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203 > Disorders Of Ovulation > Flashcards

Disorders Of Ovulation Flashcards

1
Q

Kisspeptin is a?

A

GnHR secretatgogue

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2
Q

KISS1 Neurons are responsive to?

A

Oestrogen

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3
Q

Amenorrhoea?

A

Lack of period for more than 6 months

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4
Q

Oligomenorrhoea?

A

Usually more than 6 weeks apart

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5
Q

Polymenorrhoea?

A

Less than 3 weeks apart

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6
Q

Causes of ovulation problems?

A

Hypothalamus:

Kallmans syndrome GnHR syndrome, functional hypothalamic amenorrhoea (menses switch off) due to weight loss, exercise and stress or anorexia

Pituitary tumour
Pituitary surgery/ radiotherapy

Hyperandrogenism;( POCS, congenital adrenal hyperplasia) - stimulate Antral follicle proliferation and follicular maturation arrest

Premature Ovarian insufficiency (chromosomal abnormalities turners, auto immune, iatrogenic)

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7
Q

Hirsutism?

A

Androgen dependent: Excess body hair in male distribution

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8
Q

Hirsutism causes?

A

PCOS/ idiopathic- 95%
Cushing’s<1%
Adrenal/ovarian tumour<1%
Non classic congenital adrenal hyperpplasia 1%

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9
Q

Features of PCOS?

A
  1. Hyperadrogenism: hirsutism, acne
  2. Chronic oligomenorrhoes/amenorrhoea (less than 9 a year)/ sub fertility
  3. obesity (but 25% of women are lean)
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10
Q

USS appearance?

A

More than 10 subcapsular follicles 2-8mm in diameter arranged around a thickened ovarian stroma

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11
Q

Hormone levels in PCOS?

A

Reduced SHBG
Normal oestrogen
High androgen and free testosterone
Increased LH normal FSH 3:1

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12
Q

Treatment for PCOS?

A

Lifestyle medication
Stop smoking
COC

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13
Q

Antiandrogens?

A

Cyproterone acetate and spironalactone

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14
Q

Primary ovarian insufficiency?

A

Primary or secondary amenorrhoea

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15
Q

Leptin works by which system?

A

Kisspeptin system

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16
Q

Vagus let discharge alters how?

A

Increased mucus post ovulation

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17
Q

How to diagnose ovulation?

A

Measure progesterone through blood test 7 days before someone expects menstrual period

LH detection kits

Transvaginal pelvic ultrasound- from day 10 to see developing follicle size and corpus luteum

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18
Q

Urinary kits detect?

A

LH surge

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19
Q

How to monitor follicle changes?

A

Transnational pelvic ultrasound

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20
Q

Hypertrichosis?

A

Excessive hair growth anywhere on the body in either males or females.

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21
Q

PCOS prevalence?

A

5-10%

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22
Q

What percentage of females with PCOS are elan?

A

25%

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23
Q

Where is sex hormone binding globulin produced and what does it bind?

A

Produced in liver and binds to testosterone and oestradiol

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24
Q

When does SHGB increase and decrease?

A

Increased by oestrogen and decreased by testosterone

25
Q

Insulin resistance makes PCOS?

A

Worse, less SHGB so more free testosterone therefore acne, hirsutism

And more androgen production in ovarian theca cells

26
Q

What percentage of infertility is due to PCOS?

A

15% is due to lack of ovulation of which 80% due to PCOS

27
Q

PCOS can cause endometrial cancer how?

A

High oestrogen, lack of progesterone, thickening of endometrium, so hyperplasia

28
Q

How does COC help with PCOS?

A

Increase SHGB and so decrease free testosterone
Decrease FSH and LH and so ovarian stimulation

Regulates cycle and decreases endometrial hyperplasia

29
Q

Side effects with COC?

A

Weight gain, venous thrombosis, adverse effects on metabolic risk factors

30
Q

How does cyproterone acetate work?

A

Inhibits binding of testosterone and 5 alpha dihyrdotestosterone to androgen receptors

31
Q

How does spironolactone work?

A

Anti mineralocorticoids and anti androgen properties

32
Q

Metformin combined with what can help with ovulation?

A

Clomifene

33
Q

Hair removal cream eflornithine?

A

Inhibits ornithine decarboxylase enzyme in hair follicles so targets thickness and strength

34
Q

Causes of primary ovarian insufficiency?

A

Autoimmunity
X chromosomal abnormalities turners and fragile X
Genetic predisposition
Iatrogenic

35
Q

Premature ovarian failure management?

A

Fertility-IVF with donor egg
Monitor bone density DEXA
HRT continue until age 52
Psychological support

36
Q

Turner syndrome?

A

Completes/partial x monopsony in some/all cells
50% of cases will be XO
Rest: partial absence of X

37
Q

Turner syndrome prevalence?

A

1:2000-2500

38
Q

Turner’s presentation?

A 
Short stature
Problems with aorta 
Renal congenital
Metabolic syndrome
Hypothyroidism
Ears/hearing problems
Osteoporosis
39
Q

Congenital adrenal hyperplasia?

A

Disorder of cortisol biosynthesis

40
Q

CAH carrier frequency?

A

1:60

41
Q

95% of CAH is caused by?

A

21-hydroxylase deficiency,

So cortisol deficiency, may not make aldosterone and too much androgens

42
Q

How to diagnose CAH?

A

17 hydroxyprogesterone in synacthen test

43
Q

CAH in childhood?

A

2/3 are slat losing

And 1/3 is non salt losing/ simple virilising

44
Q

CAH presentation in adulthood?

A

Hirsutism, acne, olio-amenorrhoea, subfertility

45
Q

CAH treatment?

A

Glucocorticoid and mineralocorticoids replacement (hydrocortisone and fludrocortisone)

Salt in infancy

46
Q

Excess glucocorticoid treatment could cause?

A

Inhibits growth

47
Q

How does risperidone cause hyperprolactinaemia?

A

High affinity for D2 receptors, and so antagonises dopamine causing a rise in prolactin

48
Q

How to diagnose ovulation?

A

Day 21 progesterone blood test

49
Q

Difference between primary and secondary amenorrhoea?

A

Primary- never had one

Secondary- had periods but stopped now

50
Q

Hypertrichosis?

A

Androgen independent hair growth

51
Q

Prevalence of PCOS?

A

5-10%

52
Q

Where is SHGB produced? And what does it bing to?

A

In liver, binds to testosterone and oestradiol

53
Q

What is SHGB increased and decreased by?

A

Increased by oestrogen

Decreased by testosterone

54
Q

Premature ovarian failure hormone levels?

A

High LH and FSH

55
Q

Permissive effect?

A

Presence of one hormone is required for another to exert is full effect on target cell

56
Q

Androgen independent hair growth is called?

A

Hypertrichosis

57
Q

What is virilisation?

A

Frontal balding
Deepening of the voice
Male type muscle mass
Clitromegaly

58
Q

What increases and decreases level of SHBG?

A

Increased by oestrogen

Decreased by testosterone

59
Q

PCOS and the metabolic syndrome?

A

Increasing insulin resistance with insulin

Increase in androgen production by ovarian theca cells

Decreased production of SHBG by the liver

Impaired glucose tolerance

Dyslipidaemia

Vascular dysfunction

Increased risk of CVD

203 (74 decks)

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