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Endocrinology > Endo 9 - Endocrine Infertility > Flashcards

Endo 9 - Endocrine Infertility Flashcards

1
Q

Which cells within the testes does LH stimulate and what does it make these cells produce?

A

Leydig cells - Testosterone

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2
Q

What is testosterone responsible for?

A

Secondary sexual characteristics and aids spermatogenesis

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3
Q

Which cells within the testes does FSH stimulate and what does it make these cells produce?

A

Sertoli cells - stimulated to make sperm and inhibin A

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4
Q

Where are the sertoli cells located>?

A

Seminiferous tubules

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5
Q

What does inhibin A inhibit?

A

FSH secretion from the pituitary

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6
Q

What are the 3 phases of the menstrual cycle?

A

Follicular phase, ovulation, luteal phase

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7
Q

What does LH stimulate in the ovaries?

A

Oestradiol and progesterone

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8
Q

What does FSH stimulate in the ovaries?

A

follicular development and inhibin production

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9
Q

What effect does oestrogen have on the HPG axis in the follicular phase of the menstrual cycle?

A

Negative feedback - inhibits LH and FSH

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10
Q

What does the leading follicle develop into by day 10?

A

Graffian Follicle

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11
Q

Once oestrogen reaches a certain level is switches to positive feedback, how does it do this?

A

Increases GnRH secretion

Increases LH sensitivity to GnRH

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12
Q

What does the mid cycle LH surge cause?

A

triggers ovulation

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13
Q

Define infertility

A

inability to conceive after 1 year of regular unprotected sex

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14
Q

What is primary gonadal failure and what effects does it have on the HPG axis?

A

Gonads not working
No production of oestrogen/testosterone so you will get

High GnRH, high FSH, high LH

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15
Q

Describe the levels of hormones in the HPG axis in hypothalamic/pituitary disease?

A

Low FSH
Low LH
Low GnRH

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16
Q

Clinical features of male hypogonadism?

A

loss of libido
impotence
small testes
decreased muscle bulk

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17
Q

State 5 causes of male hypogonadism

A 
Kallman's 
Hypopituitarism
Illness
Hyperprolactinaemia
Androgen receptor deficiency
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18
Q

Name a congenital cause of primary hypogonadism

A

Klinefelters (XXY)

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19
Q

Name an acquired cause of primary hypogonadism

A

Testicular torsion

20
Q

What are the main investigations for male hypogonadism?

A 
Check hormones - LH, FSH, testosterone 
check MRI for pituitary if all low
Prolactin
Sperm count
Chromosomal analysis
21
Q

What hormone is given to all patients with hypogonadism?

A

Testosterone

22
Q

Why is testosterone given to all patients with hypogonadism?

A

to increase muscle bulk and protect against osteoporosis

23
Q

How do you restore fertility in someone with hypothalamic/pituitary disease?

A

Subcutaneous gonadotrophins

stimulates testosterone

24
Q

What is the treatment for hyperprolactinaemia?

A

Dopmaine agonists e.g. bromocriptine and cabergoline

25
Q

What are the main actions of testosterone?

A
  • development of male genital tract
  • maintains fertility
  • secondary sexual characteristics
  • Anabolic e.g. muscle
26
Q

Is testosterone heavily protein bound or nah?

A

Heavily protein bound

27
Q

What two hormones can testosterone be converted to?

A

dihydrotestosterone (DHT)

17-oestradiol

28
Q

What enzyme converts testosterone to DHT?

A

5- reductase

29
Q

Which enzyme converts testosterone to oestradiol?

A

Aromatase

30
Q

Which receptors does oestradiol work on?

A

oestrogen receptors

31
Q

What type of receptors are oestrogen receptors and androgen receptors?

A

Nuclear - have to go inside the nucleus to have their effect

32
Q

Does testosterone restore fertility?

A

No

33
Q

What is the difference between primary and secondary amenorrhoea?

A 
primary = failure to develop spontaneous menstruation by age of 16
secondary = absence of menstruation for 3 months in a woman who previously had cycles
34
Q

What is oligomenorrhea?

A

irregularly long cycles

35
Q

List some causes of Ameorrhoea?

A 
Pregnancy 
Lactation
Ovarian failure
Hypothalamic/Pituitary disease
Kallman's
Low BMI
Obesity
Post pill amenorrhoea
36
Q

State some of the features of Turner’s syndrome

A

short stature

cubitus valgus

37
Q

State the investigations for amenorrhoea

A 
Pregnancy test!!!
LH, FSH, Oestradiol
Prolactin
Thyroid
Chromosomal
38
Q

What two things is PCOS associated with?

A

increased cardiovascular risk

insulin resistance - diabetes

39
Q

What is the criteria for diagnosing PCOS?

A

Need 2 of the following

  • Polycystic ovaries
  • Clinical signs of androgen excess
  • Oligoovulation
40
Q

What are the clinical features of PCOS?

A

Hirsuitism
Menstrual Irregularities
Increased BMI

41
Q

What is the treatment of PCOS?

A
  • control diabetes - metformin

- Clomifene - antioestrogenic in HPA so binds and stops negative feedback thus increases gonadotrophin release

42
Q

Which hypothalamic hormone has a stimulatory effect on prolactin?

A

thyrotrophin releasing hormone

43
Q

What effect does hyperprolactinaemia have on the HPG axis?

A

Reduces GnRH pulsatility

Switches off gonadal function

44
Q

State some causes of hyperprolactinaemia

A

Prolactinoma
Dopamine Antagonists
Pituitary adenoma
PCOS

45
Q

What are the clinical features of hyperprolactinaemia?

A

Galactorrhoea
hypogonadism
prolactinoma - bitemporal hemianopia

Endocrinology (18 decks)

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