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Endocrinology Y2 > Endocrine Infertility > Flashcards

Endocrine Infertility Flashcards

1
Q

What stimulates LH and FSH release

A

GnRH

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2
Q

Where is LH and FSH released from

A

Pituitary

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3
Q

What does LH release stimulate in males and where

A

LH stimulates testosterone production in the testes (leydig cells)

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4
Q

3 phases of the female mentrual cycle?

A

Follicular phase -> ovulation -> luteal phase

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5
Q

What does LH stimulate in females and where (2)

A

Oestradiol and progesterone production in the ovaries

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6
Q

What does FSH stimulate in females and where (2)

A

FSH stimulates follicular development and inhibin production

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7
Q

What does inhibin do

A

Inhibit FSH

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8
Q

What does FSH release stimulate in males and where

A

FSH stimulates sertoli cells in seminiferous tubules -­‐-­‐> sperm and inhibin A and

B

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9
Q

How is GnRH released (time)

A

Pulsatile

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10
Q

What cells produce testosterone in males testes

A

leydig cells

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11
Q

what is testosterone responsible for (2)

A

secondary sexual characteristics and aids spermatogenesis

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12
Q

What cells produce sperm and and inhibin

A

Sertoli cells in seminiferous tubules

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13
Q

What does testosterone inhibit

A

has negative feedback on the hypothalamus and the pituitary (GnRH and FSH/LH)

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14
Q

What does inihibin inhibit in males

A

FSH

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15
Q

What day is the Graffian follicle developed

A

10

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16
Q

Oestrogens initial effect on hormone secretion in females?

A

Oestrogen initially has negatively inhibits LH and FSH secretion

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17
Q

When does oestrogens effect on LH and FSH change in females

A

In the luteal phase

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18
Q

What does oestrogen do in the luteal phase (2)

A

It increases GnRH release and increases LH sensitivity to GnRH
This leads to a mid-­‐cycle LH surge

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19
Q

What does the LH surge do

A

This triggers ovulation from the leading follicle

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20
Q

What is infertility defined as

A

Definition: inability to conceive after 1 year of regular unprotected sex
1/6 couples can be affected

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21
Q

What is primary gonadal failure

A

Testes or ovaries not working

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22
Q

What are the levels of testosterone/oestradiol in primary gonadal failure

A
  • Low
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23
Q

Levels of GnRH, LH, FSH, testosterone/oestradiol in primary gonadal failure? Why

A
  • Low negative feedback
  • High GnRH
  • High LH/FSH
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24
Q

What is secondary gonadal failure

A

Hypo/pituitary disease

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25
Q

Levels of GnRH, LH, FSH, testosterone/oestradiol in secondary gonadal failure? Why

A
  • Low LH/FSH

- Low testosterone/oestradiol

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26
Q

ENDOGENOUS SITES OF ANDROGEN PRODUCTION: (5)

A 
Interstitial Leydig cells of the testes
Adrenal cortex (males and females)
Ovaries
Placenta
Tumours
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27
Q

MAIN ACTIONS OF TESTOSTERONE: (40

A
  1. Development of male genital tract
  2. Maintains fetility in adulthood
  3. Control of secondary sexual characteristics
  4. Anabolic effects (muscle/bone)
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28
Q

What converts testosterone to dihydrotestosterone

A

5alpha-reductase

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29
Q

what does 5 alpha-reductase do

A

converts testosterone to dihydrotestosterone

30
Q

What converts testosterone to 17beta-OESTRADIOL

A

Aromatase

31
Q

What does aromatase do

A

Converts testosterone to 17beta-OESTRADIOL

32
Q

Clinical features of MALE HYPOGONADISM: (5)

A
  • Loss of libido
  • Impotence
  • Small testes
  • Decrease muscle bulk
  • Osteoporosis
33
Q

What are 3 causes of secondary gonadal failure

A
  1. Hypopituitarism
  2. Kallman’s syndrome
  3. Illness/underweight
34
Q

What happens in Kallmans syndrome

A

 GnRH neurones don’t develop or migrate proeperly- no GnRH release and ANOSMIA (because GnRH neurones and smell-related neurones migrate together)

35
Q

What two conditions do you get with Kallmans syndrome

A

Anosmia and hypogonadism

36
Q

Why do you get anosmia in Kallmans syndrome

A

because GnRH neurones and smell-related neurones migrate together

37
Q

Features of Kallmans syndrome? (3)

A

prepubertal, lack of smell, testes originally undescended

38
Q

What are 2 causes of primary gonadal failure

A
  1. Congenital Klinefelter’s syndrome (XXY)

2. Acquired testicular torsion, chemotherapy

39
Q

Genotype of Klinefelters

A

XXY

40
Q

2 causes of hypogonadism in males not to do with primary gonadal disease or hypo/pituitary disease

A
  • Hyperprolactinaemia

- Androgen receptor deficiency (rare)

41
Q

4 tests to find the cause of hypogonadism in males?

A
  • LH, FSH, testosterone (if all low get a pituitary MRI as it suggests secondary hypogonadism)
  • Prolactin
  • Sperm count AZOOSPERMIA= Absence of sperm in ejaculate
    OLIGOSPERMIA= Reduced numbers of sperm in ejaculate
  • Chromosomal analysis (Klinefelter’s XXY)
42
Q

Treatment for males with hypogonadism?

A
  • Replacement testosterone for all patients
  • For fertility, IF hypo/pituitary disease
    Subcutaneous gonadotrophins (LH/FSH)
43
Q

treatment to induce fertility in someone with primary hypogonadism

A

There is none poor guy

44
Q

Effects of testosterone use in adults (4)

A
  1. Lean body mass
  2. Muscle size/strength
  3. Bone formation and mass (in young males)
  4. Libido and potency
45
Q

LH/FSH/Testerone - which can restore fertility in someone with X gonadal failure?

A

LH/FSH in secondary gonadal failure

46
Q

What is primary amenorrhoea

A

Failure to begin spontaneous menstruation by age of 16yrs

47
Q

What is secondary amenorrhoea

A

Absence of menstruation for 3 months in a woman who has previously had cycles

48
Q

What is oligoamenorrhoea

A

Irregular long period cycles

49
Q

causes of amenorrhoea (5)

A
  1. Pregnancy/lactation
  2. Ovarian failure:
  3. Gonadotrophin failure:
  4. Hyperprolactinaemia
  5. Androgen excess - Gonadal tumour
50
Q

How can ovarian failure cause amenorrhoea (3)

A 
Premature ovarian failure early menopause
Ovariectomy/chemotherapy
Ovarian dysgenesis (Turner’s syndrome 45 XO lacking one chromosome)
51
Q

What is Turners syndrome

A

45 XO -> lacking one chromosome, causes short stature, cubitus valgus etc

52
Q

How can Gonadotrophin failure cause amenorrhoea (3)

A

Hypo/pituitary disease
Kallman’s syndrome
Low BMI Leptin deficiency turns off periods

53
Q

Investigations of hypogonadism in women? (7)

A
  1. Pregnancy test
  2. LH/FSH/Oestradiol
  3. Day 21 progesterone Low= not ovulated in that cycle
  4. Prolactin, thyroid function tests
  5. Androgens (testosterone, androstenedione, DHEAS) High in PCOS or (possibly) a tumour
  6. Chromosomal analysis (Turner’s 45 XO)
  7. Ultrasound scan ovaries/uterus Useful in PCOS
54
Q

Main treatment options for hypogonadism in women? (3)

A
  1. Treat the cause (e.g. low BMI)
  2. Primary ovarian failure No treatment for infertility, but can give HRT to replace hormones
  3. Hypothalamic/pituitary disease:
    HRT for oestrogen replacement
    Fertility Gonadotrophins (LH/FSH) Part of IVF treatment
55
Q

Criteria to diagnose polycystic ovarian syndrome?

A

Need 2 of:
Polycystic ovaries on the ultrasound scan
Oligoovulation/anovulation
Clinical/biochemical androgen excess:
1E.g. increased growth of hair in a male pattern

56
Q

CLINICAL FEATURES OF polycystic ovarian syndrome? (3)

A
  • Hirsutism
  • Menstrual cycle disturbance
  • Increased BMI
57
Q

treatment for polycystic ovarian syndrome?

A
  • Metformin
  • Clomiphene
  • Gonadotrophin therapy as part of IVF treatment
58
Q

Clomiphene is good for?

A

Good for regulating periods

59
Q

Effect of clomiphene?

A

Anti-oestrogenic in the hypothalamo-pituitary axis
Binds to oestrogen receptors in the hypothalamus, blocking negative feedback, resulting in increased GnRH and gonadotrophin secretion

60
Q

dopamine is X to prolactin secretion

A

inhibitory

61
Q

Prolactin secretion is stimulated by …

A

TRH

62
Q
  • Prolactin X GnRH PULSATILITY
A

DECREASES

63
Q

Prolactin X LH ACTION ON OVARY/TESTES

A

decreases

64
Q

prolactin effects on the LH/GnRH

A

Decreases GnRH pulsatility and LH stimulation of testes/ovaries

65
Q

Causes of hyperprolactinaemia (7)

A
  1. Dopamine antagonist drugs
  2. Prolactinoma
  3. Stalk compression due to pituitary adenoma Blocks dopamine travelling to pituitary
  4. Polycystic ovarian syndrome
  5. Hypothyroidism (high TRH)
  6. Oestrogens (OCP), pregnancy, lactation
  7. Idiopathic
66
Q

CLINICAL FEATURES of hyperprolactinaemia (4)

A
  • Galactorrhoea
  • Reduced GnRH secretion/LH action Hypogonadism
  • Prolactinoma:
    Headache
    Visual field defect
67
Q

What medicines can cause hyperprolactinaemia

A

Dopamine antagonists:
Anti-emetics (metoclopramide) Anti-sickness tablets
Anti-psychotics (phenothiazines)

68
Q

Treatment for hyperprolactinaemia (3)

A
  1. Treat the cause e.g. stop drugs
  2. Dopamine agonist:
    BROMOCRIPTINE
    CABERGOLINE
  3. Prolactinoma Dopamine agonist therapy, pituitary surgery rarely needed
69
Q

D2 receptor agonist drugs? (2)

A

BROMOCRIPTINE

CABERGOLINE

70
Q

Main use of metformin?

A

Insulin sensitivity in diabetes

Endocrinology Y2 (18 decks)

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