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Androgenic Alopecia

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241. The EAU – EANM – ESTRO – ESUR – SIOG Guidelines on Prostate Cancer

receiving testosterone therapy: observations from 5-year median followup of 3 registries. J Urol, 2015. 193: 80. 60. Watts, E.L., et al. Low Free Testosterone and Prostate Cancer Risk: A Collaborative Analysis of 20 Prospective Studies. Eur Urol, 2018. 74: 585. 61. Zhou, C.K., et al. Male Pattern Baldness in Relation to Prostate Cancer-Specific Mortality: A Prospective Analysis in the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol, 2016. 183: 210. 62. Lian, W.Q., et al. Gonorrhea and Prostate

2020 European Association of Nuclear Medicine

242. Congenital adrenal hyperplasia

hydroxysteroid dehydrogenase deficiency. History and exam genetic predisposition weight loss failure to thrive vomiting hypotension ambiguous genitalia hyperpigmentation poor feeding irregular menses infertility male-pattern baldness (females) short stature precocious puberty polycystic ovaries hirsutism severe cystic acne genetic predisposition Diagnostic investigations serum 17-hydroxyprogesterone serum 11-deoxycortisol serum chemistry microfilter paper radioimmunoassay for 17-hydroxyprogesterone genetic (...) -wasting crisis in the first 4 weeks of life are likely to be affected with CAH. The diagnosis is confirmed by biochemical findings, such as an unequivocally elevated serum concentration of 17-hydroxyprogesterone. Serum concentrations of delta-androstenedione and progesterone are increased in males and females with 21-hydroxylase-deficient CAH. Serum concentrations of testosterone and adrenal androgen precursors are increased in affected females and prepubertal males. Definition Congenital adrenal

2017 BMJ Best Practice

243. Lichen Sclerosus

of application and not necessarily potency to avoid the use of multiple preparations which can cause confusion. However, some may prefer weaker steroids instead, in particular in children. Patients should be instructed to use emollients and avoid any irritation of the genital skin (cleansing products, frequent exposure to water, incontinence , cloths, some may find that sports such as cycling / riding a horse etc. may exacerbate their symptoms). Oral contraceptive pills with anti-androgenic properties may (...) often see an erythema next to depigmented spots (either hyperkeratotic or sclerotic) and fissures. Purpura or ecchymoses are typical and harmless but for some patients distressing features of LS. The Köbner phenomenon that describes the development of lesions in previously normal skin after scratching or other trauma is well recognized.(Wallace 1971) Scarring is common and is observed in about 80% of women and 30% of girls with LS.(Cooper 2004) It may lead to loss and agglutination of the labia

2018 European Dermatology Forum

244. Utian Translational Science Symposium report: New Ttherapies for Leiomyomas: When Surgery May Not Be the Best Option

directactiononthepituitarygland.Withtheabsenceofovarian function and lower estrogen levels, there are multiple, short- termadverseevents(AEs),includinghotflashes,jointstiffness, vaginal dryness, and reduced libido. Potential long-term AEs such as bone loss and the medical complications of early menopause make this approach inappropriate. Thus, there is a huge unmet need for safer, better-tolerated medications. Received June 28, 2019; revised and accepted June 28, 2019. This report was developed by The North American Menopause Society (...) that have shown promise in targeting them in clinical trials. MANAGEMENT OF WOMEN WITH UTERINE LEIOMYOMAS: WHY WE NEED NEW OPTIONS Wendy L. Wolfman, MD, FRCS(C), FACOG, NCMP Uterine leiomyomas are monoclonal smooth-muscle tumors originating from the myometrium, affecting up to 70% of white women and 80% of black women by the age of menopause. 1,2 Fifty percent of women with leiomyomas experience significant health effects because of the triad of bleeding, bulk, or reproductive complications. 3,4 Loss

2018 The North American Menopause Society

245. Hirsutism: Evaluation and Treatment

reported in this guideline has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. Recommendations Hirsutism can be slowly but dramatically improved with a 3-pronged approach to treatment: mechanical hair removal, suppression of androgen production, and androgen receptor blockade. Lifestyle changes, including weight loss and exercise, will lower serum androgen levels and improve self-esteem in patients with polycystic ovary syndrome. The patient (...) . Evaluation A thorough history and physical examination plus selected laboratory evaluations will confirm the diagnosis and direct treatment. Treatment Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve or hasten the therapeutic response. Outcomes At least 6 to 9 months of therapy are required to produce improvement in hirsutism. Evidence The quality of evidence

2017 Society of Obstetricians and Gynaecologists of Canada

246. Paediatric Urology

therapy with LHRH and HCG in cryptorchid infants. Eur J Pediatr, 1993. 152 Suppl 2: S31. 66. Forest, M.G., et al. Effects of human chorionic gonadotropin, androgens, adrenocorticotropin hormone, dexamethasone and hyperprolactinemia on plasma sex steroid-binding protein. Ann N Y Acad Sci, 1988. 538: 214. 67. Aycan, Z., et al. Evaluation of low-dose hCG treatment for cryptorchidism. Turk J Pediatr, 2006. 48: 228. 68. Hesse, V., et al. Three injections of human chorionic gonadotropin are as effective (...) using gonadotropin releasing hormone for improvement of fertility index among children with cryptorchidism: a meta-analysis and systematic review. J Pediatr Surg, 2014. 49: 1659. 105. Coughlin, M.T., et al. Age at unilateral orchiopexy: effect on hormone levels and sperm count in adulthood. J Urol, 1999. 162: 986. 106. Tasian, G.E., et al. Age at orchiopexy and testis palpability predict germ and Leydig cell loss: clinical predictors of adverse histological features of cryptorchidism. J Urol, 2009

2018 European Association of Urology

247. Renal Transplantation

patients. Eur Urol, 2010. 58: 927. 120. Heylen, L., et al. The Impact of Anastomosis Time During Kidney Transplantation on Graft Loss: A Eurotransplant Cohort Study. Am J Transplant, 2017. 17: 724. 121. Weissenbacher, A., et al. The faster the better: anastomosis time influences patient survival after deceased donor kidney transplantation. Transpl Int, 2015. 28: 535. 122. Basu, A., et al. Adult dual kidney transplantation. Curr Opin Organ Transplant, 2007. 12: 379. 123. Haider, H.H., et al. Dual kidney (...) al. Evaluation of the Vascular Surgical Complications of Renal Transplantation. Ann Vasc Surg, 2016. 33: 23. 172. Giustacchini, P., et al. Renal vein thrombosis after renal transplantation: an important cause of graft loss. Transplant Proc, 2002. 34: 2126. 173. Wuthrich, R.P. Factor V Leiden mutation: potential thrombogenic role in renal vein, dialysis graft and transplant vascular thrombosis. Curr Opin Nephrol Hypertens, 2001. 10: 409. 174. Parajuli, S., et al. Hypercoagulability in Kidney

2018 European Association of Urology

248. Male Hypogonadism

of Testosterone Deficiency: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med, 2016. 13: 1787. 10. Kaufman, J.M., et al. The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev, 2005. 26: 833. 11. Wu, F.C., et al. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab, 2008. 93: 2737. 12 (...) . Hall, S.A., et al. Correlates of low testosterone and symptomatic androgen deficiency in a population-based sample. J Clin Endocrinol Metab, 2008. 93: 3870. 13. Nieschlag, E., et al., Testosterone: action, deficiency, substitution. 2004, Cambridge. 14. Parker, K.L., et al. Genes essential for early events in gonadal development. Cell Mol Life Sci, 1999. 55: 831. 15. Brinkmann, A.O. Molecular mechanisms of androgen action--a historical perspective. Methods Mol Biol, 2011. 776: 3. 16. Bentvelsen, F.M

2018 European Association of Urology

249. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth ( i.e. , in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder (...) 1.0 Diagnosis of hirsutism 1.1. We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score (2 |⊕⊕OO). In those cases where serum total testosterone levels are normal, if sexual hair growth is moderate/severe or sexual hair growth is mild but there is clinical evidence of a hyperandrogenic endocrine disorder (such as menstrual disturbance or progression in spite of therapy), we suggest measuring an early morning serum total and free testosterone by a reliable

2018 The Endocrine Society

250. Male Infertility

Obstet Gynecol, 2009. 21: 223. 57. Baccetti, B., et al. Ultrastructural studies of spermatozoa from infertile males with Robertsonian translocations and 18, X, Y aneuploidies. Hum Reprod, 2005. 20: 2295. 58. Miyagawa, Y., et al. Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study. J Urol, 2005. 173: 2072. 59. Ferlin, A., et al. Male infertility and androgen receptor gene mutations: clinical features (...) and identification of seven novel mutations. Clin Endocrinol (Oxf), 2006. 65: 606. 60. Gottlieb, B., et al. Molecular pathology of the androgen receptor in male (in)fertility. Reprod Biomed Online, 2005. 10: 42. 61. Rajender, S., et al. Phenotypic heterogeneity of mutations in androgen receptor gene. Asian J Androl, 2007. 9: 147. 62. Tincello, D.G., et al. Preliminary investigations on androgen receptor gene mutations in infertile men. Mol Hum Reprod, 1997. 3: 941. 63. Giwercman, A., et al. Preserved male

2018 European Association of Urology

251. Testicular Cancer

malignancy. Eur Urol, 2002. 42: 229. 102. Spermon, J.R., et al. Fertility in men with testicular germ cell tumors. Fertil Steril, 2003. 79 Suppl 3: 1543. 103. Nieschlag E, Pharmacology and clinical use of testosterone, In: Testosterone-Action, Deficiency, Substitution., Nieschlag E., Behre HM., Nieschlag S., Eds. 1999, Springer Verlag Berlin-Heidelberg-New York. 104. Skoogh, J., et al. Feelings of loss and uneasiness or shame after removal of a testicle by orchidectomy: a population-based long-term

2018 European Association of Urology

252. Prostate Cancer

, I.M., et al. The influence of finasteride on the development of prostate cancer. N Engl J Med, 2003. 349: 215. 57. Haider, A., et al. Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries. J Urol, 2015. 193: 80. 58. Watts, E.L., et al. Low Free Testosterone and Prostate Cancer Risk: A Collaborative Analysis of 20 Prospective Studies. Eur Urol, 2018. 74: 585. 59. Zhou, C.K., et al. Male Pattern Baldness in Relation

2018 European Association of Urology

253. Ribociclib (Kisqali) - breast cancer

, adrenal medulla, and spleen. After oral dosing, the highest tissue concentrations were found in the pituitary gland, preputial gland, thyroid gland, and spleen. Pigmented rats showed a similar tissue distribution as albino rats, except that melanin-containing structures like the eye (choroid, ciliary body), meninges and hair follicles had high exposure to radiolabeled material and a slow elimination. In the choroid and ciliary body of the eye, radioactivity was still measurable after 840 h (the last (...) and decreased motor activity (male: marked; female: slight) 10 mg/kg: head shaking, labored respiration, licking excessively, reddened ears, and eye lids partially closed. M: gasping, salivation, and reddened eyes. F: recumbency, trembling, vomiting, retching, reddened body, and soft feces. F: slight body weight loss; M & F: reduction in food consumption Repeat dose toxicity Table 5. Summary of repeat-dose toxicity study performed with ribociclib Study ID/GLP/ Duration Species/Sex/ Number/Group Dose (mg/kg

2017 European Medicines Agency - EPARs

254. Müllerian Agenesis: Diagnosis, Management, and Treatment

development because of the peripheral aromatization of testosterone to estrogen. The lack of functional androgen receptors results in decreased or absent pubic and axillary hair. The vagina is typically shortened and the uterus or cervix does not develop because of in utero production of müllerian-inhibiting substance by the testes. Although the incidence of androgen insensitivity syndrome in females is 1:20,000, it may be as high as 1.1% in female infants with inguinal hernias ( , ). The diagnosis (...) . While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect

2018 American College of Obstetricians and Gynecologists

255. Erectile Dysfunction

, neurologic disease, endocrinopathies, medication-related side effects, and psychosocial issues. Vascular issues are particularly important because in some cases they can be improved with lifestyle interventions, such as dietary changes, weight loss, and increased physical activity (see Guideline Statement 7). Key questions regarding ED include identifying the onset of symptoms, symptom severity, degree of bother, specification of whether the problem involves attaining and/or maintaining an erection (...) or are progressive; worsening symptoms may suggest the presence of progressive underlying comorbidities, particularly cardiovascular comorbidities, that need to be definitively addressed. Categorizing ED severity involves integrating findings from the history and physical, responses to questionnaire content, and any additional diagnostic tests undertaken. It is important to distinguish ED from PE or early ejaculation, defined as ejaculation before or shortly after penile penetration 48 leading to subsequent loss

2018 American Urological Association

256. Erectile Dysfunction

vascular disease, tobacco use, neurologic disease, endocrinopathies, medication-related side effects, and psychosocial issues. Vascular issues are particularly important because in some cases they can be improved with lifestyle interventions, such as dietary changes, weight loss, and increased physical activity (see Guideline Statement 7). Key questions regarding ED include identifying the onset of symptoms, symptom severity, degree of bother, specification of whether the problem involves attaining (...) leading to subsequent loss of erection due to the resolution phase, and from the refractory period, an interval after ejaculation/orgasm in which the penis will not become erect and which tends to increase in duration as a man ages. Information about changes in libido, orgasm, and penile morphology (e.g., the possible presence of PD) also is needed. The timing of specific symptoms should be ascertained in relation to the onset of ED as these symptoms may be primary causes of ED or secondary effects

2018 American Urological Association

257. Evaluation and Management of Testosterone Deficiency

.® Physical Symptoms and Signs Reduced energy Reduced endurance Diminished work performance Diminished physical performance Loss of body hair Reduced beard growth Fatigue Reduced lean muscle mass Obesity Cognitive Symptoms and Signs Depressive symptoms Cognitive dysfunction Reduced motivation Poor concentration Poor memory Irritability Sexual Symptoms and Signs Reduced sex drive Reduced erectile function 21 spinal cord injury, diabetes, renal failure, and heart disease. A linear regression model (...) are taken on separate occasions with both conducted in an early morning fashion. (Strong Recommendation; Evidence Level: Grade A) 3. The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs.(Moderate Recommendation; Evidence Level: Grade B) 4. Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure

2018 American Urological Association

258. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults Full Text available with Trip Pro

( , , , , , ). Non-specific symptoms from an abdominal mass include abdominal discomfort (nausea, vomiting, abdominal fullness) or back pain. Classical malignancy-associated symptoms such as weight loss, night sweats, fatigue or fever are rarely present ( ). Table 1 Clinical presentation of ACC. # Autonomous adrenal hormone excess 50–60 Hypercortisolism (Cushing syndrome)* 50–70 Androgen excess (virilization) in female patients* 20–30 Estrogen excess (feminization) in male patients* 5 Mineralocorticoid excess* 2 (...) . An increasing number of cases are diagnosed within the group of incidentally discovered adrenal masses (incidentalomas) (≈ 10–15%). However, the likelihood of an adrenal incidentaloma being an ACC is low ( , , ). About 50–60% of patients with ACC have clinical hormone excess. Hypercortisolism (Cushing syndrome) or mixed Cushing and virilizing syndromes are observed in the majority of these patients. Pure androgen excess is less frequent while estrogen or mineralocorticoid excess are very rare

2018 European Society of Endocrinology

259. Regorafenib (Stivarga) indicated as monotherapy for the treatment of adult patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib treatment

, variceal bleeding, weight loss. The stage of the disease together with the occurrence of severe symptoms adds up to a worsened prognosis, which in turn impacts functional status and patient quality of life [19] [20] [21] [22]. Alt- hough diagnosis at earlier stages of the disease allows for treatment options with a possibility of cure, even with local therapies of resection and ablation, 5-year survival can be as low as 50% [7] [23]. Further, 63.8% of HCC patients undergoing surgical resection and >70

2018 EUnetHTA

260. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency Full Text available with Trip Pro

androgen normalization, to optimize the adrenal steroid treatment profile. (1|⊕⊕⊕○) 4.6 In all individuals with classic congenital adrenal hyperplasia, we recommend monitoring for signs of mineralocorticoid deficiency or excess. (1|⊕⊕⊕○) Stress dosing 4.7 In all patients with congenital adrenal hyperplasia who require glucocorticoid treatment, for situations such as febrile illness (>38.5°C), gastroenteritis with dehydration, major surgery accompanied by general anesthesia, and major trauma we (...) -oxyandrogen pathway, in which androstenedione is converted in the adrenal to 11 β -hydroxyandrostenedione (11OHA4) and then in the adrenal and/or peripheral tissues to 11-ketoandrostenedione and ultimately 11-ketotestosterone (11KT). The production of 11OHA4 and 11KT is an important pathway in postnatal life and may also occur in the fetal adrenal. (b) In the absence of the 21-hydroxylase activity of P450c21, three pathways lead to androgens. First, the pathway from cholesterol to DHEA remains intact

2018 Pediatric Endocrine Society

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