性腺疾病的诊断-青岛.pptVIP

1994年-2007年国内报道Turner综合征 1994年-2007年国内报道Klinefelter综合征 4.1男性乳房发育的表现 女性男性化和多毛症，是女性激素性别存在问题的典型表现之一。 部分来源于《基础与临床内分泌》第5版 第12章 多毛症的初步评价 见参考文献[NEJM-Hirsutism P2583] Algorithm for the Initial Evaluation of Hirsutism. Risk assessment includes more than evaluating the degree of hirsutism. Medications that cause hirsutism include anabolic or androgenic steroids (whether these drugs have been used by athletes and patients with endometriosis or sexual dysfunction should be considered). If hirsutism is moderate or severe or if risk factors for underlying disorders (as shown) are present, androgen excess must be ruled out. Assessment of the plasma free testosterone level in the early morning (ideally, on days 4 to 10 of the menstrual cycle in cycling women) — the time for which norms are standardized — is the most sensitive measure. However, a level that is measured at random usually suffices, and a total testosterone level is reasonable to consider if reliable assessment of free testosterone is not readily available. A normal total testosterone level supports the diagnosis of idiopathic hirsutism, although a normal level does not rule out androgen excess. An early-morning plasma free testosterone level, as determined by a specialty laboratory, is indicated if the total testosterone level is marginally elevated (i.e., within about 20 ng per deciliter [0.69 nmol per liter] of the upper limit of normal), if the response to cosmetic therapy is unsatisfactory, or if features suggestive of other disorders emerge. An elevated plasma free testosterone level is an indication for endocrinologic evaluation to determine the cause. Other disorders to be considered, as shown, include neoplasm and various endocrinopathies. Polycystic ovary syndrome is the most common. Cushing’s syndrome is suggested by the development of truncal obesity, moon face, buffalo hump, purple striae, or proximal muscle weakness; virilizing congenital adrenal hyperplasia or polycystic ovary syndrome by the prematu