decreased while TSH/T4 is normal - Tx underlying illness only (no need for Synthroid) Thyroid storm:  fever, HF, psych changes/coma; Tx: PTU, propranolol/BB, steroids (vs. Myxedema coma from hypothyroidism: hypothermia/hypotension/bradycardia/bradypnea, desaturation, AMS, hyponatremia, hypoglycemia; Tx with Synthroid + hydrocortisone) *if TSH/T3/T4 are all weirdly increased or decreased, cause is likely a pituitary tumor *suspect toxic multinodular goiter when patient experiences hyperthyroid symptoms after receiving IV iodine contrast

Hypertension

Hyperaldosteronism:   - hypernatremia, hypokalemia, metabolic alkalosis (basically the opposite of RTA type 4) - Tx with thiazide Renal artery stenosis:  Tx with ACEi Cushing’s Disease: - round and squishy - Dx: elevated 24 hour urine cortisol, 1mg dexamethasone suppression test (positive if fails to bring cortisol <5), elevated late salivary cortisol

Lipid disorders

- start screening every 5 years in >35yoM, >45yoF; or >20 if +CAD risk - goals: LDL<160, Cholesterol <190; pretty much decrease both goals by 30 for every additional CAD risk up to 3 times - diet > exercise - offer Orlistat if BMI>30 - offer Bariatric surgery if BMI >40 OR >35 with obesity-related condition

Ovarian disorders and female reproductive health

Polycystic ovary syndrome: - amenorrhea and virilization - Dx: bleeds with progesterone challenge, has elevated LH - Tx hirsuitism with OCP --> if fails: spirnolactone; use clomiphene if wants babies Amenorrhea:   1. primary ovarian insufficiency: elevated FSH = menopause --> if normal: check karyotype to r/o Turner’s (obtain cardiac imagining and kidney US for all patients with Turner’s) *if amenorrheic because of super athleticism: screen for bulimia 2.  hypothalamic cause: functional/tumor/lymphoma; has decreased FSH and NO withdrawal bleed after progesterone challenge 3.  anatomic cause/Asherman syndrome: adhesions basically retain periods; also has no withdrawal bleeding --> Tx: surgery Ovarian cancer: - hyperandrogenism; normal DHEA levels but elevated total testosterone levels >200 in a woman = ovarian cancer until proven otherwise - Dx: TVUS --> adrenal CT

Testes and male reproductive health

Male hypogonadism:  total testosterone <200 +: - increased LH/FSH = primary testicular failure (Klinefelter’s, Mumps orchitis, XRT, autoimmune) - normal/decreased LH/FSH, elevated prolactin = secondary cause (prolactinoma --> MRI brain, opiates, steroids) --> obtain iron study to rule out hemochromatosis* *Hemochromatosis presents as tan Diabetes with elevated transaminases, and hypogonadism; has OA symptoms and is associated with CPPD/Pseudogout Male infertility: - Cystic Fibrosis is associated with azospermia, bilateral absence of vas deferens Gynecomastia: associated with anabolic steroids, marijuana, spironolactone - if elevated estradiol --> check testicular ultrasound to r/o neoplasm --> chest/adrenal CT to r/o choriocarcinoma (elevated beta hCG, lung infiltrates, hemoptysis) - if elevated LH, decreased testosterone --> check karyotype to r/o Klinefelters (associated with increased risk of breast cancer) *testosterone therapy can worsen OSA, erythrocytosis, and increases risk of clots

Diabetes mellitus

Type I: - associated with other autoimmune diseases (Celiac, vitiligo, thyroid) - DKA Type II: - Dx with two of the following on separate days: (1) fasting >126, (2) A1c >6.5%, (3) random >200, or just one of this: (4) 2 hour gtt >200 *if a health-seeming patient >35yo with h/o CAD or 2 CAD risk factors wants to do a vigorous exercise program --> do an exercise stress test first Diabetes mellitus and pregnancy:  STOP ACE/ARB/statin (teratogenic!) - obtain eye exam once/trimester - BP control with methyldopa, BB (labetalol), CCB, Hydralazine - goal: preprandial BG <90, 1 hour postprandial <120 using NPH and short-acting insulin (NOT long-acting insulin or orals) - require annual DM screening after delivery Diabetes goals: - BP <140/90: use ACEi - start statin regardless of LDL if cholesterol >135 and check yearly - cholesterol goal <135 > LDL goal <100 - annual eye exam with Q3-5 year dilated eye exam - urine albumin excretion <30; if >30, start ACEi/ARB Indications for continuous BG monitoring: (1) postprandial hyperglycemia (2) Dawn phenomenon: morning hyperglycemia (vs. Somogyi = rebound hyperglycemia) (3) overnight hypoglycemia Diabetes complications: - acute mononeuropathy: spontaneously resolves, no Tx - gastroparesis: Tx: small meals, Reglan/Erythromycin (vs. Rifaximin for Scleroderma-related bacterial overgrowth that presents similarly as bloating) - orthostatic hypotension: Tx with compression stockings +/- fludrocortisone - peripheral neuropathy: BG control --> DULOXETINE > pregabalin - HHS: plasma osm >320, BG >600-1000, normal pH/ketones; Tx with NS --> insulin --> when BG<200 and tolerating PO --> SQ insulin - DKA:  pH <7.3, bicarb <15, BG >250, elevated ketones  elevated AG vs. Diabetes insipidus: excessive thirst for cold water, can’t concentrate urine - r/o DM, hypercalcemia - Dx: water deprivation test --> if urine osm still <200 --> desmopressin challenge: (1) can concentrate after challenge = positive test --> brain MRI; Tx intranasal or PO desmo/vasopressin (2) still can’t concentrate after desmo: negative test --> kidney ultrasound; Tx sodium restriction and thiazide *if Lithium-induced: Tx Amiloride

Disorders of calcium metabolism and bone

Hypercalcemia: - hyperparathyroidism associated with MEN I and IIa (increased PTH or normal PTH with increased calcium and decreased phos), chondrocalcinosis, bone cyst --> Dx: Sestamibi scan --> Surgery *Indications for parathyroidectomy: (1) Age <50yo (2)  Ca >12 or 1 above baseline (3) GFR<60 (4) 24 hour urine Ca >400 (5) symptoms of hypercalcemia - drug-induced hypercalcemia: lithium, thiazide - sarcoidosis: increased calcitriol = active Vit D = 1, 25 Vit D - cancer / multiple myeloma: CRAB, difference in urine vs dipstick protein due to presence of undetected light chain, hypervitaminosis D - Dx: check ionized calcium first --> r/o decreased TSH --> PTH/Ca/Phos/25Vit D levels --> decreased urine calcium ( = familial hypocalciuric hypercalcemia --> Dx: CASR mutation, urine Ca;Cr ratio <0.01) Hypocalcemia:  check ionized level, because may be due to hypoalbuminemia - associated with DiGeorge - symptoms include circumoral paresthesia, Chvostek cheek tap, Trousseau BP cuff Hyperphosphatemia: - CKD (increased PTH, decreased Vit D) --> Tx: Calcitriol/1,25VitD - hypoparathyroid (decreased PTH) - pseudohypoparathyroid (increased PTH, normal Vit D) Hypophosphatemia:  - bone tenderness due to vitamin deficiency Paget’s:   - hat size changes, bone pains, fractures, femur/tibia bowing, cranial nerve compressions; heart failure - elevated alk phos --> bone scan - Tx: bisphosphonate Osteoporosis:  T-score<-2.5 (ignore age-adjusted Z-score) - get DEXA every 10 years (if normal) in woman >65 OR younger if FRAX >9.3% (they smoke, have h/o hip fx, steroid use, etc) Vitamin D deficiency and osteomalacia:   - proximal muscle weakness/falls (especially in elderly), bone pain - decreased calcium, phosphate; increased alk phos - associated with Celiac disease, liver disease, kidney disease - Dx: bone marrow biopsy (BMB) - Tx: ergocalciferol/Vit D2 Renal osteodystrophy:  ESRD pt w decreased Ca, Vit D; increased Phos, PTH; chondrocalcinosis at knees and pubic symphysis

Anterior pituitary disorders

Pituitary tumors:  MRI (order first if mass effect) - associated with MEN I, pregnancy, and check TSH! (1) Prolactinoma: prolactin >500, galactorrhea/amenorrhea/erectile dysfunction; Tx: Cabergoline (2) Acromegaly: Dx: IgF1 or oral glucose tolerance test that fails to decrease GH; Tx: surgery (3) Cushing’s: HTN, DM, proximal muscle weakness; Dx: 24 hour urine cortisol, elevated late night salivary cortisol --> elevated morning ACTH = pituitary tumor --> Tx: surgery > XRT - incidental pituitary tumors: f/u repeat MRI with prolactin levels - Rx (TCA, CCB, Reglan, opiates) and pregnancy  can cause elevated prolactin! Hypopituitarism: (1) apoplexy: sudden HA, vision change, AMS; Tx: steroids (2) Sheehans (after pregnancy): amenorrhea, no lactation (3) lymphocytic hypophysitis (occurs peripregnancy): sellar mass with anti-pituitary antibody; Tx: steroids OR if vision changes, surgery

Posterior pituitary and water metabolism

Hypernatremia:  DI: polyuria, inability to concentrate urine; Dx: water deprivation --> desmopressin: (1) concentrates urine (urine osms goes up) = MRI brain and Tx w desmo/vasopressin; (2) still doesn’t concentrate (urine osms stay low) = kidney ultrasound and Tx with salt restriction, thiazide Hyponatremia:  SIADH:  urine osm > serum osm, urine osm >500, euvolemic (vs. psychogenic polydipsia where decreased serum AND urine osm)

Endocrine tumors and endocrine manifestations of tumors

Pancreatic tumors associated with MENI (hypercalcemia/hyperparathyroid, prolactinoma/pituitary tumor): - Insulinoma: Dx 72 hour fast (BG<45, insulin >5) --> CT abdomen --> still not detected?: check endoscopic ultrasound - VIPOMA: watery diarrhea - Gastrinoma/Zollinger-Ellison syndrome:  severe dyspepsia; Dx: gastrin levels --> secretin stimulation test causing increased gastrin >200 - Glucagonoma:  hyperglycemia, pustular rash, diarrhea, DVTs - Carcinoid: flushing, N/V/D/AP; Dx: 24 hour urine 5-HIAA Malignancy-associated hypercalcemia (squamous cell):  decreased PTH, normal/decreased phosphate, increased PTHrpeptide Ectopic ACTH (Cushing’s) due to tumor: associated with small cell, medullary thyroid cancer (elevated calcitonin), bronchial carcinoid (flushing, wheezing) SIADH from tumor:  associated with small cell; hyponatremia and euvolemia; urine osm >500

Hypoglycemia

- most commonly after gastrectomy/gastric bypass - insulin use: decreased C-peptide - sulfonylurea: increased C-peptide --> check for medication in urine - insulinoma:  seen in MEN I with hypercalcemia/hyperparathyroid, prolactinoma/pituitary adenoma; Dx with 72 hour fast: if BG <45 and insulin >5 --> CT abdomen - exercise-induced delayed hypoglycemia: Tx: complex carbs

Polyglandular disorders

MENI (”3P’s”):   (1) Pituitary: prolactinoma, acromegaly, Cushings (2) Pancreas:  insulinoma hypoglycemia, VIPoma diarrhea, gastrinoma GERD, carcinoid flushing, glucagonoma hyperglycemia (3) Parathyroid: hypercalcemia MENIIa: (1) Parathyroid: hypercalcemia (2) PCC: hypertension (3) Medullary thyroid cancer: elevated calcitonin MENIIb: (1) Marfan’s/neuromas (2) PCC: hypertension (3) Medullary thyroid cancer: elevated calcitonin

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[kisirliktedavisi-blog1]

Kemoterapinin Erkek Üreme Sistemine Etkisi

Kemoterapinin Erkek Üreme Sistemine Etkisi

Son yıllarda gerek çocuklarda gerekse yetişkinlerde malign hastalıkların tedavisinde çeşitli ilaç ve ilaç kombinasyonu içeren tedavilerin uygulanması ile büyük başarılar sağlanmıştır.

Kısırlık etkili testis kanserleri, lenfoma ve akut lenfositik lösemideki tedavi ile elde edilen sonuçlar bunlara örnek teşkil eder.

Ancak kemoterapinin gonadlar üzerine olan, dolayısı ile fertilite üzerine olan etkisi gittikçe önem kazanmakta ve bu toksik etkiyi önleyici veya fertilitenin kısırlığa dönmemesi için çeşitli tedbirler alınmaya başlanmıştır.

Aslında kemoterapi veya radyoterapi alan hastalarda kısırlık ve seksüel disfonksiyona neden olan patolojinin görüldüğü vakaların %40-70’ i hücre aplazisi ve leyding hücrelerindeki disfonksiyonla birlikte testiküler harabiyet olduğu tespit edilmiştir.

Kanser tedavisinde kullanılan bu kemoterapotiklerle bu ilaçların fiziksel, kimyasal ve cerrahi tedavi metodları ile uygulanması sonunda azospermia, libido azalması ve erektil disfonksiyon meydana gelebilmektedir.

Bu ilaçlar ile birlikte testislerde yaşanan değişiklikler hafif spermatogenez bozulmalarından, fibrozis, germinal aplazi ve leyding hücre harabiyetine kadar uzanır. İlaçların kesilip kısırlığın ortadan kalkması ve cinsel fonksiyonlardaki iyileşme süreci ise 2 ile 10 yıl arasında değişmektedir.

Kemoterapinin Erkek Üreme Sistemine Etkisi

[jinekologercankose-blog]

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