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Endocrinology > Endocrine infertility > Flashcards

Endocrine infertility Flashcards

1
Q

Infertility

A

Inability to conceive after 1 year of regular unprotected sex (occurs in 1 out of 6 couples)
-caused by male abnormalities (30%), female abnormalities (45%) or unknown cause (25%)

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2
Q

Male hypogonadism (testosterone deficiency) clinical features

A
  • Loss of libido
  • Impotence
  • Small testes
  • Decreased muscle bulk
  • Osteoporosis
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3
Q

Male hypogonadism causes

A 
Hypothalamic-pituitary disease
-Hypopituitarism
-Kallmann syndrome (anosmia, low GnRH)
-Illness/underweight
Primary gonadal disease
-Congenital->Klinefelter syndrome (XXY)
-Acquired->testicular torsion, chemotherapy
Hyperprolactinaemia
Androgen receptor deficiency
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4
Q

Male hypogonadism investigations

A

-LH/FSH/Testosterone
if all low do pituitary MRI
-Prolactin
-Sperm count
azoospermia=absence of sperm in ejaculate
oligospermia=reduced numbers of sperm in ejaculate
-Chromosomal analysis
check if congenital defect such as Klinefelter Syndrome

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5
Q

Male hypogonadism treatment

A

-Replacement testosterone for all patients
For fertility:
-if hypothalamic-pituitary disease, use subcutaneous gonadotrophins (LH and FSH)
-if hyperprolactinaemia, use dopamine agonist

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6
Q

Endogenous sites of androgen production

A
  • Interstitial Leydig cells of the testes (males only)
  • Adrenal cortex (males and females)
  • Ovaries and placenta (females only)
  • Tumours
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7
Q

Testosterone actions

A
  • Male genital tract development
  • Maintains fertility in adulthood
  • Control of secondary sexual characteristics
  • Anabolic effects (muscle, bone)
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8
Q

Adult clinical uses of testosterone

A
  • Increases lean body mass
  • Increases muscle size and strength
  • Increases bone formation and bone mass in young men
  • Increases libido and potency
  • DOES NOT RESTORE FERTILITY (requires gonadotrophin treatment to restore normal spermatogenesis)
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9
Q

Amenorrhoea

A

Absence of menstruation (menstrual periods)

  • Primary=failure to begin spontaneous menstruation by 16 years old
  • Secondary=absence of menstruation for 3 months in a women who has previously had menstrual cycles
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10
Q

Amenorrhoea causes

A
  • Pregnancy
  • Lactation
  • Ovarian failure (premature ovarian failure, ovariectomy, chemotherapy, ovarian dysgenesis such as Turner Syndrome=45,XO)
  • Gonadotrophin failure (hypothalamic/pituitary disease, Kallmann syndrome, low BMI, post pill amenorrhoea)
  • Hyperprolactinaemia
  • Androgen excess (gonadal tumour)
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11
Q

Amenorrhoea investigations

A
  • Pregnancy test
  • LH, FSH, Oestradiol
  • Day 21 progesterone
  • Prolactin, thyroid function tests
  • Androgens (testosterone, androstenedione, DHEAS)
  • Chromosomal analysis (check if congenital defect such as Turner Syndrome=45, XO)
  • Ultrasound scan of ovaries/uterus
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12
Q

Amenorrhoea treatment

A

CAUSE

  • Primary ovarian failure=infertile and requires HRT
  • Hypothalamic/pituitary disease=HRT for oestrogen, Gonadotrophins for fertility as part of IVF
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13
Q

Oligomenorrhoea

A

Infrequent (irregular long) cycles

-less severe than Amenorrhoea

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14
Q

Polycystic Ovarian Syndrome (PCOS)

A
  • hormonal imbalance
  • incidence=1 in 12 women of reproductive age
  • associated with increased cardiovascular risk and insulin resistance
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15
Q

PCOS diagnosis

A

2 of:

  • Polycystic ovaries on ultrasound scan
  • Oligoovulation/ anovulation
  • Clinical/ biochemical androgen excess
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16
Q

PCOS clinical features of androgen excess

A
  • hirsutism or acne
  • menstrual cycle disturbance
  • increased BMI
17
Q

PCOS treatment (fertility)

A
  • Metformin
  • Clomiphene
  • Gonadotrophin therapy as part of IVF
18
Q

Clomiphene

A

Fertility drug

  • anti-oestrogenic in hypothalamo-pituitary axis
  • binds to oestrogen receptors in the hypothalamus, blocking normal negative feedback leading to increased GnRH and gonadotrophin secretion
19
Q

Hyperprolactinaemia causes

A
  • Dopamine antagonist drugs (anti-emetics such as metoclopramide, anti-psychotics such as phenothiazines etc)
  • Prolactinoma
  • Stalk compression due to pituitary adenoma
  • PCOS
  • Hypothyroidism
  • Oestrogens (oral contraceptive pills), pregnancy and lactation
  • Idiopathic (unknown cause)
20
Q

Hyperprolactinaemia clinical features

A
  • Galactorrhoea
  • Reduced GnRH secretion/LH action leading to hypogonadism
  • Prolactinoma (headaches, visual field defect)
21
Q

Hyperprolactinaemia treatment

A

TREAT THE CAUSE

  • Dopamine agonist drugs (Bromocriptine and Cabergoline)
  • If prolactinoma, requires dopamine agonist therapy with pituitary surgery rarely needed
22
Q

Stages of the 28 day menstrual cycle

A
  • Follicular phase
  • Ovulation
  • Luteal phase
23
Q

Regulation of prolactin secretion

A

TRH from the hypothalamus increases secretion while dopamine decreases secretion

Endocrinology (18 decks)

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