Endocrinology / / May 22, 2016
P od syndrome excessive function of the testicles is commonly understood as the premature development of sexual glands and the appearance of children of secondary sexual characteristics.Normal should be considered the beginning of pubertal development in girls aged 8 to 10 years, boys - from 10 to 11 years.An earlier start of sexual development is considered abnormal and requires finding its cause.Early puberty is more common in girls (more than twice).
premature sexual development in boys appears to increase the testicles, penis, early development of secondary sexual characteristics (pubic hairiness, the growth of facial hair, a rough tone of voice).
All this is accompanied by the early development of the skeleton and muscles;these children look older than their years, first overtaking in the growth of their peers.However, in the subsequent sets premature closure of epiphyseal areas, and the growth of children is stopped.
psychic development usually lags behind physically.
variety of reasons for early puberty is conventionally divided into the following groups, which do not cover all forms of this disease:
- The first group - early puberty in patients with lesions of the pineal gland (mostly boys),
- the second group - early sexualmaturation in the defeat gonads;
- third group - early puberty in patients with lesions of the adrenal cortex;
- the fourth group - early puberty in dropsy of the ventricles, tumors bottom of III ventricle, after suffering encephalitis etc.
to the defeat of the sex glands, causing premature puberty in boys, are growths arising from the interstitial testicular cells...
tumors are of interstitial cells in structure or adenoma, or carcinoma and have a high androgenic activity.Malignant tumors metastasize through the blood and lymphatic system.The clinical picture, together with evidence of precocious puberty, an increase in one of the testes.Diagnosis is based on palpation, in which the egg is determined by hilly increase.
In 80-90% of cases of early puberty careful examination does not reveal any change of any of the nervous system or in the glands of internal secretion.It remains unknown what excessively activate gonadotropic pituitary function in these patients.Allocate them to "constitutional type of early sexual development."
is essential proportionality of gonads of expression of secondary sexual characteristics: convoluted tubules of the testes contain mature sperm and interstitial tissue - a lot of Leydig cells.
mental development and psychosexual maturation lags behind physically, but gradually leveled.Most of them are married at the usual time, and have healthy babies die at different ages, differing from the others only low growth.
Diagnosis and differential diagnosis
main diagnostic problem is the differentiation adrenogenital syndrome of early sexual development "constitutional type" and cerebral etiology.Differential diagnosis should be based mainly on a study of 17-keto steroids.When adrenogenital syndrome, this figure increases dramatically, reaching 15-40 mg per day;in other forms of premature puberty usually have normal numbers (2-10 mg per day).The dramatic decline in the level of urinary 17-keto steroids after taking cortisone shows more about adrenal hyperplasia.The lack of response to cortisone when it detects a large number of dehydroepiandrosterone speaks of adrenal tumors and is an indication for suprareno-radiography.
adrenogenital To differentiate the syndrome from other forms of precocious puberty plays a significant role testicular examination.When ''s constitutional type "their sizes reach adult values (3.5 cm).When adrenogenital syndrome, they are much smaller.In case of doubt, it is a biopsy of the testicle.Histological examination at adrenogenital syndrome states tubular immaturity and lack of Leydig cells.In other forms of early puberty observed a pronounced spermatogenesis and Leydig cells.
testicular tumor is diagnosed on the basis of palpation, in which revealed nodular or diffuse, dense consistency increase in one or both testicles.However, this increase may be due to the presence of ectopic tissue in conjunction with adrenal virilizuyuschey adrenal tumor.At a bilateral localization increase egg can think about the presence in them of adrenal tissue.Reduction of the 17-keto steroids and resorption infiltrates after receiving a cortisone confirms this diagnosis.In doubtful cases also shows testicular biopsy.
When precocious puberty on the basis of an intracranial tumor localization requires careful neurologic and ophthalmologic examination.
- ovarian hormones.Estrogens
- ovarian anatomy
- ovarian hormones.Androgens
- Treatment syndrome Cushing's
- androgen-producing tumors of the adrenal cortex
- Biological effects of catecholamines
- diagnosis and treatment of pheochromocytomas
- Diseases of the adrenal medulla
- Treatment of chronic adrenal insufficiency
- primary testicular failure
- functionmale genital gland.Embryology, anatomy and physiology
- thymus gland and its physiology
- STATUS THYMICO-LYMPHATICUS (lymphoidotoxemia)
interstitial cell testicular tumorsThey must be surgically removed.Typically, early puberty subjected to reverse development.Long-term results in the majority of patients are good, since malignant transformation is rare.
horionepitelioma testis occurs extremely malignant, metastasizing before the recognition of the main chamber.
Tumors bottom of III ventricle and gray hillock within the jurisdiction of a neurosurgeon.Radically remove them, however, it is not always possible, so the prognosis is usually unfavorable.Where necessary, suitable decompressive craniotomy, which facilitates the suffering and prolongs the life of some patients.
In all forms of precocious puberty with children should be carried out educational work aimed at clarifying the nature of their features.This must be done at an early age in an accessible form for this age.Of particular importance is advocacy for children with so-called constitutional type of premature sexual development, which no treatment is indicated.