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endocrine > Causes Of Infertility > Flashcards

Causes Of Infertility Flashcards

1
Q

what is kallmanns syndrome

A

Genetic disorder that causes that causes hypogonadotropic hypogonadism and an impaired sense of smell

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2
Q

who is more likely to get kallmanns syndrome

A

males
although affects both genders

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3
Q

clinical presentation of kallmanns syndrome

A

hypogonadism
hyposmia/anosmia

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4
Q

management of kallmanns syndrome

A

hormone replacement therapy

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5
Q

what is the most common genetic cause of hypogonadism

A

klinefelter’s syndrome

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6
Q

what causes klinefelters syndrome

A

genetic nondisjunction

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7
Q

genotype usually seen in klinefelters

A

47 XXY

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8
Q

investigation for klinefelters

A

karyotyping

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9
Q

complications of klinefelters

A
  • increased incidence of cryptorchidism, learning disability and psychosocial issues
  • Increased risk of breast cancer and non-Hodgkin lymphoma
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10
Q

what is premature ovarian failure

A

when ovaries stop working before the age of 40

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11
Q

name some genetic causes of premature ovarian failure

A

turners syndrome
fragile X

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12
Q

name some other causes of premature ovarian failure

A

idiopathic
chemo/radiotherapy
oophorectomy

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13
Q

clinical presentation of premature ovarian failure

A

hot flushes, night sweats
atrophic vaginitis
amenorrhoea
infertility

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14
Q

endocrine features of premature ovarian failure

A

high FSH, LH
low oestradiol

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15
Q

management of premature ovarian failure

A

HRT
egg or embryo donation
cryopreservation if it is anticipated

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16
Q

what is the most common endocrine disorder in women

A

polycystic ovary syndrome

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17
Q

how do people get PCOS

A

its inherited

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18
Q

what can PCOS be exacerbated by

A

weight gain

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19
Q

what is associated with PCOS

A

insulin resistance

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20
Q

clinical presentation of PCOS

A

obesity
hirsutism or acne
cycle abnormalities and infertility

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21
Q

what is needed for a diagnosis of PCOS

A

2/3 of:
1. oligo/amenorrhoea
2. polycystic ovaries
3. clinical or biochemical signs of hyperandrogenism (acne, hirsutism)

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22
Q

what are the signs of polycystic ovaries (3)

A

increased ovarian volume
12+ 2-9mm follicles
unilateral or bilateral

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23
Q

endocrine features of PCOS

A
  • high free androgens
  • normal oestrogen levels
  • high LH
  • impaired glucose tolerance
    • normal pancreatic reserve, so hyperinsulinemia
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24
Q

what is given to patients with PCOS who want to get pregnant

A

clomiphene citrate

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25
Q

what is given to restore menstruation and ovulation in patients with PCOS

A

metformin

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26
Q

what is anorexia nervosa

A

an eating disorder characterised by a pathological fear of gaining weight and distorted body image

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27
Q

who is more likely to develop anorexia

A

females

28
Q

endocrine features of anorexia nervosa

A

low FSH, LH and oestradiol

29
Q

what is the problem in type 1 ovulatory disorder

A

hypothalamus

30
Q

what is the problem in type 2 ovulatory disorder

A

pituitary

31
Q

what is the problem in type 3 ovulatory disorder

A

ovaries

32
Q

what is type 4 ovulatory disorder

A

PCOS

33
Q

how can we assess ovulation in a patient with regular cycles

A

midluteal serum progesterone

34
Q

how can we assess ovulation in a patient with irregular cycles

A

hormone evaluation

35
Q

what is a progesterone challenge test

A

administration of progesterone to induce a period

36
Q

what would indicate a normal result in a progesterone challenge test

A

withdrawal bleeding 7-10 days after progesterone

37
Q

what other tests can you do in ovulatory disorders

A

MRI of pituitary
transvaginal ultrasound
bone density scan

38
Q

management of type 1 anovulation

A

stabilise weight
pulsatile GNRH or gonadotrophin daily injections

39
Q

what is used to asses if treatment of type 1 anovulation is working

A

ultrasound

40
Q

what are the 2 main types of tubal disease

A

infective and non-infective

41
Q

name some causes of infective tubal disease

A

pelvic inflammatory disorder
transperitoneal spread e.g. appendicitis
following a procedure

42
Q

name some infections associated with pelvic inflammatory disorder

A

chlamydia, gonorrhoea

43
Q

name some non-infective causes of tubal disease

A

endometriosis
fibroids, polyps
congenital

44
Q

what can occur as a result of pelvic inflammatory disorder

A

hydrosalpinx

45
Q

what is hydrosalpinx

A

the fallopian tube is blocked and fills with serous or clear fluid near the ovary

46
Q

clinical presentation of pelvic inflammatory disorder

A

abdo/pelvic pain
febrile
vaginal discharge
infertility/ectopic pregnancy

47
Q

what is endometriosis

A

the presence of endometrial glands outside the uterine cavity

48
Q

how do we investigate endometriosis

A

US scan

49
Q

US scan of a patient with endometriosis

A

uterus fixed and retroverted
chocolate cysts on ovary

50
Q

clinical presentation of endometriosis

A

dysmenorrhoea usually before menstruation
painful sex, defaecation
chronic pelvic pain
menorrhagia

51
Q

what is primary hypogonadism

A

the testes are primarily affected

52
Q

name some congenital causes of primary hypogonadism

A

klinefelter’s syndrome
cryptorchidism
Y-chromosome microdeletions

53
Q

acquired causes of primary hypogonadism

A

testicular trauma/torsion
chemo/radiotherapy
varicocele
mumps

54
Q

what is varicocele

A

varicose veins in the scrotum

55
Q

what is secondary hypogonadism

A

hypothalamus or pituitary is primarily affected

56
Q

hypergonadotrophic hypogonadism

A

primary

57
Q

hypogonadotrophic hypogonadism

A

secondary

58
Q

name 2 congenital causes of secondary hypogonadism

A

kallmanns
prader-willi syndrome

59
Q

name some acquired causes of secondary hypogonadism

A

pituitary damage
hyperprolactinaemia
obesity/diabetes
acute systemic illness
eating disorders, excessive exercise

60
Q

clinical presentation of pre-pubertal onset of male hypogonadism

A

small sexual organs
decreased body hair, high pitched voice
gynaecomastia
decreased bone and muscle mass

61
Q

clinical presentation of post-pubertal onset of male hypogonadism

A

normal pubertal development
decreased libido
decreased pubic/axillary hair
decreased muscle and bone mass

62
Q

investigations of male hypogonadism

A
  1. measure AM testosterone
  2. repeat if low
  3. measure LH/FSH
63
Q

elevated LH/FSH hypogonadism

A

hypergonadotrophic hypogonadism

64
Q

low/inappropriately normal LH/FSH hypogonadism

A

hypogonadotrophic hypogonadism

65
Q

when should testosterone be measured and why

A

8-11AM as it peaks in the morn

66
Q

management of male hypogonadism

A

testosterone replacement therapy

67
Q

when is testosterone replacement contraindicated

A

previous hormone responsive cancer
possible prostate cancer
haematocrit >50%
severe sleep apnoea or heart failure

endocrine (15 decks)

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