REPRODÜKTİF ENDOKRİNOLOJİ Prof. Dr. Özer Açbay
Gonadarj Telarj Adrenarj
Stages of breast development according to Marshall and Tanner: Stage 1: preadolescent; elevation of papilla only. Stage 2: breast bud stage; elevation of breast and papilla as a small mound, enlargement of areolar diameter. Stage 3: further enlargement of breast and areola with no separation of their contours. Stage 4: projection of areola and papilla to form a secondary mound above the level of the breast. Stage 5: mature stage; projection of papilla only, resulting from recession of the areola to the general contour of the breast.
Stages of female pubic hair development according to Marshall and Tanner Stage 1: preadolescent; there is no pubic hair. Stage 2: sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, appearing chiefly along the labia. This stage is difficult to see on photographs. Stage 3: hair is considerably darker, coarser, and curlier. The hair spreads sparsely over the junction of the pubic region. Stage 4: hair is now adult in type, but the area covered by it is still considerably smaller than in most adults. There is no spread to the medial surface of the thighs. Stage 5: hair is adult in quantity and type, distributed as an inverse triangle of the classical feminine pattern. The spread is to the medial surface of the thighs but not up the linea alba or elsewhere above the base of the inverse triangle.
Aromataz
Dişide hipogonadizmin semptom ve sonuçları 1. Amenore (primer, sekonder) veya oligomenore 2. Sekonder seks karekterlerinin yokluğu veya gerilemesi 3. Ürogenital traktus regresyonu sonucu üriner infeksiyonlara yatkınlık ve disparoni 4. İnfertilite 5. Cilt dokusunun gerginliğini kaybetmesi, kuru ve kırışık bir görünüm alması 6. Psişik belirtiler (sıcak basmaları, irritabilite, depresyon) 7. Osteoporoz 8. Kardiyovasküler hastalık riskinin artması
A diagram of the testis shows the relationship of Sertoli cells to germ cells. Evidence for the secretion of estradiol (E2) and gonadotropin-releasing hormone (GnRH) by the adult Sertoli cell is tentative, but the hormones have been suggested as local modulators of Leydig cell function. (ABP, androgen binding protein)
FSH Sertoli hücreleri ve spermatogoniumların yüzeyindeki spesifik reseptörlerine bağlanır. FSH Sertoli hücrelerinde androjen-bağlayıcı protein, inhibin, aromataz ve plasminojen activatörlerinin sentez ve salınımını artırır
Seminifer tubuluslar testis volümünün %60 ını oluşturur. Prepubertal testis uzunluğu 2 cm ve volümü yaklaşık 2mL dir (Prader orchidometer). Puberte ile birlikte testis volümü artmaya başlayıp 16 yaşında erişkin ölçüleri olan 4 cm uzunluk ve 15-25 ml volüme ulaşır.
Stages of male genital development and pubic hair development, according to Marshall and Tanner: 11.3 12.6 12.4 14.5 13.4 14.8 Genital development Stage 1: preadolescent. Testes, scrotum, and penis are about the same size and proportion as in early childhood. Stage 2: the scrotum and testes have enlarged; the scrotal skin shows a change in texture and also some reddening. Stage 3: growth of the penis has occurred, at first mainly in length but with some increase in breadth; there is further growth of the testes and scrotum. Stage 4: the penis is further enlarged in length and breadth with development of the glans. The testes and scrotum are further enlarged. The scrotal skin has further darkened. Stage 5: genitalia are adult in size and shape. No further enlargement takes place after stage 5 is reached. Public hair development: Stage 1: preadolescent; there is no pubic hair. Stage 2: sparse growth of long, slightly pigmented, downy hair, straight or slightly curled, appearing chiefly at the base of the penis. Stage 3: hair is considerably darker, coarser, and curlier and spreads sparsely over the junction of the pubes. Stage 4: hair is now adult in type, but the area it covers is still considerably smaller than in most adults. There is no spread to the medial surface of the thighs. Stage 5: hair is adult in quantity and type, distributed as an inverse triangle. The spread is to the medial surface of the thighs but not up the linea alba or elsewhere above the base of the inverse triangle. Most men will have further spread of the pubic hair.
Timing of Sexual Maturity Stages in White Males Genital Stages Stage Mean age SD 2 11.3 1.0 3 12.6 1.0 4 14.5 1.1 5 Pubic Hair Stages Stage Mean age SD 2 11.3 0.9 3 12.4 1.0 4 13.7 0.9 5 14.8 1.0 6
Prader's orchidometer.
World Health Organization Criteria of Normality for a Semen Sample (1992)
Erkekte hipogonadizmin belirti ve bulguları Prepubertal Sekonder seks karekterlerinin gelişmemesi Pubertal büyüme atağının olmaması Sesin kalınlaşmaması Penis (<3 cm) ve testisin (<2.5 cm, <5mL) küçük kalması Skrotum cildinin pigmante olmaması Kas gelişimin yetersiz kalması Jinekomasti Önikoid vücut yapısı Üst vücut yarımı/alt vücut yarımı<0.9 Kulaç uzunluğu boydan en az 5 cm daha uzun
Postpubertal Libido azalması İnfertilite Seksüel kılların azalması Kas yapısının gerilemesi Jinekomasti Kişilik değişimleri Osteoporoz
Dişide hipergonadotropik (primer) hipogonadizm 1. Pure gonadal disgenezi 2. Turner Sendromu (45XO) 3. 17α-hidroksilaz eksikliği 4. Prematüre over yetmezliği Otoimmun Familyal Sitotoksik ilaçlar, RXT Over tümörleri Ooferektomi 5. Rezistan over sendromu
Erkek hipergonadotropik (primer) hipogonadizm nedenleri 1. LH receptor mutations 2. Klinefelter Sendromu (47XXY) 3. Konjetital Anorşi 3. Testiküler hasar Kriptorşidizm Viral orşit sekeli Otoimmun Travma İlaçlar (spironolactone, alcohol, ketoconazole) RXT 4. Kronik böbrek yetmezliği 5. Kronik karaciğer hastalığı
Hipogonadotropik (sekonder) hipogonadizm 1. İdiopatik 2. Kallmann sendromu 3. Hipotalamik ve hipofizer tümörler Kraniofarengioma, germinom, menengiom, gliom Hipofiz adenomları (özellikle prolaktinoma) Metastatik karsinomlar 4. Empty sella sendromu 6. Hipofizektomi ve kraniyal RXT sonrası 7. Granülomatöz hastalıklar: tbc, sarkoidoz 10. Prader Willi Sendromu, Laurence-Moon-Bardet-Biedl sendromu
Hipogonadizm tanısı 1. Sekonder seks karekterlerinin durumu 2. Jinekolojik muayene, testisler ve penis muayenesi 3. Serum gonadotropin düzeyleri, PRL 4. Serum seks hormonları düzeyleri 5. Karyotip analizi 6. T3, T4, TSH, kortizol, kalsiyum ve fosfor düzeyleri 7. Uterus, over ve testislerin görüntülenmesi (US, CT, MRI) 8. Hipofiz ve hipotalamik bölge görüntülenmesi (MRI, CT)