Endocrine infertility Flashcards
What is the main control pathaway of sex hormones?
Hypothal GnRH -> Pit (LH/FSH) -> testes/ ovaries for Testo, Progest, Oestrogen
In Female, rememember 3 phases-follicular is like menm
Ovulation, positive feedback of oestradiol on hypothalamus, and then shedding-porgesterone rise
What are the levels of hormones found in gonad disroders
Can be caused by hypopituarism or Kallmans syndrome (low GnRH)
Hypo-primary gonadal failure-HIGH LH FSH, low androgens
secondary/terti gonadal failure-LH and FSH low, low androgens (cant measure GnRH
What are the main causes of male Hypogonadism?
Can be caused by hypopit, Kallmans syndrome (anosmia and low GnRH (genetic), Illness, Underweight, Primary gonadal disease (kleinfesters, Testicular torsionm Chemotherapy)-Hyperprolactinaemia, ANdrogen receptor deficiency (rare)
What are the main investigations for male hypogonadism?
Check hormones-
If all Low-MRI Pit, if only some-find issue
Prolactin levels
Sperm Count (absence (zoospermia or Oligospermia (less)
DNA test
What are the treatments for Male hypogonadism>
If not looking for baby-just replace the homrone missing
If want baby and Hypo/pit baby-replace both gonadotrophin
For Hyperprolactinemea-dopamine agonist
What are the main roles of testosterones in men
develop male genital tract, maintain feritlity in adulthood, control secondary sexual char, Anabolic effects (grow bone, muscle)
98% of testo protein bound
What are the different fates of testo after production?
98% bound
Either becomes duhydrotestosterone, which acts via androgen receptor
Or can become 17b Oestradiol
What are the clinical uses of Testosterone?
If hypogonadal, help restore body badd, muscle size, libido and potency
BUT not restore ferility if pit/hypo disease, or not producing sperm
What are the 3 priamry disorders in female (in the lecture)
Amenorrhoae, Polycystic ovarian syndrom and prolactinaemia
What is are the different Amenorrhoae?
Primary-failure to ever have any, secondary-absence for 3 months, but has had before.
Oligo-irregular long cycles
ps: Periods are rarely relly 28 days. usually 25-35
What are the main causes of amenorrhoae?
Pregnancy!!
Ovarian failure-PRemature ovarian insuficiency, Ovariectomy/chemo, ovarian dysgenesis (like turners)
Gonadotrophin failure-Hypo/PIt, Kallmans syndrome, Low BMI, post pill
Hyperprolactinaemia
Androgen excess-gonadal tumour
What are the main examinations for amenorrhoae?
Pregancy test, LH, FSH, Oestradiol
DAy 21 progesterone-should pick up the rise if ovulating normally
Prolactin
Androgens (testi), Chromosome, Ultrasound scan ovaries
What are the main treatments of amenorrhoae?
Mainly treat the cause-(like low BMI)
If primary ovarian failure-infertile, HRT
If hypothalamic/pit - HRT (for fertility, gonadotrophins, part of IVF treatment)
What are the Clinical signs of Polycysteic ovarian syndrome?
Hirsutism (male like), Menstrual cycle distrubance, Increased BMI
But very poorly understood, associated with higher BMI and CVD risks
Polycystic ovariaes of USS, Oligoovulation, Clinical biochemical androgen excess
What are the treatments for PCOS?
Metformin
Clomiphene-anti oestogenic in the Hypo/Pit axis (blick pit-like kickstart period)
Gonadotrophin therapy
