3: Ovulatory disorders + male hypogonadism (Newey)

Question 1

Looks like we were given the same lecture twice, most of this is a rehash but there are some male hypogonadism questions at the end, soz

Question 2

What is GnRH?

Answer 2

Gonadotrophin releasing hormone

released by hypothalamus

stimulates release of FSH and LH from anterior pituitary

Question 3

What sort of GnRH pulses stimulate the release of

FSH

LH?

Answer 3

FSH - LOW frequency pulses

LH - HIGH frequency pulses

Question 4

How long does the menstrual cycle last?

Answer 4

28 - 35 days

Question 5

What are the two phases of the menstrual cycle?

Answer 5

Follicular phase

Luteal phase

Question 6

When roughly does ovulation occur?

Answer 6

Around 14 days, midway between follicular and luteal phases

Question 7

Surge of which hormone triggers ovulation?

Answer 7

LH

Question 8

What is the dominant hormone in the luteal phase?

Answer 8

Progesterone

Question 9

Oestradiol peaks when?

Progresterone peaks when?

Answer 9

Oestradiol before ovulation

Progesterone after

Question 10

Which hormone causes thickening of the endometrium?

Answer 10

Oestrogen

Question 11

How does oestrogen affect gonadotrophin release in the follicular phase and luteal phase?

Answer 11

Pos feedback follicular

Neg feedback luteal

Question 12

Which hormone is secreted by the corpus luteum and maintains early pregnancy?

Answer 12

Progesterone

Question 13

A high serum progesterone level one week on Day 21 indicates what?

Answer 13

Woman has ovulated

Question 14

Irregular cycles cause ___.

Answer 14

anovulation

Question 15

Ovulation disorders cause which symptoms?

Answer 15

Oligomenorrhoea (cycles longer than 35 days)

Amenorrhoea (no period)

Question 16

Issues with which glands cause anovulation?

Answer 16

Hypothalamus

Pituitary

Question 17

What are the levels of FSH and LH in hypothalamic pituitary failure?

Answer 17

Low

because no GnRH produced

Question 18

Because no FSH and LH are released in hypothalamic pituitary failure, oestrogen is __.

Answer 18

low

Question 19

How can oestrogen deficiency be investigated?

Answer 19

Progesterone challenge test

Imitates peak in luteal phase, negative if no menstruation occurs afterwards

Question 20

How is hypothalamic-pituitary related anovulation treated?

Answer 20

GnRH injections (pulsatile)

OR

Gonadotrophin (LH/FSH) injections

Question 21

What is the most common endocrine disease in women and causes anovulation with a positive progesterone challenge test?

Answer 21

Polycystic ovary syndrome

Question 22

What are the three diagnostic criteria for polycystic ovary syndrome?

Answer 22

Oligo/amenorrhoea

Polycystic ovaries

Hyperandrogenism (acne, hirsutism due to increased testosterone)

Question 23

How is PCOS treated before ovulation is induced?

Answer 23

Weight loss

Lifestyle modification

Folic acid

Rubella immunisation

Question 24

Why do patients with PCOS take oestrogen tablets e.g Clomid?

Answer 24

Induces ovulation

Question 25

Apart from oestrogen tablets, what other treatments exist for PCOS?

Answer 25

Gonadotrophin injections

Ovarian drilling?!?!?!?!

Question 26

What, normally associated with diabetes, is also seen in the majority of PCOS patients?

Answer 26

Insulin resistance

big long list of reasons why, don’t really matter

Question 27

Which drug is used to address insulin resistance in PCOS?

Answer 27

Metformin

Question 28

Why does PCOS cause insulin resistance?

Answer 28

High levels of LH causes hyperinsulinaemia for some reason

Insulin lowers level of transporter which mops up testosterone

> Masculinisation (acne, hirsutism)

Question 29

What are some risks of using drugs like Clomid and gonadotrophin injections to stimulate ovulation?

Answer 29

Ovarian hyperstimulation

Multiple pregnancy (twins are evil)

Ovarian cancer

Question 30

Multiple pregnancy (twins, triplets) tend to be (premature / late) and can have lots of complications.

Answer 30

premature

complications - cardio, resp, disability

Question 31

Using ovulation induction for long periods of time has been linked to what?

Answer 31

Ovarian cancer

Question 32

What is ovarian failure?

Answer 32

Failure to produce new eggs

High FSH and LH, low oestrogen

Amenorrhoea

i.e the menopause

Question 33

What is premature ovarian failure?

Answer 33

Menopause before the age of 40

Question 34

Which genetic syndrome causes premature ovarian failure?

Answer 34

Turner syndrome

45 XO

Question 35

If a person with premature ovarian failure wanted to conceive, how would they go about this?

Answer 35

Combined oral contraceptive pill to replace oestrogen

Egg / embryo replacement because they don’t have any

Counselling

Question 36

What can cause testicular failure in men?

Answer 36

Klinefelter syndrome

47 XXY

Question 37

Men with ___ testes may have testicular failure.

Answer 37

undescended

Question 38

Apart from Klinefelter’s and undescended testes, what can cause testicular failure?

Answer 38

Trauma

Question 39

What pituitary problem can cause infertility?

Answer 39

Hyperprolactinaemia secondary to a pituitary tumour

Question 40

What are the tell tale signs of hyperprolactinaemia?

Answer 40

Amenorrhoea

Galactorrhoea

Visual field disruption

Question 41

What inhibits the release of prolactin normally?

Answer 41

Dopamine

So dopamine antagonists (anti-depressants) may cause hyperprolactinaemia

Question 42

What is an example of a drug used to treat hyperprolactinaemia?

Answer 42

Dopamine agonist

e.g cabergoline

Question 43

What is the most important test to determine whether or not a woman is ovulating?

Answer 43

Progesterone challenge test

If she’s not ovulating, then check all the other hormones

Question 44

Which scan is routine for all women with infertility?

Answer 44

Ultrasound pelvis