Clinical reproduction Flashcards
what gene determines sex
SRY
what does SRY lead to
testes
what 2 cells do testes contain of importance and what do they secrete
- sertoli - mullerian inhibitin factor
2. leydig - Testosterone
what does MIF do?
inhibs. mullerian duct - the growth of female internal genitalia
what does T do
develops the wolfian system - male gentials
what is CAIS karyotype
XY
CAIS gonads
testes - undescended
CAIS external genitals
female
CAIS internal genitals
none
CAIS T, E, LH levels
T -high
E - high
LH - HIGH - no feedback via receptor
where does E come from in CAIS
aromatized from T
what surgery is needed in CAIS
orchidectomy
how does T circulate?
2% free
38 % albumin bound
60% - SHBG bound
what T is bio T
albumin bound and free
what does T feedback into
hypothalumus - neg to GnRh
pit. - neg to LH/FSH
what are 8 target organs of T
- skin
- muscle
- male sex organs
- marrow - stims stem cells
- brain - libido, cognition
- liver - protein syn
- kidney - EPO porduction
- bone - linear growth
what are 2 types of hypogonadism
- primary - testicular insult
2. secondary - hypo or pit. insult
what are LH, FSH, T levels in primary
LH/fsh - high
T -low
what are LH, FSH, T levels in secondary
LH/FSH/T all low
6 causes of primary hypogonad
- congenital
- infectious - mumps
- trauma
- drugs
- infiltration - hemochromatosis
- idiopathic
7 causes of secondary hypogonad
- neoplasia - pit or hypo lesion
- congenital - Kallman’s
- trauma - TBI, radiation
- drugs
- infiltration
- anorexia
- idopathic
how does prolactin effect T
supress GnRh> low LH/FSH > low T
2 things that can affect T levels
- production
2. aromatization
what is best way to treat with T
injections
what is klinefelter karyotype
XXY
how common is klinefelter
1/660
what are complications of klinefelter
- low T
- infertility
- diabetes
- hypothyroidism
- low bone mineral
- gynecomastia
what is 5 most common cause of infertility
- male factors30-50
- tubal factors 20-30
- ovulatory 10-15
- cervical 5-15
- idiopathic 10-20
what does exogenous T do to male fert
bad via negative feddback
when does one investiage for inferility
after 1 year of trying
most important test for fertility
semen analysis ( more than one sample needed)
3 DDx for abnomalr semen
- impaired production (hypogonadism)
- idiopathic
- obstruction (10-20%)
which os more common type of hypogonadism
primary
what is sertoli cell only syndrome
- have leydig and sertoli cells
2. no germs cell and spermatozoa
therapy for obstruction
surgical intervention
therapy for 2nd hypogonadism
E blockade or synthetic LH/FSH
therapy for prolactin excess
dopamine agonist
treatment of primary hypogonadism (klinefelters)
testicular sperm extraction
5 causes of ED
Psychogenic Endocrine Neurologic Insufficent blood Substances
what does PDE-5is do
stop PDE-5 from degrading cAMP>more cAMP>smooth muscle relaxation
