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Case 12: Female Reproductive System > Disorder of Female Reproductive Tract > Flashcards

Disorder of Female Reproductive Tract Flashcards

1
Q

What is the function of FSH

A

Act on granulosa cells to stimulate growth of follicles

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2
Q

What is the function of LH

A

Act on theca cells that turns follicle into corpus luteum by triggering ovulation

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3
Q

What does granulosa cells secretion for negative feedback & where does it act

A

Inhibin on pituitary

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4
Q

What does theca cells secretion for negative feedback & where does it act

A

Progesterone on the pituitary & hypothalamus

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5
Q

What is the appearance of the HPG axis during pre-puberty

A

Highly sensitive to - feedback by gonadal steroids & low levels of gonadal steroids & gonadotropins

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6
Q

What is the appearance of the HPG axis during puberty

A

Increased GnRH pulsatility & ovarian estradiol secretion

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7
Q

What is the function of estradiol

A

Linear growth & breast development called thelarche

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8
Q

What is adenarche

A

Onset of adrenal androgen secretion that stimulate axillary & pubic hair growth

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9
Q

What is menarche

A

Initiation of menses 2-3 years after onset of puberty

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10
Q

What is menopause

A

Permanent cessation of menstruation from physiological loss of ovarian function due to follicle number decreased & menopause few or none left

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11
Q

After what periods is it classified as menopause

A

12 consecutive months of amenorrhea

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12
Q

What occur during peri-menopause

A

FSH rises 1-2 year before menopause trying to stimulate follicles growth
LH & estrogen remain unchanged

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13
Q

What occur during post-menopause

A

FSH & LH increase significantly
Estrogen decrease increasing risk of coronary heart disease & osteoporosis

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14
Q

What is the 2 cycles happening at the same time

A

Ovaries cycle with follicular & luteal
Endometrium with proliferation & secretion

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15
Q

When does the follicular phase occur

A

10-16 days (change)

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16
Q

What is the main hormone during follicular phase for the endometrium

A

Estrogen

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17
Q

What is the HPO axis during follicular phase

A

GnRH
LH stimulate FSH release & theca cell releasing androgens & aromatase convert to estrogen
FSH act on granulosa cells to release inhibin & estrogen for negative feedback

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18
Q

What occur during mid cycle of menstrual cycle

A

Estrogen negative feedback switch to positive feedback & increase gonadotropin sensitivity to GnRH

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19
Q

What 3 things are the LH surge responsible for during mid cycle

A

Completion of meiosis I
Forceful follicular wall rupture
Ovulation

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20
Q

What is the HPO axis during mid cycle

A

GnRH
LH stimulate granulosa cells to release progesterone & theca cell releasing androgens & aromatase convert to estrogen with + feedback on pituitary & hypothalamus

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21
Q

When does the luteal phase occur

A

14 days exactly

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22
Q

What is the main hormone during luteal phase

A

Progesterone & highest at day 21

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23
Q

What happens during luteal phase

A

Corpus luteum formation
Continue prepare of uterus for implantation by increase blood supply & glands secretion

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24
Q

What is the HPO axis during luteal phase

A

GnRH
LH acting on the corpus luteum to secrete inhibin for negative feedback, increased progesterone secretion & estrogen secretion
All promoting uterus growth

25
Q

What is the principle ovarian hormone

A

Oestradiol

26
Q

What is another form of estrogen in small amount

A

Estrone formed by androstenedione conversion in ovaries

27
Q

What is 2 other sources other than the ovaries that secrete estrogen

A

Corpus luteum
Placenta

28
Q

What is the concentration of estrogen throughout lifespan

A

Low before puberty
Cyclical changes
Low concentration during menopause

29
Q

Is estrogen mostly bound or free

A

Mostly bound to SHBG or albumin
2-3% free & biologically active

30
Q

What is the 5 functions of estrogen

A

Stimulate muscle & bone growth
Maintain secondary sex characteristics
Affects CNS by increasing sex drive
Initiate repair & growth of endometrium
Stimulate synthesis of SHBG

31
Q

What are the 3 sources of progesterone

A

Intermediate in steroid biosynthesis
Corpus luteum
Placenta

32
Q

What is the cyclical changes of progesterone

A

Rise in send half of menstrual cycle & fall if no conception

33
Q

Is progesterone mostly bound or transported

A

1-2% free
Extensively bound to albumin & transcortin

34
Q

What is the 5 functions of progesterone

A

Promote secretion & prepare endometrium for implantation
Maintain early pregnancy
Pyrogenic at ovulation
Thickening of cervical mucous
Decrease contractions

35
Q

What is the source of androgens

A

Ovaries produce even after menopause

36
Q

To what is androgen bound to

A

SHBG that has higher affinity for testosterone than esotrgen

37
Q

What 3 things occurs with excess androgens

A

Hirsutism
Loss of female characteristics
Masculinization or virilisation

38
Q

What is the 2 functions of androgens in females

A

Muscle growth
Pubic & axillary hair growth

39
Q

What 4 things increases SHBG

A

Oestrogen (stimulate synthesis)
Hyperthyroidism (stimulate synthesis)
Liver cirrhosis (increase estrogen)
Anorexia

40
Q

What decreases SHBG

A

Androgen (inhibit synthesis)
Hypothyroidism (inhibit synthesis)
Glucocorticoid (increase insulin resistance)
Obesity

41
Q

What is early puberty called

A

Precocious

42
Q

What is early menopause called

A

Primary ovarian insufficiency

43
Q

What is secondary puberty called

A

Delayed puberty

44
Q

What is amenorrhea

A

Absence of menstruation for 3 months

45
Q

What is oligomenorrhea

A

Infrequent or irregular menstrual bleeding or long menstrual cycles of 35-40 days

46
Q

What is the 2 types of amenorrhea

A

Primary: failure to reach menarche by 15 w/ normal growth & secondary sex characteristics
Secondary: cessation of regular menses for more than 3 months or irregular menses for 6 months

47
Q

What is the 2 types of primary amenorrhea causes

A

1. Ovarian disorders:
Gonadal dysgenesis (Turner syndrome)
Premature ovarian failure (idiopathic, autoimmune, viral, chemotherapy or radiation)
2. Outflow tract/uterus disorders:
Müllerian duct anomalies
Androgen insensitivity syndrome
Asherman’s syndrome

48
Q

What is the effect of primary amenorrhea causes

A

Decrease estrogen but increased FSH & LH

49
Q

What is the effect of secondary amenorrhea causes

A

Decrease estrogen, LH & FSH

50
Q

What is the 2 types of secondary amenorrhea causes

A

1. Hypothalamic disorders:
Kallmann’s syndrome
Hypothalamic infiltration
Weight loss, stress or exercise
2. Pituitary disorders:
Prolactin secreting tumour
Granulomatous infiltration
Sheehan’s syndrome

51
Q

What is PCOS

A

Excess androgen production & LH prevent LH surge that allows for ovulation & remain as a cyst

52
Q

What is 5 features of PCOS

A

Menstrual irregularities & infertility
Hyperandrogenism feature like hirsutism, acne & male pattern balding
Central obesity
Insulin resistance
Multiple ovarian follicles due to failure of development of dominant follicle

53
Q

How does the presence of androgen features occur

A

Excess androgen & insulin production suppress SHBG synthesis & more free testosterone

54
Q

What is the biochemical pattern of PCOS

A

Oestradiol & FSH is normal
LH is high

55
Q

What is used for biochemical testing of PCOS

A

Free androgen index = total testosterone / SHBG

56
Q

What is hirsutism

A

Male pattern of hair growth

57
Q

What is 5 causes of hirsutism

A

Ovarian (PCOS or tumor)
Adrenal (congenital adrenal hyperplasia or tumour)
Cushing syndrome
Idiopathic
Drugs

58
Q

What is 4 concerning feature of hirsutism

A

Virilisation
Serum testosterone >5.2
Rapid onset
Palpable abdominal mass

59
Q

What is 5 laboratory testing of hirsutism

A

SHBG
S-testosterone
DHEA-S (concerned about tumor)
17-OH progesterone (exclude late onset CAH)
Cortisol (Cushing)

Case 12: Female Reproductive System (10 decks)

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