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BRS 4: Endocrinology > 4.13: Sex hormones (part 1 of 2) > Flashcards

4.13: Sex hormones (part 1 of 2) Flashcards

1
Q

Definition of puberty

A

Maturation of reproductive organs

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2
Q

What 3 things occur during puberty

A

Production of sex steroids
Develop secondary sexual characteristics
Attain capability to reproduce

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3
Q

Classification of puberty

A

Tanner stages used to determine development during puberty

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4
Q

Tanner staging in girls

A

Thelarche - breast development

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5
Q

Tanner staging in boys

A

Genitalia - testicular volume

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6
Q

Tanner staging in both genders

A

Pubarche - pubic hair

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7
Q

-arche definition

A

Onset of

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8
Q

Gonadarche

A

Onset of Activation of gonads by HPG axis

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9
Q

Thelarche

A

Onset of Breast development

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10
Q

Menarche

A

Onset of menstrual cycles

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11
Q

What gender is adrenarche more important in

A

Girls as in boys testes are producing testosterone

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12
Q

Spermarche

A

Onset of spermatogenesis

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13
Q

Adrenarche

A

Onset of adrenal androgen production ( starts 2years before gonadarche)

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14
Q

Pubarche

A

Onset of pubic hair

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15
Q

Puberty hormone in girls

A

Oestradiol

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16
Q

4 secondary sexual characteristics in girls

A

Breast development
Hair growth- pubic, axillary
Sweat gland composition - skin oiliness, acne
Changes to external genitalia

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17
Q

Puberty hormone in boys

A

Testosterone

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18
Q

4 secondary sexual characteristics

A

Depending of voice
Hair growth - pubic, axillary then facial
Sweat gland composition
Changes to external genitalia

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19
Q

1st sign of puberty in girls

A

Thelarche

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20
Q

Late sign of puberty in girls

A

Menarche

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21
Q

Testicular size of prepubertal boys

A

<4mls

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22
Q

Adult male testicular size

A

> 15mls

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23
Q

Adrenarche

A

Activation of adrenal androgen production

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24
Q

Changes to gonadarche during puberty

A

Activation of HPG axis

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25
Q

Menarche occurs

A

2.3yrs after Thelarche
Soon after peak height velocity (PHV)
Mean age 12.7yrs

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26
Q

Primary amenorrhoea is

A

Lack of period from birth

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27
Q

Commonest physiological cause of secondary amenorrhoea

A

Pregnancy

28
Q

Secondary amenorrhoea is

A

Loss of periods after previously having them

29
Q

Secondary amenorrhoea at the start of the menstrual cycle

A

Common for irregularities
Periods start but then stop for at least 3-6montha

30
Q

Menstrual cycles in adult women last

A

28 days
Vary by +-2days each month

31
Q

Amenorrhoea in adult women

A

No periods at least 3-6months
Or up to 3periods per year

32
Q

Oligo-menorrhoea in adult women

A

Irregular or infrequent periods > 35day cycles
Or 4-9 cycles per year

33
Q

Follicular phase of menstrual cycle (5)

A

1) FSH rises
2) 2-3 follicles start to grow
3) producing E2 (Oestradiol) and Inhibin B
4) these reduce FSH (-ve feedback)
5) restrict FSH window and non-dominant follicles undergo atresia

34
Q

Follicular phase (pre-ovulatory phase)

A

6) dominant Graafian follicle emerges
7) E2 continues to increase
8) switch to +ve feedback by high E2
9) induces LH surge
10) causing ovulation

35
Q

What two hormones does the Corpus luteum produce

A

Progesterone
Oestradiol

36
Q

How to measure if ovulation has occurred

A

Measure progesterone levels at day 21

37
Q

3 stages of endometrium - uterine cycle

A

Menstrual phase, proliferative phase , secretory phase

38
Q

In the Proliferative phase of menstrual cycle

A

Growth of new epithelial cells
Gland proliferation
Increase in stroma

39
Q

Secretory phase of uterine cycle

A

Transform to be receptive for Implantation:
Increased volume of stromal cells&raquo_space; thick spongy lining
Cross screw shaped glands secrete glycogen
Coiling and lengthening of spiral arteries

40
Q

GnRH secretion has to be ___ to stimulate the pituitary gland

A

Pulsation

41
Q

What does the continuous non-pulsation administration of GnRH cause

A

Decreased LH/FSH secretion

42
Q

Hypogonadism is

A

Decreased oestrogen in a woman
Decreased testosterone in a man

43
Q

In primary Hypogonadism

A

Direct damage to testes or ovaries
High LH / FSH
Low E2/ testosterone
Reduced negative feedback

44
Q

In Secondary Hypogonadism

A

Damage to hypothalamus or pituitary gland

45
Q

Primary Hypogonadism in men can lead to

A

Infection
Trauma
Cancer of testes

46
Q

Primary cause of Hypogonadism in women

A

Menopause

47
Q

Examples of Secondary Hypogonadism

A

Pituitary tumour
High prolactin
Low or normal LH/FSH
Low E2/testosterone

48
Q

In menopause

A

Primary Hypogonadism-
Low E2
High LH/FSH
Low Inhibin : greater effect on FSH so more FSH affected

49
Q

Menopausal symptoms are due to

A

Lack of estradiol

50
Q

10 symptoms of menopause

A

Skin dryness / hair thinning
Hot flushes
Mood disturbances
Osteoporosis - decreased BMD
Joint pains
Sexual dysfunction
Genito-urinary disturbance
Weight gain
Amenorrhoea- peri- leading up to menopause, post- after 1 year
Cessation of fertility

51
Q

Treatment of menopausal symptoms

A

Menopausal hormone therapy (MHT)
Oestrogen replacement (stimulates endometrium to proliferate) and progesterone if endometrium is intact to prevent risk of endometrial hyperplasia / cancer ( if bleeding post menopause)

52
Q

At what age does menopause occur

A

Range : 45-55 years
Only 1% menopause <40 years old

53
Q

Ovarian reserve marker

A

AMH - anti-müllerian hormone

54
Q

Early menopause is called (before age 40)

A

Premature ovarian insufficiency (POI)

55
Q

Complications of POI

A

Previously known as POF (ovarian failure)
Conception can happen in 20%
Diagnosis high FSH > 25iU/L

56
Q

Symptoms of POI

A

Same as menopause

57
Q

Causes of POI

A

Autoimmune
Genetic e.g fragile X syndrome
Previous cancer therapy

58
Q

Male hormonal changes at old age

A

Late onset Hypogonadism ( lower testosterone levels) no significant changes

59
Q

Free hormone hypothesis - testosterone

A

2% active free testosterone
60% SHBG-bound testosterone - strongly binds ‘unavailable’
28% albumin-bound testosterone , albumin weakly binds testosterone “bioavailable”

60
Q

Testosterone changes with old age

A

Total testosterone unchanged by SHBG is increased, free testosterone reduced

61
Q

What kind of rhythm does testosterone have

A

Diurnal rhythm
High in morning (measured before 11am)

62
Q

7 Symptoms of testosterone deficiency

A

Sexual dysfunction- reduced libido, erectile dysfunction
Hair growth - frequency of shaving
Energy levels - general well being, fatigue
Mood disturbance
Body composition- increased fat/ reduced muscle mass, gynaecomastia (breast enlargement)
Spermatogenesis - high levels of intratesticular testosterone needed
Bone health - via conversion to oestrogen

63
Q

Why does testosterone have Local tissue effects

A

Enzymes within tissues convert testosterone to other things

64
Q

Local tissue effects of testosterone in the scalp

A

5-alpha reductase converts testosterone into di-hydro-testosterone; leading to male pattern baldness
DHT is a more potent ligand for androgen receptor (AR)

65
Q

Local tissue effects of testosterone in adipose tissue

A

Aromatise present in adispose tissue converts testosterone to oestrogens
Obesity related Hypogonadism

66
Q

Using local tissue effects to reduce risk of breast cancer

A

Using an aroma taste inhibitor to prevent conversion of testosterone to oestrogen

67
Q

Using local tissue effects to stop prostate cancer

A

5-alpha reductase inhibitor to prevent DHT being made

BRS 4: Endocrinology (10 decks)

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