Endocrine infertility

Question 1

Define “infertility”

Answer 1

Inability to conceive after 1 year of regular unprotected sex

Question 2

Describe the biochemical markers of primary gonadal failure

Answer 2

High GnRH, LH and FSH with low sex steroid

Question 3

Describe the biochemical markers of hypopituitary disease

Answer 3

Low LH and FSH –> low sex steroid

Question 4

Recall 4 causes of male hypogonadism

Answer 4

1. Hypothalamo-pituitary disease (hypopituitarism/Kallman’s)
2. Primary gonadal disease
3. Hyperprolactinaemia
4. Androgen receptor deficiency

Question 5

Recall 3 causes of hypothalamic-pituitary disease causing male hypogonadism

Answer 5

Hypoputuitarism

Kallman’s syndrome

Question 6

What is Kallman’s syndromea failure of?

Answer 6

Faulty GnRH production

Question 7

Recall 3 clinical features of Kallman’s syndrome

Answer 7

Anosmia
Undescended testes
Small stature

Question 8

Recall one congenital and 2 acquired causes of primary gonadal disease in men

Answer 8

Congenital: Kleinfelter’s
Acquired: testicular torsion, chemotherapy

Question 9

Recall the medical terms used to refer to complete absence of/ reduced nu,ber of sperm in the ejaculate

Answer 9

azoospermia/ oligospermia

Question 10

How is male infertility treated in hypothalamo-pituitary disease?

Answer 10

LH and FSH replacement

Question 11

How is male infertility treated in hyperprolactinaemia?

Answer 11

DA agonist

Question 12

Recall 4 causes of amennorhoea that aren’t pregnancy/ lactation

Answer 12

Ovarian failure
Gonadotropin failure
Hyperprolactinaemia
Androgen excess (gonadal tumour)

Question 13

Recall 4 causes of ovarian failure

Answer 13

Damage/Dysgenesis/Discontinuation

1. Premature ovarian insufficiency
2. Ovariectomy
3. Chemotherapy
4. Turners (–> ovarian dysgenesis)

Question 14

Recall 4 causes of Gonadotropin failure in female infertility

Answer 14

Hypothalamo-pituitary disease
Kallman’s
Low BMI
Post-pill amennorhoea

Question 15

Recall 6 investigations in female infertility

Answer 15

Pregnancy
Prolactin
Progesterone day 21
Pituitary function
Turner's (chromosomal analysis)
Androgens
Radiology (US of ovaries)
TFTs

Question 16

What is the main therapy used in female infertility?

Answer 16

HRT

Question 17

List the diagnostic criteria for PCOS

Answer 17

2 of the following:
PCOs on US
oligo-anovulation
Biochemical androgen XS

Question 18

Recall 3 clinical features of PCOS

Answer 18

1. Hirsuitism
2. Menstrual disturbance
3. Increased BMI

Question 19

Recall 2 pharmacologial treatments for PCOS

Answer 19

Metormin, clomiphene

Question 20

Why is metformin used in PCOS treatment?

Answer 20

Increases insulin sensitivity - helps to prevent diabetes, which they are at increased risk of

Question 21

Recall the mechanism of action of clomiphene

Answer 21

Anti-oestrogenic in the HPA - antagonises oestrogen receptors –> increased GnRH

Question 22

Recall the hypothalamic controls that influence prolactin secretion

Answer 22

TRH stimulates, DA inhibits

Question 23

Recall 6 possible causes of hyperprolactinaemia

Answer 23

1. Hypothyroidism (gives HIGH TRH)
2. Prolactinoma
3. PCOS
4. DA antagonist treatments
5. Pituitary adenoma –> stalk compression
6. Pregnancy/ lactation

Question 24

Recall 2 DA antagonists that may be taken therapeutically

Answer 24

1. Anti-emetics

2. Anti-psychotics

Question 25

Recall 2 clinical features of hyperprolactinaemia

Answer 25

1. galactorrhoea

2. hypogonadism

Question 26

Recall 2 symptoms of prolactinoma

Answer 26

1. Headache

2. Visual field defect

Question 27

Recall what classof drugs that could be used to treat hyperprolactinaemia, and give 2 examples

Answer 27

DA agonists:
Bromocriptine
Cabergoline

Question 28

Recall secretory products of sertoli cells

Answer 28

1. Sperm
2. Inhibin A
3. Inhibin B

Question 29

Which cells in the female HPG axis produce inhibin and what stimulates this?

Answer 29

Granulosa cells

FSH

Question 30

Recall the 2 functions of oestrogen in the HPA axis at very high concentrations

Answer 30

1. Pos feed back on GnRH, LH and FSH

2. Increase LH sensitivity to GnRH

Question 31

Which enzyme converts testosterone to DHT?

Answer 31

5-alpha-reductase

Question 32

Recall 5 clinical features of male hypogonadism

Answer 32

Small testes
Loss of libido
Impotence
Decreased muscle bulk
Osteoporosis

Question 33

Define primary amenorrhoea

Answer 33

Failure to spontaneously begin menstruating by age of 16