Endocrine infertility Flashcards
Define “infertility”
Inability to conceive after 1 year of regular unprotected sex
Describe the biochemical markers of primary gonadal failure
High GnRH, LH and FSH with low sex steroid
Describe the biochemical markers of hypopituitary disease
Low LH and FSH –> low sex steroid
Recall 4 causes of male hypogonadism
- Hypothalamo-pituitary disease (hypopituitarism/Kallman’s)
- Primary gonadal disease
- Hyperprolactinaemia
- Androgen receptor deficiency
Recall 3 causes of hypothalamic-pituitary disease causing male hypogonadism
Hypoputuitarism
Kallman’s syndrome
What is Kallman’s syndromea failure of?
Faulty GnRH production
Recall 3 clinical features of Kallman’s syndrome
Anosmia
Undescended testes
Small stature
Recall one congenital and 2 acquired causes of primary gonadal disease in men
Congenital: Kleinfelter’s
Acquired: testicular torsion, chemotherapy
Recall the medical terms used to refer to complete absence of/ reduced nu,ber of sperm in the ejaculate
azoospermia/ oligospermia
How is male infertility treated in hypothalamo-pituitary disease?
LH and FSH replacement
How is male infertility treated in hyperprolactinaemia?
DA agonist
Recall 4 causes of amennorhoea that aren’t pregnancy/ lactation
Ovarian failure Gonadotropin failure Hyperprolactinaemia Androgen excess (gonadal tumour)
Recall 4 causes of ovarian failure
Damage/Dysgenesis/Discontinuation
- Premature ovarian insufficiency
- Ovariectomy
- Chemotherapy
- Turners (–> ovarian dysgenesis)
Recall 4 causes of Gonadotropin failure in female infertility
Hypothalamo-pituitary disease
Kallman’s
Low BMI
Post-pill amennorhoea
Recall 6 investigations in female infertility
Pregnancy Prolactin Progesterone day 21 Pituitary function Turner's (chromosomal analysis) Androgens Radiology (US of ovaries) TFTs
What is the main therapy used in female infertility?
HRT
List the diagnostic criteria for PCOS
2 of the following:
PCOs on US
oligo-anovulation
Biochemical androgen XS
Recall 3 clinical features of PCOS
- Hirsuitism
- Menstrual disturbance
- Increased BMI
Recall 2 pharmacologial treatments for PCOS
Metormin, clomiphene
Why is metformin used in PCOS treatment?
Increases insulin sensitivity - helps to prevent diabetes, which they are at increased risk of
Recall the mechanism of action of clomiphene
Anti-oestrogenic in the HPA - antagonises oestrogen receptors –> increased GnRH
Recall the hypothalamic controls that influence prolactin secretion
TRH stimulates, DA inhibits
Recall 6 possible causes of hyperprolactinaemia
- Hypothyroidism (gives HIGH TRH)
- Prolactinoma
- PCOS
- DA antagonist treatments
- Pituitary adenoma –> stalk compression
- Pregnancy/ lactation
Recall 2 DA antagonists that may be taken therapeutically
- Anti-emetics
2. Anti-psychotics
