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Androgenic Alopecia

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261. 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

262. 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

263. Testosterone Replacement Guidelines

aetiology, androgen deficiency secondary to testicular failure (hypergonadotrophic hypogonadism) of various aetiology, and constitutional delay of growth and puberty (CDGP). The aim of testosterone replacement therapy is to mimic the normal pattern of puberty and mimic requirements at different stages of pubertal development 1 . This guideline aims to provide the clinician with testosterone dosing regimens for pubertal induction, progression and post-pubertal maintenance, as well as for penile growth (...) ? Premature epiphyseal closure and stunting of final height (if high doses taken) ? Mood swings, acne, behavioural disturbance ? Worsening of sleep apnoea ? Polycythaemia ? Gynaecomastia ? Weight gain ? Hypertension ? Cholestatic jaundice ? Electrolyte disturbance Future possible issues in adulthood ? Suppression of spermatogenesis - discontinue when seeking fertility ? Acceleration of male pattern balding ? Worsening of benign prostatic hypertrophy, possible prostate cancer Page | 10 ? Possible

2019 British Society for Paediatric Endocrinology and Diabetes

264. 4th ESO?ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)

these regimens as (neo)adju- vant treatment and for whom ChT is ap- propriate. Other options are, however, available and effective, such as capecita- bine and vinorelbine, particularly if avoiding alopecia is a priority for the patient. I/A 71% In patients with taxane-naive and anthracy- cline-resistant ABC or with anthracycline maximum cumulative dose or toxicity (i.e. cardiac) who are being considered for further ChT, taxane-based therapy, preferably as single agent, would usually be considered (...) by an important expression of androgen receptor (AR; luminal AR subtype). The fact that bicalutamide, an anti- androgen approved for the treatment of prostate cancer, is avail- able, has led to some off-label use in advanced TNBC. However, the panel believes that this type of agent should not be used in routine clinical practice, in view of the very limited data that exist [46–48] and until the determination of the AR is optimised and standardised. Unfortunately, the development of enzaluta- mide, another

2018 European Society for Medical Oncology

265. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

. J Appl Behav Anal. 2011 Fall;44(3):523-41. doi: 10.1901/jaba.2011.44-523. PMID: 21941383.X-1 D-66 766. Mrozek-Budzyn D, Majewska R, Kieltyka A, et al. [Lack of association between thimerosal-containing vaccines and autism]. Przegl Epidemiol. 2011;65(3):491- 5. PMID: 22184954.X-1 767. Myck-Wayne J, Robinson S, Henson E. Serving and supporting young children with a dual diagnosis of hearing loss and autism: the stories of four families. Am Ann Deaf. 2011 Fall;156(4):379-90. PMID: 22256539.X-1 768

2017 Effective Health Care Program (AHRQ)

266. CRACKCast E128 – Thyroid and Adrenal Disorders

Cold intolerance Coarse, brittle hair Alopecia Dry skin Lethargy Agitation Mononeuropathy Proximal myopathy Signs of hypothyroidism: Vitals – normal or low and slow Refer to box 120.5 in Rosen’s 9 th edition for the symptoms and signs of hypothyroiditis [7] List 5 lab abnormalities, 2 ECG findings, and 1 CXR finding in hypothyroidism An elevated TSH level with a low T4 level is indicative of primary hypothyroidism. Other laboratory findings may include: Mild anemia, Hypercholesterolemia, Elevated (...) , conjunctival hyperemia, and chemosis. Graves’ ophthalmopathy is also associated with restrictive extraocular myopathy, and exophthalmos . As the disease progresses, patients may experience restriction of their upward gaze from infiltration of the inferior rectus muscle and visual loss from optic nerve involvement (compression by inflamed, enlarged orbital contents). Ophthalmologic findings: Thyroid Stare Proptosis / exophthalmos AP distance from orbital ridge to ant cornea > 20mm Excessive tearing Diplopia

2017 CandiEM

268. Interventions to Address Sexual Problems in People With Cancer

education may need to be provided on the changes in erection and alternative ways to maintain sexual intimacy. Body image, including such issues as weight changes, disfigurement, scarring, and hair loss, should be discussed and normalized in men. Clinicians should check testosterone levels, even if the patient has a cancer that is not typically associated with hormone changes. Options should be discussed when testosterone levels are within normal range but the patient or clinician feels supplementation (...) be associated with improvement in the domains of the sexual response. To this end, any underlying physical issue contributing to sexual dysfunction should be identified and managed. Sexual Response for Men Recommendations Body image is important to men’s sexual health. Issues such as weight change, increase in breast size, disfigurement, scarring, and hair loss should also be discussed and normalized in men. Normalizing these issues may help men reach a new comfort level with body image and functioning

2017 American Society of Clinical Oncology Guidelines

269. Obesity in Adolescents

, 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, or consequential damages, incurred in connection with this publication or reliance on the information presented. Obesity in Adolescents ABSTRACT: Rates of obesity among adolescents in the United States have increased at a dramatic rate (...) screen overweight and obese adolescents for depression, bullying, and peer victimization and appropriately refer to school-based and community-based resources as well as psychiatric services. There are currently no evidence-based guidelines for the use of pharmaceutical agents in the management of obesity in adolescents. The obstetrician–gynecologist should caution against the use of weight loss supplements. A multidisciplinary team, including an experienced bariatric surgeon, dietitian

2017 American College of Obstetricians and Gynecologists

270. The 2017 hormone therapy position statement of The North American Menopause Society

is preserved, reduces risk for osteoporosis and relatedfractures,VVA,anddyspareunia,withbenefitseen in observational studies for atherosclerosis and CVD, cognition, and dementia. Younger women may require higher doses for symptom relief or protection against bone loss. Ovarian conservation is recommended, if possible, when hysterectomy for benign indications is performed in pre- menopausal women at average risk for ovarian cancer. SKIN, HAIR, AND SPECIAL SENSES Estrogentherapymay (...) in appropriate candidates. Prevention of bone loss Hormonetherapyhasbeenshownindouble-blindRCTsto prevent bone loss, and in the WHI, to reduce fractures in postmenopausal women. 24,25 Premature hypoestrogenism Hormonetherapyisapprovedforwomenwithhypogonad- ism, POI, or premature surgical menopause without contra- indications, with health benefits for menopause symptoms, prevention of bone loss, cognition and mood issues, and in observational studies, heart disease. 26-31 Genitourinary symptoms Hormone

2017 The North American Menopause Society

271. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline Full Text available with Trip Pro

identity, the prevalence of GD/gender incongruence was much greater in this group than in the general population without a DSD. This supports the concept that there is a role for prenatal/postnatal androgens in gender development ( – ), although some studies indicate that prenatal androgens are more likely to affect gender behavior and sexual orientation rather than gender identity per se ( , ). Researchers have made similar observations regarding the potential role of androgens in the development (...) of gender identity in other individuals with DSD. For example, a review of two groups of 46,XY persons, each with androgen synthesis deficiencies and female raised, reported transgender male (female-to-male) gender role changes in 56% to 63% and 39% to 64% of patients, respectively ( ). Also, in 46,XY female-raised individuals with cloacal exstrophy and penile agenesis, the occurrence of transgender male changes was significantly more prevalent than in the general population ( , ). However, the fact

2017 Pediatric Endocrine Society

272. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

posterior hairline 40 Broad short-appearing neck 40 Pterygium colli (webbed neck) 25 Thorax Broad chest (shield chest) 30 Inverted nipples 5 Skin, nails, and hair Increased skin ridge count 30 Lymphedema of hands and feet 25 Multiple pigmented naevi 25 Nail hypoplasia/dystrophy 10 Vitiligo 5 Alopecia 5 Skeleton Bone age delay 85 Decreased bone mineral content 50–80 Cubitus valgus 50 Short fourth metacarpal 35 Genu valgum 35 Congenital hip luxation 20 Scoliosis 10 Madelung deformity 5 Heart Bicuspid (...) recommend a formal audiometric evaluation every 5 years regardless of the initial age at diagnosis, initial hearing threshold levels, karyotype and/or presence of a mid-frequency sensorineural hearing loss, to assure early and adequate technical and other rehabilitative measures (⨁⨁◯◯). R 6.2. We recommend aggressive treatment of middle-ear disease and otitis media (OM) with antibiotics and placement of myringotomy tubes as indicated (⨁⨁◯◯). R 6.3. We recommend screening for hypothyroidism at diagnosis

2017 European Society of Endocrinology

273. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline

; decreased frequency of morning erections; decreased performance • Somatic: Increased visceral body fat/obesity; decreased lean muscle mass; decreased strength; fatigue/loss of energy; decreased physical activity/ vitality; low bone mineral density; anemia; flushes; loss of facial, axillary and pubic hair/slow beard growth; decline in general feeling of well-being • Psychological: Depression/depressed mood; mood changes; irritability; inability to concentrate; insomnia/sleep disturbancesGuidelines CMAJ 5 (...) refractory to standard treatment, as well as for men taking glucocorticoid or opioid therapy and men with HIV infection if they have experienced weight loss (weak recommendation; low-quality evidence). 9. In men with erectile dysfunction and no other manifestations of testosterone deficiency syndrome, we suggest investigation only after a trial of phosphodiesterase type 5 (PDE-5) inhibitors has failed (weak recommendation; low-quality evidence). Treatment 10. We recommend that men with documented

2015 CPG Infobase

274. Palbociclib (Ibrance) - locally advanced or metastatic breast cancer

in identifying patients who may benefit from endocrine therapy. ER-positive tumors make up 65% of tumors in women aged 35 to 65 years and 82% of tumors in women older than 65 years. These cancers are largely estrogen driven in postmenopausal women where the main source of the tumor’s estrogen is from conversion of androgens to estrogens via aromatase enzyme action. 2.1.2. Epidemiology Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed in 2012. This cancer (...) or amplification leading to deregulation of CDK4/6, while in triple-negative disease for example, loss of the Rb gene or protein is the main mechanism (Figure xxx). It might therefore be assumed that Rb itself may not be a useful biomarker for screening of patients with ER-positive disease due to the low expected frequency of Rb loss in this population. Nevertheless, in the present pivotal study 1008 (PALOMA-2), immunohistochemical (IHC) analysis of Rb was conducted. The results in this subgroup are presented

2016 European Medicines Agency - EPARs

276. Neofordex - dexamethasone. To treat adults with multiple myeloma

phosphate, the LD 50 values were 6.5, 794 and 577 mg/kg, respectively (which corresponded to 4.9, 603 and 439 mg/kg dexamethasone; Van Leeuwen, 2010). The acute systemic toxicity of dexamethasone was low. In rats (8 males/group) subcutaneously administered dexamethasone at 6, 15, 30, 60 and 120 mg/kg, deaths occurred at =30 mg/kg on Days 6 and 7 post dose and were attributed to infection. Body weight loss (approximately 29.5%) occurred at the highest doses; at the intermediate and lower doses, arrest (...) Up to 40 µg/ml 4, 8, 12 days • 80 µg/ml impaired follicle differentiation and oocyte maturation. • Androgen, estrogen and progestin secretion patterns were impaired at all doses levels Assessment report EMA/CHMP/6613/2016 Page 23/61 Female fertility (Baldwin, 1974) Rat; 4 to 12F Subcutaneous 100, 200, or 500 µg (0.25, 0.5 and 1.25 mg/kg) Up to 4 days • Ovulation reduced or inhibited • Delayed ovulation by. • Extended oestrous cycle to 5 days Female fertility (Rockwell, 2009) Rat; 86F

2016 European Medicines Agency - EPARs

277. Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations

for efficacy and safety, focusing on ameliorating symptoms, restoring virilisation, avoiding polycythaemia and maintaining or improving bone mineral density. Treatment aims to relieve an individual’s symptoms and signs of androgen deficiency by administering standard doses and maintaining circulating testosterone levels within the reference interval for eugonadal men. Evaluation for cardiovascular disease and prostate cancer risks should be undertaken as appropriate for eugonadal men of similar age (...) . Nevertheless, when there is a reasonable possibility of substantive pre-existing prostate disease, digital rectal examination and prostate-specific antigen testing should be performed before commencing testosterone treatment. Changes in management as result of the position statement: Treatment aims to relieve symptoms and signs of androgen deficiency, using convenient and effective formulations of testosterone. Therapy should be monitored for efficacy and safety. The Endocrine Society of Australia

2016 MJA Clinical Guidelines

278. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting Full Text available with Trip Pro

posterior hairline 40 Broad short-appearing neck 40 Pterygium colli (webbed neck) 25 Thorax Broad chest (shield chest) 30 Inverted nipples 5 Skin, nails, and hair Increased skin ridge count 30 Lymphedema of hands and feet 25 Multiple pigmented naevi 25 Nail hypoplasia/dystrophy 10 Vitiligo 5 Alopecia 5 Skeleton Bone age delay 85 Decreased bone mineral content 50–80 Cubitus valgus 50 Short fourth metacarpal 35 Genu valgum 35 Congenital hip luxation 20 Scoliosis 10 Madelung deformity 5 Heart Bicuspid (...) recommend a formal audiometric evaluation every 5 years regardless of the initial age at diagnosis, initial hearing threshold levels, karyotype and/or presence of a mid-frequency sensorineural hearing loss, to assure early and adequate technical and other rehabilitative measures (⨁⨁◯◯). R 6.2. We recommend aggressive treatment of middle-ear disease and otitis media (OM) with antibiotics and placement of myringotomy tubes as indicated (⨁⨁◯◯). R 6.3. We recommend screening for hypothyroidism at diagnosis

2016 European Society of Human Reproduction and Embryology

279. Cochrane team criticises the ECDC experts' draft advice on oseltamivir use

he passed away unexpectedly. In a way, it might have been an ideal departure. We pray his soul may rest in peace. In this issue, we featured a new indication “male pattern baldness” of “dutasteride”, 5- a -reductase inhibitor. We have fundamental questions after reviewing it. Based on the package insert, it is indicated for “androgenic alopecia”. However, is “male pattern baldness” really a disease? Does it really need to be treated? TAMIYA, Jiro, an actor who committed suicide at the age of 43 (...) , was distressed about his sparse hair. Reportedly, he underwent hair implantation every year in Britain, and suffered from its severe complications such as migraine and memory impairment. In those days, another actor advertised wigs on TV and immediately lost his job offers. However, nowadays advertising hair tonics or wigs does not seem to affect actors’ popularity. Male-pattern baldness is also a proof of high sexual function in males. Is alopecia (sparse hair) a “disease” which is more serious than harms

2016 Med Check - The Informed Prescriber

280. Lumark - lutetium, isotope of mass 177

as radiolabel for this purpose in Phase 1 trials. 177 Lu -labeled J591 antibodies were evaluated in 35 patients with androgen-independent prostate cancer with dose levels varying from 10mCi/m 2 - 75 mCi/m 2 and retreatment occurring at 6 – 12 weeks intervals up to a maximum of 4 treatments. Targeting of all known sites of prostate cancer metastases in soft tissue and bone was seen in all Assessment report EMA/427491/2015 Page 34/53 30 patients. With regard to antitumor activity, none of the 7 patients

2015 European Medicines Agency - EPARs

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