Adrenal malfunction and virilization

[جوري]

we start off simply enough by a common pathway with cholesterol, yes that same one that clogs arteries but let's get a bit abstract

cholesterol
.
.
.
.
progesterone (yes the female hormone)
. . '
. ' '
' ' '
' cortisol '
Aldosterone sex hormones

Do forgive my very crude dramatization
between each one of these is a series of enzymes and other steps not particularly important for our purposes, should there be a mal-function in any, we'd end up missing one or several of those either,androgens, cortisol or the mineralcortioics some of those conditions aren't compatible with life ... but our topic deals with virilization so we'll forgo the other two who have their own sets of ramifications for another day and discuss congenital adrenal hyperplasia specifically known as 21 hydrxylase deficiency. in short the two other pathways get shut down or made in very low amounts that the pathways shifts to the sex hormones and we have an over production of those (androgens)...aldosterone meanwhile, sends a signal to ACTH which is a hormone produced by the anterior pituitary gland that stimulates the adrenal cortex,the adrenals become hyperplastic hence the name congenital adrenal hyperplasia, and since there is a deficient enzyme the process becomes viscous cycle... this syndrome can actually also occur in the adult, and since there is a 21 hydroxylase deficiency we get a rise in 17 hydoxy progesterone, it is another enzyme in the cholesterol/progesterone path..and we can actually use its elevation for diagnostic purposes but I digress...

Now when this enzyme is missing in females upon birth they will have what is known as ambiguous genitalia.. it is good because now you have found out early and can help her, however the actual problem is in the male because they are missing aldosterone (mineralocorticoids) and that is very bad as they end up with what is known as 'salt wasting' nephropathy. Their kidneys aren't able to retain sodium, thus these males become hypotensive and dehydrated..

Now there is a non-classic form of this which enables them to produce some amount of cortisol and mineralocorticoid, until under extreme stress... this occurs in 1/100 birth, which makes it an extremely common autosomal recessive disorder and one that all new borns are and should be tested for....hopefully in you dear reader, no enzyme is missing... but if it is, then hopefully you are being given what you are missing cortisone and some other glucocorticoids which crosses over to other topics that we can talk about if there is enough interested generated in adrenal insufficiency....
That was your bed time story today...

:w:

[جوري]

not sure why the hormones are messed up in my drawing?... here is an actual one though it has more steps than I want to share for the purpose of this topic..

:w:

[Noor 13]

:sl:
I learned all these things in med school and find it very interesting but I honestly doubt that people who are not medically trained will be interested in these things. Don't get me wrong I just think it maybe should be less scientific and more for "all day" use ifyou understand what I mean.
Please forgive me if I made you upset-just a suggestion
:sl:

[------]

:salamext:

Erm...wot? :X

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[جوري]

:sl:
I learned all these things in med school and find it very interesting but I honestly doubt that people who are not medically trained will be interested in these things. Don't get me wrong I just think it maybe should be less scientific and more for "all day" use ifyou understand what I mean.
Please forgive me if I made you upset-just a suggestion
:sl:

:sl:
No upset(ness) from your feedback dear sis..
People who don't know about Islam might not be interested in detailed topics on jurisprudence yet scholars write detailed topics anyway, might it pique someone's curiosity? or the key to a conversion?!..
I like to serve a few purposes when I start topics such as this, and have done for a while..
1- might spark someone's interest in medicine
2-although I don't personally feel I have gotten too medical in the topic, I have covered very briskly an autosomal recessive disorder that occurs at a rate of 1/100, meaning a highly likely chance that someone on this very forum or a random 'googler' might be researching this topic as we write may or may not benefit from the explanation
3- much of the research out there that is aimed at lay people almost insults their intelligence or is too technical leaving a physician with the highest burden.
An average encounter is 15-20 mins, which should cover not only history/physical/counseling but management and write up, will leave one cheating their pts on one level more often than not it is the time spent in counseling... anyone familiar with Islamic teachings knows that Allah loves those who do a thorough job, thus, I think of it as having shared of myself in the way of Allah insha'Allah
4-Some people out of ignorance or culture or whatever reason, might think a child born with ambiguous genitalia or some lysosomal disorder is a curse from God.. I merely want to share that none of us are immuned from such an event and thereby highlight how much in fact goes right for the rest of us on daily basis that we deem 'natural' when in fact is a minutia of intricate design and great engineering of the multitudes of blessings that we should be thankful for! And give the incentive to look forward to help our fellow wo/man less fortunate!
last and certainly not least there is a very selfish reason behind it which more often than not might include but not limited to a rough draft to something I am working on, for my professional life of which a small portion is shared to see how it will be received. Sometimes I get feedback, sometimes I don't, I am not aggrieved by either condition.

Thank you for time and feedback extended
Regards
M


:w:

[gladTidings]

:sl:

Wow, interesting sis!

I am actually learning about the adrenal gland this evening (roughly covered the pituatary and thyroid glands this afternoon). Actually I was just about to give up with adrenal, I always found it abit difficult to get into I think because of the chemical structures involved (in the biosynthesis of corticosteroids pathway) just puts me off completely. Adrenal disorders are quite interesting, although we havent gone into syndromes included in your post.

Nice to know Im not the only one having to read about the adrenal gland for bed time.:smile:

Ws.

[al_islam]

I think the topic is dealt with and explained pretty well.

You can't really find a 'layman' term for autosomal recessive disorder.

Im just finishing off my bioscience degree with a view to medicine.

I think I know where to come for help :)

Hate hate hate immunology, and pharmacology !!!

[جوري]

Endocrine functions and dysfunctions are quite expansive and has the whole field of endocrinology dedicated to it, so give yourself a break, many people find it difficult even professionals..Go ahead on a regular day and ask a doctor about Pseudo pseudo hypoparathyroidism as opposed to albright hereditary osteodystrophy and see what they come up with without having to do some research in advance or having this be their actual livlihood..practicing, even in the form of writing is what most learned and learning people do to solidify a difficult concept!

Actually if you want, you can continue yourself this topic, whatever you learn, share and that way, it will not only cement itself in your head but give others an opportunity to observe a chemical factory at play..
:w:

[جوري]

I think the topic is dealt with and explained pretty well.

You can't really find a 'layman' term for autosomal recessive disorder.

Im just finishing off my bioscience degree with a view to medicine.

I think I know where to come for help :)

Hate hate hate immunology, and pharmacology !!!

Jazaka Allah khyran
I find those 'high yield series' very easy to read and quite informative, try this book for immunology, it is in PDF format and a fast read!
http://books.google.com/books?id=K6V...CURNOY#PPP1,M1

and this one for pharmacology

http://books.google.com/books?id=upB...MDIU41L07hUkww

:w:

[al_islam]

Don't mean to go offtopic with the endocrine fun.

But here goes anyway:

I was asked a question in my pharmacology exam about the uses, effects of drugs used in treatment of Alzheimers.

I answered defining the process of Parkinson's, involving the neuro degenerative pathways and the nigro stantial pathway. and then went on to describe L-Dopa precursors and other drugs used for treatment.

Uses include slowing down degenration but no actual cure.

L-dopa providing more dopa....(using the pathway of where L-Dopa is needed for Dopamine as a precursor).

Other drugs also.

Limitations are that it isnt curable.

Any good ?

[al_islam]

Jazaka Allah khyran
I find those 'high yeild series' very easy to read and quite informative, try this book for immunology, it is in PDF format and a fast read!
http://books.google.com/books?id=K6V...CURNOY#PPP1,M1

and this one for pharmacology

http://books.google.com/books?id=upB...MDIU41L07hUkww

:w:

Jazak Allah Khayrun.

Im on holidays now, but will definitely check them out when my brain has recovered from exams !!

I assume You are a practising Doctor.

I think Ill apply to Warwick and Qmul....but postgrad Medcicine is difficult to get into.

[جوري]

Don't mean to go offtopic with the endocrine fun.

But here goes anyway:

I was asked a question in my pharmacology exam about the uses, effects of drugs used in treatment of Alzheimers.

I answered defining the process of Parkinson's, involving the neuro degenerative pathways and the nigro stantial pathway. and then went on to describe L-Dopa precursors and other drugs used for treatment.

Uses include slowing down degenration but no actual cure.

L-dopa providing more dopa....(using the pathway of where L-Dopa is needed for Dopamine as a precursor).

Other drugs also.

Limitations are that it isnt curable.

Any good ?

I find the best answers come from your understanding of the subject and not a mere cut and paste of an article thus I commend you on an excellent effort.. You've done very well--
people are working on implanted pace makers, some other current rx are deep brain stimulation, thalamotomy, and pallidotomy, there is also duodenal levodopa infusion and tissue transplanation with dopamine producing cells-- but no data is definitive...
easier to clone from stolen cells than find a cure or spend money on research for many a current and common ailments than plague humanity the way I see it, but I don't wish to branch off into other topics....


:w: