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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
Levels of GnRH, LH, FSH, testosterone/oestradiol in secondary gonadal failure? Why
- Low LH/FSH | - Low testosterone/oestradiol
26
ENDOGENOUS SITES OF ANDROGEN PRODUCTION: (5)
``` Interstitial Leydig cells of the testes Adrenal cortex (males and females) Ovaries Placenta Tumours ```
27
MAIN ACTIONS OF TESTOSTERONE: (40
1. Development of male genital tract 2. Maintains fetility in adulthood 3. Control of secondary sexual characteristics 4. Anabolic effects (muscle/bone)
28
What converts testosterone to dihydrotestosterone
5alpha-reductase
29
what does 5 alpha-reductase do
converts testosterone to dihydrotestosterone
30
What converts testosterone to 17beta-OESTRADIOL
Aromatase
31
What does aromatase do
Converts testosterone to 17beta-OESTRADIOL
32
Clinical features of MALE HYPOGONADISM: (5)
- Loss of libido - Impotence - Small testes - Decrease muscle bulk - Osteoporosis
33
What are 3 causes of secondary gonadal failure
1. Hypopituitarism 2. Kallman’s syndrome 3. Illness/underweight
34
What happens in Kallmans syndrome
 GnRH neurones don’t develop or migrate proeperly- no GnRH release and ANOSMIA (because GnRH neurones and smell-related neurones migrate together)
35
What two conditions do you get with Kallmans syndrome
Anosmia and hypogonadism
36
Why do you get anosmia in Kallmans syndrome
because GnRH neurones and smell-related neurones migrate together
37
Features of Kallmans syndrome? (3)
prepubertal, lack of smell, testes originally undescended
38
What are 2 causes of primary gonadal failure
1. Congenital Klinefelter’s syndrome (XXY) | 2. Acquired testicular torsion, chemotherapy
39
Genotype of Klinefelters
XXY
40
2 causes of hypogonadism in males not to do with primary gonadal disease or hypo/pituitary disease
- Hyperprolactinaemia | - Androgen receptor deficiency (rare)
41
4 tests to find the cause of hypogonadism in males?
- 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
Treatment for males with hypogonadism?
- Replacement testosterone for all patients - For fertility, IF hypo/pituitary disease Subcutaneous gonadotrophins (LH/FSH)
43
treatment to induce fertility in someone with primary hypogonadism
There is none poor guy
44
Effects of testosterone use in adults (4)
1. Lean body mass 2. Muscle size/strength 3. Bone formation and mass (in young males) 4. Libido and potency
45
LH/FSH/Testerone - which can restore fertility in someone with X gonadal failure?
LH/FSH in secondary gonadal failure
46
What is primary amenorrhoea
Failure to begin spontaneous menstruation by age of 16yrs
47
What is secondary amenorrhoea
Absence of menstruation for 3 months in a woman who has previously had cycles
48
What is oligoamenorrhoea
Irregular long period cycles
49
causes of amenorrhoea (5)
1. Pregnancy/lactation 2. Ovarian failure: 3. Gonadotrophin failure: 4. Hyperprolactinaemia 5. Androgen excess - Gonadal tumour
50
How can ovarian failure cause amenorrhoea (3)
``` Premature ovarian failure early menopause Ovariectomy/chemotherapy Ovarian dysgenesis (Turner’s syndrome 45 XO lacking one chromosome) ```
51
What is Turners syndrome
45 XO -> lacking one chromosome, causes short stature, cubitus valgus etc
52
How can Gonadotrophin failure cause amenorrhoea (3)
Hypo/pituitary disease Kallman’s syndrome Low BMI Leptin deficiency turns off periods
53
Investigations of hypogonadism in women? (7)
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
Main treatment options for hypogonadism in women? (3)
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
Criteria to diagnose polycystic ovarian syndrome?
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
CLINICAL FEATURES OF polycystic ovarian syndrome? (3)
- Hirsutism - Menstrual cycle disturbance - Increased BMI
57
treatment for polycystic ovarian syndrome?
- Metformin - Clomiphene - Gonadotrophin therapy as part of IVF treatment
58
Clomiphene is good for?
Good for regulating periods
59
Effect of clomiphene?
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
dopamine is X to prolactin secretion
inhibitory
61
Prolactin secretion is stimulated by ...
TRH
62
- Prolactin X GnRH PULSATILITY
DECREASES
63
Prolactin X LH ACTION ON OVARY/TESTES
decreases
64
prolactin effects on the LH/GnRH
Decreases GnRH pulsatility and LH stimulation of testes/ovaries
65
Causes of hyperprolactinaemia (7)
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
CLINICAL FEATURES of hyperprolactinaemia (4)
- Galactorrhoea - Reduced GnRH secretion/LH action Hypogonadism - Prolactinoma: Headache Visual field defect
67
What medicines can cause hyperprolactinaemia
Dopamine antagonists: Anti-emetics (metoclopramide) Anti-sickness tablets Anti-psychotics (phenothiazines)
68
Treatment for hyperprolactinaemia (3)
1. Treat the cause e.g. stop drugs 2. Dopamine agonist: BROMOCRIPTINE CABERGOLINE 3. Prolactinoma Dopamine agonist therapy, pituitary surgery rarely needed
69
D2 receptor agonist drugs? (2)
BROMOCRIPTINE | CABERGOLINE
70
Main use of metformin?
Insulin sensitivity in diabetes

Endocrinology Y2 (18 decks)

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