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LCRS - endo > Endocrine infertility > Flashcards

Endocrine infertility Flashcards

1
Q

Testosterone feedback loop diagram

A
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2
Q

Follicular phase feedback loop diagram

A
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3
Q

Feedback loop at ovulation diagram.

(oestrogen +ve feedback)

A
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4
Q

Define infertility.

A

Inability to conceive after 1 year of regular unprotected sex.

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5
Q

How common is infertility.

A

1:6 couples

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6
Q

What abnormalities most commonly cause infertility?

A

Females - 45%

Males - 30%

Unknown - 25%

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7
Q

What hormone levels are seen in primary gonadal failure?

A

high GnRH, high LH/FSH due to low testosterone/oestrodiol. No -ve feedback

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8
Q

What hormone levels are need in hypo/pituitary disease causing infertility?

A

Low LH/FSH leading to low testosterone/oestrodiol - failure to stimulate gonads due to pituitary/hypothalamus failiure.

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9
Q

List some clinical features of male hypogonadism?

A
  • Loss of libido = sexual interest / desire
  • Impotence
  • Small testes
  • Decrease muscle bulk
  • osteoporosis
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10
Q

List causes of male hypogonadism.

A

•Hypothalamic-pituitary disease

–Hypopituitarism

–Kallmans syndrome (anosmia & low GnRH)

–Illness / underweight

•Primary gonadal disease

–Congenital: Klinefelters syndrome (XXY)

–Acquired: Testicular torsion, Chemotherapy

  • Hyperprolactinaemia
  • Androgen receptor deficiency
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11
Q

Give 2 features of Kallman’s syndrome.

A

Testes originally undescended.

Low stature

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12
Q

What can be investigated to diagnose male hypogonadism?

A

•LH, FSH, testosterone

–If all low >> MRI pituitary

  • Prolactin
  • Sperm count

–Azoospermia = absence of sperm in ejaculate

–Oligospermia = reduced numbers of sperm in ejaculate

Chromosomal analysis (Klinefelters XXY).

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13
Q

How can male hypogonadism be treated?

A

Replacement testosterone.

For fertility (e.g. with pituitary/hypothalamic disease) - replacement gonadotrophins.

Administer dopamine agonist to combat hyperprolactinaemia.

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14
Q

Name the endogenous sites of production of androgens.

A
  1. interstitial Leydig cells of the testes
  2. adrenal cortex (males and females)
  3. ovaries
  4. placenta
  5. tumours
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15
Q

Name the 4 main actions of testosterone.

A
  1. development of the male genital tract
  2. Maintains fertility in adulthood
  3. Control of secondary sexual characteristics
  4. Anabolic effects (muscle, bone)
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16
Q

What proportion of circulating testosterone is protein bound?

A

98%

17
Q

Diagram outling action of testosterone - conversion and receptor

A
18
Q

Give the clinical uses of testosterone.

A
  • lean body mass
  • muscle size and strength
  • bone formation and bone mass (in young men)
  • libido and potency

It will not restore fertility, which requires treatment with gonadotrophins to restore normal spermatogenesis.

19
Q

Define primary amenorrhoea.

A

Absence of periods. Failure to being spontaneous menstruation by 16 years old.

20
Q

Define secondary amenorrheoa

A

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

21
Q

Define oligomenorrhoea.

A

Irregular long cycles

22
Q

List the causes of amenorrhoea.

A

Pregnancy/lactation.

Ovarian failure

  • premature ovarian insufficiency
  • ovariectomy/chemotherapy.
  • overian dysgenesis (Turners 45 XO) - lacking one chromosome.

Gonadotrophin failure.

–Hypo / pit disease

–Kallmann’s syndrome (anosmia, Low GnRH)

–Low BMI

–Post pill amenorrhoea

Hyperprolactinaemia.

Androgen excess (gonadal tumour)

23
Q

Give some characteristics of Turners syndrome.

A

short stature

cubitus valgus (wide carrying angle)

gonadal dysgenesis.

24
Q

How common is Turners syndrome?

A

1:5000 live female births

25
Q

How can amenorrhoea be investigated?

A

Pregnancy test.

LH/FSH, oestradiol (if very low)

Day 21 progesterone (should be high)

Prolactin/thyroid function tests.

Test for androgens (testosterone, androenedione, DHEAS).

Chromosomal analysis (Turners)

Ultrasound scan of ovaries/uterus.

26
Q

Explain how amenorrhoea might be treated.

A

Treat cause (e.g. low weight)

HRT in case of primary ovarian failure.

Hypothalamic/pituitary disease - HRT for oestrogen replacement, gonadotrophins (LH/FSH) for fertility.

27
Q

How common is PCOS?

A

1 in 12 women of reproductive age.

28
Q

What is PCOS associated with?

A

increased cardiovascular risk and insulin resistance.

29
Q

Outline the criteria for PCOS diagnosis.

A

Polycystic ovaries on USS

oligo-/anovulation

clinical/biochemical androgen excess.

30
Q

Name 3 clinical features of PCOS.

A

Hirsuitism.
menstrual cycle disturbance.

Increased BMI

31
Q

Name two drugs used to treat PCOS.

A

Metformin

Clomiphene

32
Q

Outline the mechanism of action of clomiphene.

A

Bind to oestrogen receptors in hypothalamus. Block normakl -ve feedback –> increased GnRH and gonadotrophins.

33
Q

Diagram to show control of prolactin secretion.

A
34
Q

Outline the causes of hyperprolactinaemia.

A

dopamine antagonist drugs.

  • anti-emetics (metoclopramide)
  • anti-psychotics (phenothiazines)

Prolactinoma

Stalk compression due to pituitary adenoma.

PCOS

Hypothyroidism

Oestrogens (pregnancy, lactation)

Idiopathic

35
Q

Name the clinical features of hyperprolactinaemia.

A

Galactorrhoea.

Reduced GnRH secretion/LH action –> hypogonadism.

Prolactinoma

  • headaches
  • visual field defect.
36
Q

How can hyperprolactinaemia be treated?

A

Treat cause - stop drugs being administered that might cause it.

Dopamine agonist

  • bromocriptine
  • cabergoline

Prolactinoma

  • opamine agonist therapy.
  • pituitary surgery.
37
Q
A

LCRS - endo (12 decks)

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