9) Endocrine Infertility Flashcards
Summarise the hypothalamic pituitary gonadal axis in males:
1) GnRH secreted from hypothalamus
2) FSH/LH from pituitary gland
3) Testosterone + inhibin from testes (-ve feedback)
Summarise the hypothalmis pituitary gonadal axis in females:
1) GnRH secreted from hypothalamus
2) FSH/LH from pituitary gland
3) Oestrogen + progesterone from ovaries (-ve feedback)
What are the 3 phases in the 28 day menustrual day cycle?
Follicular phase
Midcycle
Luteal phase
Define infertility:
Inability to conceive after a year of regular unprotected sex
What % of infertility is due to males vs females?
Males=30%
Females=45%
How many couples experience infertility?
1/6
What is primary gonadal failure?
Testes/ovaries (endocrine glands) fail so no testosterone/oestrogen produced
-FSH/LH levels are high as no -ve feedback
What is secondary gonadal failure?
Pituitary disease-no LH/FSH produced so also no testosterone/oestrogen
What happens in male hypogonadism?
No testosterone
Clinical features of hypogonadism:
Loss of libido
Impotence
Small testes
Decrease muscle bulk
4 possible causes of male hypogonadism:
1) primary gonadal failure
2) pituitary disease
3) hyperprolactinaemia
4) androgen receptor deficiency
How is male hypogonadism treated?
1) testosterone
2) testosterone + FSH/LH for fertility
3) dopamine agonists if caused by hyperprolactinaemia
4 functions of testosterone:
Secondary sexual characteristic
Male genital tract development
Maintains fertility
Anabolic effect-muscle + bone
2 possible products testosterone could become:
DHT
Oestrogen
3 disorders caused by female hypogonadism:
Amenorrhoea
Polycystic ovary syndrome
Hyperprolactinaemia
3 types of amenorrhoea:
Primary-never had a period
Secondary-absence of a period for 3 months
Oligomenorrhoea-long irregular cycles
7 possible causes amemnorrhoea:
1) Pregnancy
2) Lactation
3) primary gonadal failure
- premature menopause
- turners
4) secondary gonadal failure
5) Hyperprolactinaema
6) Excess testosterone
7) weight loss
How is amennorhoea treated?
Treat cause
HRT
HRT + FSH/LH for fetility
What does PCOS cause?
Most common cause of infertility
What does hyperprolactinaemia cause?
Galactorrhoea
Hypogonadism-high levels of prolactin switches off GnRH pulsatility
Bitemporal hemniaopia
Causes of hyperprolactinaemia:
PCOS
Dopamine antagonists
Prolactinoma
Idiopathic
