Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 LCRS Endocrinology > Endocrine infertility > Flashcards

Endocrine infertility Flashcards

1
Q

What is infertility?

How often does it occur?

A

Inability to concieve after one year of regular unprotected sex

It occurs in 1:6 couples

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are the causes for infertitlity?

A

Caused by abnormalities

  • in males (30%)
  • or females (45%)
  • or unknown (25%)

—> Need to see whole couple for determining infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the clinical features of male hypogonadism?

A

All due to low Testosterone:

  • loss of libido
  • small testis
  • loss of muscle bulk
  • impotence
  • osteoporosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes for male hypogonadism?

A
  1. Hypothalamic/Pituitary reasons
    • Hypopituitarism
    • Kallmanns syndrome
    • Illness/underweight (leptin effect on pituitary)
  2. Primary gonodal disease
    • genetic (e.g. Kleinfeltery syndrome XXY)
    • Aquired: testicular torison, Chemotherapy
  3. Hyperprolactinaemia
  4. Androgen receptor deficienyy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Kallmanns syndrome?

A

A syndrome that results in lowGnRH pressenting with

  • loss of smell (anosmia)
  • in males: no descend of testis + late puberty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which investigatios would you perform when someone presents with symptoms of male hypogonadism?

A

Hormone levels

  • LH, FSH high (lack of negative feedback)
  • Testosterone low

Prolactin levesl

Sperm count

Chromosomal analysis (e.g. Kleinfelters XXY)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Azoospermia?

A

Absence of sperm in ejaculate

(How would you call)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Oligospermia

A

Reduced numbers of sperm in ejaculate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Absence of sperm in ejaculate

(How would you call)

A

What is Azoospermia?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is

Reduced numbers of sperm in ejaculate

A

Oligospermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would you treat a male patient with Hypogonadism?

A
  1. Testosterone replacement for all patients
  2. When wish for fertility: also FSH + LH replacement required
  3. In Hyperprolactinaemia: Dopamine agonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the possible sites for androgen production?

A
  • Adrenals
  • Testicles (Leydig cells)
  • Ovaries
  • placenta
  • tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the main physiological actions of Testosterone?

A
  • Development of male genitalia tract
  • Maintains fertility in adulthood
  • Control of 2nd sexual characteristics
  • Anabolic effects: Muscle and Bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which pathways can testosterone undergo?

What are the enymes involved?

What are possible products?

A

Testosterone into

Dihydrotestosterone (via 5-alpha reductase) or

17ßEstradiol (Via Aromatase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the effect of testosterone treatment in adulthood?

A

It will increase

  • lean body mass
  • muscle size and strength
  • bone formation + bone mass (in young men)
  • libido and potency (but for restoring fertility also LH + FSH are needed!)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is oligomenorrhoea?

A

Prolonged, irregular periods

17
Q

What are possible causes of Amenorrhoea?

A
  1. Pregnancy/ Lactation
  2. Ovarian failure
    • premature ovarian failure
    • Ovariectomy / chemotherapy
    • ovarian dysgenesis (Turners 45 XO) – lacking one chromosome
  3. Gonadotrophin failure:
    • Hypo / pit disease
    • Kallmann’s syndrome (anosmia, Low GnRH)
    • Low BMI (Leptin inhibition of GnRH release)
    • Post pill amenorrhoea (exogenous hormone switches off hypothalamus)
  4. Hyperprolactinaemia
  5. Androgen excess: gonadal tumour
18
Q

Which investigations would you perform on someone presenting with amenorrhoea?

A
  1. Pregnancy test
  2. Hormonal profile
    • LH, FSH, oestradiol
    • Day 21 progesterone
    • Prolactin, thyroid function tests
    • Androgens (testosterone, androstenedione, DHEAS)
  3. Chromosomal analysis (Turners 45 XO)
  4. Ultrasound scan ovaries / uterus
19
Q

How would you treat somoen with amenorrhoea?

A

Treat the cause (eg low weight)!

Also treatment in dependant on the cause:

In Primary ovarian failure

  • infertile, HRT

In Hypothalamic / pituitary disease

  • HRT for oestrogen replacement
  • If Fertility wanted: Gonadotrophins (LH & FSH) – part of IVF treatment
20
Q

What is PCOS?

How often does it occur?

A

Polycystic ovarian syndrome

•Incidence: 1 in 12 women of reproductive age

21
Q

How do you diagnose polycystic ovarian syndrome?

A

For a diagnosis: two of the following features are required:

  • polycystic ovaries on USS
  • oligo- / anovulation
  • clinical / biochemical androgen excess
22
Q

What is the relationship between PCOS and risk of CVS disease and diabetis

A

PCOS are associated with increased risk in diabetis and CVS disease

23
Q

What are the clinical features of PCOS?

A
  • Hirsuitism
  • Menstrual cycle disturbance
  • Increased BMI
24
Q

How would you treat PCOS?

A

Metformin

  • decreased testosterone production

Clomiphene

  • Is anti-oestrogenic in the hypothalamo-pituitary axis
  • –> blocks negative feedback thereby increaseing GnRH levels + levels of gonadotrophins

Gonadotrophin therapy as part of IVF treatment

25
Q

What is Clomiphene?

What is it used for?

A

Is anti-oestrogenic in the hypothalamo-pituitary axis

–> blocks negative feedback thereby increaseing GnRH levels + levels of gonadotrophins

26
Q

Explain the (off-label) use of Metformin in PCOS

A

It probably reduces androgen production

27
Q

What are the causes for Hyperprolactinaemia?

A
  1. Dopamine antagonist drugs
    • Anti-emetics (metoclopramide)
    • Anti-psychotics (phenothiazines)
  2. Prolactinoma
  3. Stalk compression due to pituitary adenoma
  4. PCOS
  5. Hypothyroidism
  6. Oestrogens (OCP), pregnancy, lactation,

Idiopathic

28
Q

Explain the role of the Thyroid in fertiltiy

A

Hypothyroidism might be a cause of infertility because

  • Low T3/T4 –> no -ve feedback–>
  • high TSH levels
  • TSH has a stimmulating effect of prolactin release
  • Prolactine has a inhibitory effect on GnRH and LH/FSH
29
Q

What are the clinical features of somone with a hyperprolactinaemia?

A

Galactorrhoea

Reduced GnRH secretion / LH action >> hypogonadism

In a Prolactinoma:

  • Headache
  • Visual field defect
30
Q

How would you treat someone with hyperprolactinaemia?

A

Treat the cause – stop drugs

Dopamine agonist

  • Bromocriptine
  • Cabergoline

Prolactinoma

  • Dopamine agonist therapy (-ve feedback)
  • Pituitary surgery rarely needed
31
Q

Explain the production of female sex hormones and controll in the Hypothalamo/Pit Axis

A
32
Q

What are the expected hormonal changes with PCOS?

A
  • increase in androgens
  • increase in LH
  • (reduction in FSH)

Year 2 LCRS Endocrinology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions