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Androgenic Alopecia

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261. 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

262. 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

263. 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

264. 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

265. Polycystic ovary syndrome: What else might it be?

levels with or without symptoms. Oligomenorrhoea or amenorrhoea is present. Symptoms include clitoromegaly, extreme hirsutism, and male pattern alopecia. Acromegaly Normal or mildly raised androgen levels with or without symptoms. Oligomenorrhoea or amenorrhoea is often present. Symptoms include enlargement of the extremities, coarse features, and prognathism. Increased plasma insulin-like growth factor levels. Also consider: Hypogonadotropic hypogonadism (that is central origin of ovarian (...) Polycystic ovary syndrome: What else might it be? Differential diagnosis | Diagnosis | Polycystic ovary syndrome | CKS | NICE Search CKS… Menu Differential diagnosis Polycystic ovary syndrome: What else might it be? Last revised in September 2018 What else might it be? The diagnosis of polycystic ovary syndrome involves the exclusion of all of the following disorders, which may have a similar clinical presentation: Simple obesity Raised androgen levels with or without symptoms. Oligomenorrhoea

2018 NICE Clinical Knowledge Summaries

266. Polycystic ovary syndrome: Scenario: Management of polycystic ovary syndrome in adults

-term of PCOS. Advise women who are overweight or obese that weight loss may reduce hyperandrogenism. See the CKS topic on for more information. Discuss methods of hair reduction and removal (such as shaving and waxing), as these will remain an important part of management. See the CKS topic on for more information. Consider prescribing a COC, provided there are no contraindications. See the CKS topic on for prescribing information on COCs, including contraindications and cautions, choice, risks (...) Society Policy and Practice Guidelines is that a loss of more than 5% in body weight can be enough to restore fertility and improve metabolic markers [ ]. Choice of treatment COCs are the mainstay of the pharmacological treatment of PCOS as they can be used to manage both menstrual disorders and androgen excess symptoms (such as acne and hirsutism). Progestogens, usually given cyclically, also have a role in the management of menstrual dysfunction [ ]. The International PCOS Network advises

2018 NICE Clinical Knowledge Summaries

267. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

hyperandrogenismneedtobe considered. Historyofsymptomonsetandprogressionis criticalin assessing for neoplasia, however, some androgen-secreting neoplasms may only induce mild to moderate increases in biochemical hyperandrogenism. _ Clinicalhyperandrogenism CCR A comprehensive history and physical examination should be completed for symptoms and signs of clinical hyperandrogenism, including acne, alopecia, and hirsutism and, in adolescents, severe acne and hirsutism. **** CCR Health professionals should be aware (...) In combination with the COCP, antiandrogens could be considered for the treatment of androgen- related alopecia in PCOS. ** CPP In PCOS, antiandrogens must be used with effective contraception, to avoid male foetal undervirilisation.Variableavailabilityandregulatorystatusoftheseagentsisnotableandforsome agents, potential liver toxicity requires caution. _ Metformin EBR Metformin in addition to lifestyle, could be recommended in adult women with PCOS, for the treatment of weight, hormonal, and metabolic

2018 Society for Assisted Reproductive Technology

268. Amenorrhoea: How should I assess for an underlying cause of secondary amenorrhoea?

an eating disorder or the ). Examine for features of: Cushing's syndrome (striae, buffalo hump, significant central obesity, easy bruising, hypertension, and proximal muscle weakness). Thyroid disease. See the CKS topics on and for more information. Excess androgens (hirsutism, acne) or virilization (hirsutism, acne, deep voice, temporal balding, increase in muscle bulk, breast atrophy, and clitoromegaly). Decreased endogenous estrogen (reddened or thin vaginal mucosa). If appropriate, examine (...) gain (suggesting polycystic ovary syndrome [PCOS]). Stress, depression, weight loss, disturbance of perception of weight or shape, level of exercise, and chronic systemic illness (suggesting hypothalamic dysfunction). Symptoms of thyroid and other endocrine disease. A history of obstetric or surgical procedures (such as endometrial curettage) that may have resulted in intrauterine adhesions. A history of chemotherapy and pelvic radiotherapy (which can cause POI); and cranial radiotherapy, head

2018 NICE Clinical Knowledge Summaries

269. Amenorrhoea: How should I assess for an underlying cause of primary amenorrhoea?

raised prolactin). Haematocolpos if there is a history of cyclical lower abdominal pain (separation of the labia reveals a bulging, blue-coloured membrane, and a pelvic mass may be palpable). Features of decreased endogenous oestrogen (reddened or thin vaginal mucosa; breast development is a good marker for ovarian oestrogen production). Features of androgen insensitivity (absence of axillary and pubic hair with normal breast development; testes may be palpable in the inguinal canal or labia (...) an intracranial lesion for example, hydrocephalus. Normal height and high FSH and LH levels suggest ovarian failure (normal karyotype) or 46XY (abnormal karyotype). Normal height and low FSH and LH levels suggest constitutional delay, weight loss, anorexia nervosa, or excessive exercise. Total testosterone levels High levels of total testosterone (5.0 nanomol/L or greater) warrant investigation to exclude androgen insensitivity (46XY genotype, female phenotype), late-onset congenital adrenal hyperplasia

2018 NICE Clinical Knowledge Summaries

270. 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

271. 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

272. 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

273. 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

274. 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

275. 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

276. Gynecologic Care for Adolescents and Young Women With Eating Disorders

exclusively with another eating disorder Avoidant restrictive food intake disorder 1. Avoidance or restriction of food intake resulting in failure to meet nutritional or energy needs. Associated with one (or more) of the following: significant weight loss or inadequate weight gain with age; significant nutritional deficiency; dependence on feeding tube or supplements; or marked interference with psychosocial functioning 2. Unrelated to cultural practices or food availability 3. Not because of excessive (...) Other specified feeding or eating disorder Symptoms of feeding or eating disorders, resulting in a clinically significant problem, that do not meet the full criteria for any disorders listed above. An example of a presentation that can be specified using the other specified designation includes atypical anorexia nervosa: all of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individuals weight is within or above the normal range. *An episode of binge

2018 American College of Obstetricians and Gynecologists

277. 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

278. 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

279. 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

280. 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

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