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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
Insulin resistance makes PCOS?
Worse, less SHGB so more free testosterone therefore acne, hirsutism And more androgen production in ovarian theca cells
26
What percentage of infertility is due to PCOS?
15% is due to lack of ovulation of which 80% due to PCOS
27
PCOS can cause endometrial cancer how?
High oestrogen, lack of progesterone, thickening of endometrium, so hyperplasia
28
How does COC help with PCOS?
Increase SHGB and so decrease free testosterone Decrease FSH and LH and so ovarian stimulation Regulates cycle and decreases endometrial hyperplasia
29
Side effects with COC?
Weight gain, venous thrombosis, adverse effects on metabolic risk factors
30
How does cyproterone acetate work?
Inhibits binding of testosterone and 5 alpha dihyrdotestosterone to androgen receptors
31
How does spironolactone work?
Anti mineralocorticoids and anti androgen properties
32
Metformin combined with what can help with ovulation?
Clomifene
33
Hair removal cream eflornithine?
Inhibits ornithine decarboxylase enzyme in hair follicles so targets thickness and strength
34
Causes of primary ovarian insufficiency?
Autoimmunity X chromosomal abnormalities turners and fragile X Genetic predisposition Iatrogenic
35
Premature ovarian failure management?
Fertility-IVF with donor egg Monitor bone density DEXA HRT continue until age 52 Psychological support
36
Turner syndrome?
Completes/partial x monopsony in some/all cells 50% of cases will be XO Rest: partial absence of X
37
Turner syndrome prevalence?
1:2000-2500
38
Turner’s presentation?
``` Short stature Problems with aorta Renal congenital Metabolic syndrome Hypothyroidism Ears/hearing problems Osteoporosis ```
39
Congenital adrenal hyperplasia?
Disorder of cortisol biosynthesis
40
CAH carrier frequency?
1:60
41
95% of CAH is caused by?
21-hydroxylase deficiency, | So cortisol deficiency, may not make aldosterone and too much androgens
42
How to diagnose CAH?
17 hydroxyprogesterone in synacthen test
43
CAH in childhood?
2/3 are slat losing | And 1/3 is non salt losing/ simple virilising
44
CAH presentation in adulthood?
Hirsutism, acne, olio-amenorrhoea, subfertility
45
CAH treatment?
Glucocorticoid and mineralocorticoids replacement (hydrocortisone and fludrocortisone) Salt in infancy
46
Excess glucocorticoid treatment could cause?
Inhibits growth
47
How does risperidone cause hyperprolactinaemia?
High affinity for D2 receptors, and so antagonises dopamine causing a rise in prolactin
48
How to diagnose ovulation?
Day 21 progesterone blood test
49
Difference between primary and secondary amenorrhoea?
Primary- never had one | Secondary- had periods but stopped now
50
Hypertrichosis?
Androgen independent hair growth
51
Prevalence of PCOS?
5-10%
52
Where is SHGB produced? And what does it bing to?
In liver, binds to testosterone and oestradiol
53
What is SHGB increased and decreased by?
Increased by oestrogen | Decreased by testosterone
54
Premature ovarian failure hormone levels?
High LH and FSH
55
Permissive effect?
Presence of one hormone is required for another to exert is full effect on target cell
56
Androgen independent hair growth is called?
Hypertrichosis
57
What is virilisation?
Frontal balding Deepening of the voice Male type muscle mass Clitromegaly
58
What increases and decreases level of SHBG?
Increased by oestrogen Decreased by testosterone
59
PCOS and the metabolic syndrome?
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

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