Endocrine Disorders Affecting Reproduction Flashcards
What is the clinical application of GnRH secretion?
normally GnRH production is pulsatile
If continue GnRH is give, this downregulates FSH/LH
- can be used to time IVF cycles etc
What are the 3 categories of things that can go wrong with the HPGaxis?
- central pathology
- lack for section of LH/FSH
- hypothalamic/pituitary disease - Gonadal damage
- failure of germ cell production
- lack of sex steroid production - polycystic ovarian syndrome
What is the typical presentation of a female
Menstrual history - oligomennorhea - amennorhea - primary vs secondary Oestrogen deficiency - hot flushes, poor libido, dyspareunia Hirsutism, acne, androgenic alopecia Weight Galactorrhoea
What are the causes of amenorrhoea?
- pregnancy
Central causes - hypothalamic: anorexia, exercise, stress
- pituitary: hyperprolactinaemia, pit tumours
- hypogonadotrophic hypogondasim (failure of LH, FSH secretion)
Ovarian causes: - Turner’s
- Premature ovarian failure
Polycystic Ovarian Syndrome
Miscellaneous - thyrotoxicosis, chronic disease, local uterine problems
How can leptin affect the female reproductive system?
Congenital leptin deficiency
- Severe obesity and hyperphagia
Hypogonadotrophic hypogonadism
How is prolactin secretion regulated?
- synthesised by lactotrophs
- regulated of PRL different to the a. pituitary hormones
- negative regulation by tonic release of dopamine
What are the causes of physiological hyperprolactinaemia?
physical or psychological
post seizure
greater increase in women
PRL does have circadian rhythm with peak during sleep
- don’t examine breasts and then measure prolactin
What are the clinical features of hyperprolactinaemia?
- less apparent in post-menopausal women and men
- hypogonadism - oligo/amenorrhoea
- symptoms of low oestrogen
- ## galactorrhea
What are the pathological causes of hyperprolactinaemia?
- prolactinomas
- loss of inhibits effect of hypothalamus derived dopamine
- Drugs - dopamine antagonist e.g. phenothiazines, metoclopramide, TCAs, verapamil
- hypothyroidism link
What are the signs, symptoms and causes of primary ovarian insuffiency?
Amerrohea, oestrogen deficiency
Elevated LH, FSH
Causes:
- congenital e.g. turners
- autoimmune
- iatrogenic - chemo/radiotherapy, surgery
- mutations in FSH receptor galactossaemia, FMR1 gene permutation (fragile X)
What is the phenotype of a girl with Turner’s syndrome?
short stature streak ovaries webbed neck cubitis valgus congenital heart disease hypothyroidism lumphoedema
Describe autoimmune primary ovarian insufficiency
- often caused by autoimmune disease such as Graves, Addissons, diabetes
- POI often precedes addisions by 8-14 years
- mechanism is likely to be due to inflammatory infiltration of follicles and production of anti ovarian Ab, apoptosis and atrophy
- sharing of auto antigens between the ovary and adrenals amy explains the addissons link
What is the link between Fragile X permutation and POI?
- 1 in 200 females has the genetic change that leads to FXPOI.
- FXPOI accounts for about 4-6% of all cases of POI in women
- Mutuations in the FMR1 gene increase a woman’s risk of developing FXPOI
- FXPOI is inherited in an X-linked dominant pattern therefore one copy leads to the condition
How is Primary Ovarian Insufficiency diagnosed and managed?
- diagnosis on sera FSH and E2 levels (oestrogen)
- karyotyping and FMR-1 permutation analysis
- screening for autoimmune diseases
- AMH measurement is a good measure of ovarian reserve
- DEXA scan: risk of osteoporosis
- manage with oestrogen replacement - need progesterone added if still has uterus
What are the signs and symptoms of polycystic ovary syndrome
Aeitiology?
- oligoamenorrhoea
- hirsutism
- obesity
- infertility - anovulation
- polycystic ovaries on ultrasound
- hyperandrogegism: increased T, androstenedione (DHEA)
- increased LH/FSH ratio
Aeitiogloy = insulin resistance?
