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Y2 Endocrinology > Endocrine infertility > Flashcards

Endocrine infertility Flashcards

1
Q

How long is the menstrual cycle and what are the phases

A

28 days
Follicular phase
Ovulation
Luteal phase

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2
Q

Describe the regulation of sex hormone release in males

A
  1. Hypothalamus releases GnRH
  2. Adenohypophysis releases LH and FSH
  3. Testis produces testosterone
  4. Testosterone has a negative feedback effect on the hypothalamus, also due to inhibit production (pituitary)
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3
Q

Describe the regulation of sex hormone release in females during the follicular phase

A
  1. Hypothalamus releases GnRH
  2. Adenohypophysis releases LH and FSH
  3. Ovary produces oestradiol and progesterone
  4. Inhibit produces negative feedback effect on pituitary and hypothalamus
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4
Q

Describe the regulation of sex hormone release in females during the ovulation

A
  1. Hypothalamus releases GnRH
  2. Adenohypophysis releases a surge of LH and some FSH
  3. Ovary releases oestradiol as it undergoes ovulation
  4. Oestradiol causes a positive feedback effect on the hypothalamus
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5
Q

What is the significance of implantation in the luteal phase

A

implantation does not occur - endometrium is shed -> menstruation

Implantation does occur -> pregnancy

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6
Q

Define infertility

A

Inability to conceive after a year of regulation unprotected sex

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7
Q

What are the proportion of people where infertility is caused by abnormalities

A

Males - 30%
Females - 45%
Unknown - 25%

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8
Q

How many couples does infertility affect

A

1:6

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9
Q

How does primary gonadal failure cause infertility

A

Low testosterone / oestradiol

High GnRH and High LH and FSH due to lack of negative feedback

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10
Q

How does hypopituitary disease cause infertility

A

Low testosterone and oestradiol

Low LH and FSH released by the pituitary gland

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11
Q

What are the clinical features of male hypogonadism

A 
Loss of libido
Impotence
Small testes
Decreased muscle bulk 
Osteoporosis
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12
Q

What are the causes of male hypogonadism

A

Hypothalamic-pituitary disease:
Hypopituitarism
Kallmans syndrome (anosmia and low GnRH)
Illness/underweight

Primary gonadal disease:
Congenital - Klinefelters
Acquired: testicular torsion, chemo

Hyperprolactinaemia
Androgen receptor deficiency

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13
Q

What are the investigations carried out for male hypogonadism

A

LH, FSH , testosterone
All low -> MRI pituitary

Prolactin

Sperm count

Chromosomal analysts i.e. for Klinefelters

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14
Q

What is azoospermia

A

Absence of sperm in ejaculate

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15
Q

What is oligospermia

A

Reduced numbers of sperm in ejaculate

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16
Q

What is the treatment for male hypogonadism

A

Replacement testosterone for all

Fertility: subcutaneous gonadotrophin (LH and FSH)

Hyperprolactinaemia: dopamine agonist

17
Q

What are the endogenous sites of production of androgens

A 
Interstitial Leydig cells of the testes
Adrenal cortex 
Ovaries 
Placenta
Tumours
18
Q

What are the main action of testosterone

A 
Development of the male genital tract
Maintains fertility in adulthood
Control of secondary sexual characteristics 
Anabolic effects (muscle, bone)
19
Q

How is testosterone converted to dihydrotestosterone

A

98% protein bound circulating testosterone is converted to dihydrotestosterone via 5alpha-reductase

20
Q

How is testosterone converted to 17beta-oestradiol (E2)

A

98% protein bound testosterone is converted to 17b-oestradiol via aromatase

21
Q

How does DHT and E2 act

A

via nuclear receptors
DHT - androgen receptor
E2 - oestrogen receptor e.g. brain and adipose tissue

22
Q

What is the difference between amenorrhoea, primary amenorrhoea, secondary amenorrhoea and oligomenorrhoea

A

Amenorrhoea - absence of periods

Primary amenorrhoea - failure to begin spontaneous menstruation by 16

Secondary amenorrhoea - absence of menstruation for 3 months in a woman who has previously had cycles

Oligomenorrhoea - irregular long cycles

23
Q

What are the causes of amenorrhoea

A 
Pregnancy 
Lactation 
Ovarian failure (premature ovarian failure, ovariectomy, chemo, ovarian dysgenesis, Turner's)
Gonadotrophin failure 
Hyperprolactinaemia 
Androgen excess (gonadal tumour)
24
Q

Describe Turner’s syndrome

A

Missing one X chromosome (45)
Short stature
Cubitus valgus
Gonadal dysgenesis

25
Q

Give examples of conditions classed as gonadotrophin failure which can cause amenorrhoea

A

Hypo/pit disease
Kallmann’s syndrome (anosmia, Low GnRH)
Low BMI
Post pill amenorrhoea

26
Q

What are the investigations carried out for amenorrhoea

A 
Pregnancy test
LH, FSH, oestradiol 
Day 21 progesterone 
Prolactin, thyroid function tests 
Androgens (testosterone, androstenedione, DHEAS)
Chromosomal analysis (Turners)
Ultrasound scan ovaries/uterus
27
Q

What is the treatment of amenorrhoea

A

Treat the cause (e.g. low weight)
Primary ovarian failure - infertile, HRT

Hypothalamic/pituitary disease - HRT for oestrogen replacement
Fertility: gonadotrophin (LH and FSH) - part of IVF

28
Q

Describe the epidemiology of polycystic ovarian syndrome

A

1 in 12 women of reproductive age

Associated with increased cardiovascular risk and insulin resistance

29
Q

What is the criteria to diagnose polycystic ovarian syndrome

A

2 of the following:
polycystic ovaries on an ultrasound
Oligo/anovulation
clinical/biochemical androgen excess

30
Q

What are the clinical features of polycystic ovarian syndrome

A

Hirsuitism
Menstrual cycle disturbance
Increased BMI

31
Q

What is the treatment of polycystic ovarian syndrome

A

Metformin
Clomiphene
Gonadotrophin therapy as part of IVF treatment

32
Q

What is clomiphene

A

anti-oestrogenic in the hypothalamus-pituitary axis

Binds to oestrogen receptors in the hypothalamus thereby blocking the normal -ve feedback, resulting in an increase in GnRH and gonadotrophin secretion

33
Q

What are the causes of hyperprolactinaemia

A

Dopamine antagonist drugs:
anti-emetics (metoclopramide)
anti-psychotics (phenothiazines)

Prolactinoma

Stalk compression due to pituitary adenoma

Polycystic ovarian syndrome

Hypothyroidism

Oestrogens, pregnancy, lactation

Idiopathic

34
Q

What are the clinical features of hyperprolactinaemia

A

Galactorrhoea
Reduced GnRH secretion/LH action > hypogonadism
Prolactinoma - headache and visual field defect

35
Q

What is the treatment for hyperprolactinaemias

A 
Treat the cause e.g. stop drugs 
Dopamine agonist (bromocriptine, cabergoline)
Prolactinoma (dopamine agonist therapy, pituitary surgery?)
36
Q

What are the clinical uses of testosterone

A 
Increase:
Lean body mass
Muscle size and strength 
Bone formation and bone mass
Libido and potency

Y2 Endocrinology (19 decks)

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