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Part 1 MFSRH 2024 > Endocrinology & Adolescent Gynaecology > Flashcards

Endocrinology & Adolescent Gynaecology Flashcards

1
Q

Which dopamine agonists may be used to inhibit milk production, and which receptors do they act on?

A

Cabergoline + bromocriptine

Both act on D2 receptors

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2
Q

In what proportion of children does delayed puberty occur?

A

3%

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3
Q

What are 2 recognised galactagogues (stimulators of milk production)?

A
  1. Domperidone
  2. Metoclopramide
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4
Q

What is the predominant oestrogen during female reproductive years?

A

Estradiol (except in the early follicular phase when estrone predominantes)

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5
Q

What is the predominant oestrogen during pregnancy?

A

Estriol

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6
Q

Which drugs can cause an increased prolactin?

A

Opiates
H2 antagonists e.g. Ranitidine
SSRI’s e.g. Fluoxetine
Verapamil
Atenolol
Some antipsychotics e.g risperidone and haloperidol
Amitriptyline
Methyldopa

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7
Q

How may hyperprolactinaemia alter periods?

A

Menorrhagia

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8
Q

What are the ratios of testosterone free:albumin-bound:SHBG-bound?

A

1% free: 19% albumin-bound: 80% SHBG-bound

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9
Q

Which cells are responsible for androgen production in the ovary?

A

Theca cells

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10
Q

What hormone stimulates theca cells?

A

LH

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11
Q

Which cell are responsible for aromatisation of androgens into oestrogen?

A

Granulosa cells

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12
Q

What is leptin release from adipose tissue stimulated by?

A

Glucocorticoids
High BMI
Long-term hyperinsulinaemia
Excessive food ingestion

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13
Q

What is the most common cause of delayed puberty?

A

Constitutional delay

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14
Q

What is the definition of puberty in women?

A

Physical maturation whereby the women becomes capable of sexual reproduction

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15
Q

What is the lifespan of the corpus luteum?

A

14 days

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16
Q

How many hours after the LH surge does ovulation occur?

A

24-36 hours

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17
Q

During pregnancy, from where is bHG produced?

A

Syncytiotrophoblast

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18
Q

At what gestation does the fetal endocrinological system become fully active?

A

10/40

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19
Q

What tumour marker is used for granulosa cell tumours?

A

Inhibin

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20
Q

When does the corpus luteum cease to be essential in maintaining a pregnancy?

A

6/40

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21
Q

What are the physiological effects of progesterone?

A
  1. Increased respiratory drive
  2. Reduced bowel motility
  3. Increased basal body temperature
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22
Q

What endocrinological manifestation gives rise to the clinical manifestation of PCOS?

A

Elevated insulin - it is thought to be the insulin that stimulates androgen secretion

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23
Q

What are the stages of female puberty (and order)?

A

Growth spurt —>
Thelarche (breast development) —>
Adrenarche (pubic hair development) —>
Menarche

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24
Q

At what age is menarche considered precocious puberty?

A

If occurs prior to age 10

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25
Q

How frequently does GnRH pulse?

A

Every 90 minutes

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26
Q

What is the action of PTH on bone?

A

Stimulate osteoclasts, increasing bone resorption and therefore release of calcium

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27
Q

What is the action of PTH on kidneys?

A

Enhances resorption of calcium and magnesium from the distal tubule
Increases excretion of phosphate

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28
Q

What is the action of PTH on intestine?

A

Increases absorption of calcium by increasing vit D production

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29
Q

When does the fetus begin to produce PTH?

A

Week 12

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30
Q

What happens to maternal PTH/calcitonin level in pregnancy?

A

PTH reduced and calcitonin increased in order to maintain increased calcium transfer to the fetus - the fetus being relatively hypercalcaemic to the mother

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31
Q

Which hormones are secreted by the placenta?

A
  1. hCG
  2. Oestrogen
  3. Progesterone
  4. Relaxin
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32
Q

When does the first cleavage division of the fertilised egg take place?

A

Approx. 30 hours after fertilisation

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33
Q

At what cell stage does the embryo enter the uterus from the fallopian tube?

A

8 cell stage

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34
Q

What are the characteristics of trophoblast cells?

A
  1. Paternal X chromosome inactivation
  2. Unmethylated DNA
  3. Ability to form multi-nucleated cells
  4. Variable expression of MHC1, no MHC2 antigen expression
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35
Q

What are the functions of the trophoblast cells?

A
  1. Attachment of the placenta to the uterine wall
  2. Transport of nutrients and maternal Ig’s
  3. Elimination of fetal waste
  4. Synthesis/secretion of hormones
  5. Barrier between maternal and fetal circulations
  6. Contact between maternal immune system and conceptus
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36
Q

What are the three stages of implantation?

A
  1. Apposition - when decidualisation takes place
  2. Adhesion - when the zona pellucida is destroyed
  3. Penetration - the trophoblast produces metalloproteases that digest the ECM, facilitating trophoblast invasion into the uterine decidua
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37
Q

What are the 2 layers of trophoblast?

A

Outer syncytiotrophoblast - where cellular walls are largely lost
Inner cytotrophoblast - where cell remain recognisibly individual

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38
Q

How many lobules are there to each placenta?

A

200

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39
Q

What does each placental lobule contain?

A

A single primary stem villus

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40
Q

Until when does the placenta exceed the weight of the fetus?

A

Week 17

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41
Q

In humans, where does the placental trophoblast encounter the maternal immune system?

A
  1. The villous syncytiotrophoblast is bathed in maternal bloods
  2. The extravillous cytotrophoblast interacts with uterine tissue
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42
Q

How many ml of amniotic fluid is present at 8 weeks

A

15ml

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43
Q

Where is the amnion situated?

A

Between the inner cell mass and the trophoblast (the chorion)

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44
Q

How many layers are there to the amnion?

A
  1. Cuboidal epithelium
  2. Basement membrane
  3. Compact layer
  4. Fibroblast layer
  5. Spongy layer of mucoid reticular tissue (remnant of extraembryonic coelom)
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45
Q

How many cells thick is the trophoblast layer?

A

2-10 cells thick

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46
Q

How many layers are there in the chorion?

A
  1. Fibroblasts
  2. Reticular layer
  3. Basement membrane
  4. Trophoblast layer
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47
Q

What hormones are hCG structurally similar to?

A

LH
FSH
TSH

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48
Q

What is it that makes hCG, LH, FSH and TSH structurally similar?

A

They share an ALPHA subunit
The beta subunit varies between them

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49
Q

What type of hormones are LH and FSH?

A

Glycoprotein hormones

50
Q

At what gestation does hCG peak?

A

Week 12

51
Q

What are the divisions of the anterior pituitary?

A

Pars distalis

Pars tuberalis

52
Q

What are the divisions of the posterior pituitary?

A

Pars nervosa
Infundibular stalk/infundibulum
Median eminence

53
Q

What are the three types of hypothalamic neurosecretory cells?

A

Magnocellular neurons - release AVP or oxytocin

Hypophysiotropic neurons - release TRH, CRH, somatostatin, GHRH, GnRH and dopamine

Projection neurons

54
Q

What is another name for the anterior pituitary?

A

Adenohypophysis

55
Q

What is another name for the posterior pituitary?

A

Neurohypophysis

56
Q

What are the cell types of the adenohypophysis?

A

Acidophils
Basophils
Chromophobes

57
Q

Which nuclei are magnocellular neurons found in?

A

Supraoptic or paraventricular nuclei

58
Q

Which nuclei are hypophysiotropic neurons found in?

A

Paraventricular and arcuate nuclei

59
Q

Which nuclei are projection neurons found in?

A

Paraventricular and arcuate nuclei

60
Q

What is the embryological origin of the anterior pituitary?

A

Rathke pouch - an evagination of ectodermal cells of the oropharynx in the primitive gut

61
Q

At what gestation does the anterior pituitary become recognisable?

A

Weeks 4-5

62
Q

What is the embryological origin of the posterior pituitary?

A

Neural crest cells

63
Q

From what cell type are FSH and LH secreted?

A

Gonadotrophs

64
Q

What is the earliest sign of puberty in boys?

A

An increase in testicular volume by 4ml, or 2.5cm

65
Q

When is puberty considered precocious?

A

In girls, before the age of 8

In boys, before the age of 9

66
Q

What is SHBG?

A

A serum glycoprotein that binds to androgens and oestrogens

Hormones must be unbound (free) to function; if SHBG levels are high, there will be less free hormone to function

67
Q

Where is SHBG synthesised?

A

By the liver (primarily), brain, uterus, testes and placenta

68
Q

Is SHBG binding affinity higher for androgens or oestrogens?

A

Androgens

69
Q

What is the binding affinity - in order of strength - of SHBG?

A

Dihydrotestosterone
Testosterone
Androstenediol
Oestradiol
Oestrone

70
Q

What causes increased SHBG?

A
  1. OCP (oestrogens)
  2. Pregnancy (oestrogens)
  3. Hyperthyroidism
  4. Liver cirrhosis
  5. Anorexia
  6. AEDs
71
Q

What causes decreased SHBG?

A
  1. Androgens
  2. PCOS
  3. Hypothyroidism
  4. Obesity
  5. Cushing’s
  6. Acromegaly
72
Q

Is SHBG higher in men or women?

A

Women

This prevents systemic exposure to androgens which cause masculinisation

Approximately 69% of circulating oestrogen is bound to SHBG, 30% to albumin leaving the remainder ‘free’

73
Q

Where in females are androgens produced?

A

Ovary = 25%
Adrenal glands = 25%
Peripheral conversion of androstenedione = 50%

74
Q

Which is the most active oestrogen of the natural oestrogens?

A

Oestradiol

75
Q

In what form does the kidney excrete oestrogen?

A

Oestriol glucuronide

76
Q

Where in the body is progesterone stored?

A

Adipose tissue

77
Q

In plasma what does progesterone bind to?

A

Corticosteroid-binding globulin - CBG

Albumin

78
Q

What are the pre-ovulatory levels of progesterone?

A

<2ng/ml

79
Q

What are the post-ovulatory levels of progesterone?

A

5ng/ml

80
Q

What is the term level of progesterone?

A

100-250ng/ml

81
Q

At term how much progesterone is produced by the placenta?

A

250mg/day

82
Q

What inhibits lactation, and prevent uterine contraction until term?

A

Progesterone

83
Q

What hormones are produced in the arcuate nuclei of the hypothalamus?

A

Dopamine and GnRH

84
Q

Where are the only place FSH receptors are found?

A

Granulosa cells

85
Q

Which hormone is responsible for resumption of meiosis by the oocyte?

A

LH

86
Q

What are the physiological causes of hyperprolactinaemia?

A

Pregnancy
Lactation
Exercise
Stress

87
Q

What are the pharmacological causes of hyperprolactinaemia

A

TRH
Oesotrogen
Dopamine antagonists
Verapamil
Cimetidine

88
Q

What are the pathological causes of hyperprolactinaemia?

A

Pituitary tumour
Chest wall lesions
Spinal cord lesions
Liver failure
Chronic renal failure

89
Q

When does adrenal androgen production begin in males/females?

A

Males = 7-9 years old
Females = 6-7 years old

90
Q

When does the growth spurt in boys begin relative to girls?

A

2 years later

91
Q

When is the bone mineralization in boys/girls respectively?

A

Boys = 17.5 years old
Girls = 14-16 years old

92
Q

Which tumours secrete hCG

A

Choriocarcinoma
Germ cell tumour
Hydatiform mole

93
Q

When do menses return after pregnancy?

A

Breastfeeding women = 28 weeks postpartum

Non-breast feeding women = 9 weeks postpartum

94
Q

When does steroidogenesis start in the fetus?

A

7 weeks

95
Q

When are the testes seen in the fetus?

A

6 weeks

96
Q

When are the ovaries seen in the fetus?

A

7-8 weeks

97
Q

When does testosterone production begin in the fetus?

A

10 weeks

98
Q

When does oestrogen production begin in the fetus?

A

20 weeks

99
Q

In what form does the kidney excrete progesterone?

A

Pregnanediol glucuronide

100
Q

How does the LH surge at ovulation cause rupture of the mature oocyte?

A

Acts on theca externa

101
Q

Activation of what causes puberty?

A

Activation of the HPG axis

102
Q

What changes to the HPG axis occur as puberty progresses

A
  • Before the onset of puberty, GnRH release is inhibited by neurotransmitters such as GABA and neuropeptide-Y
  • Puberty begins when central GnRH inhibitory mechanisms decline; the exact mechanism behind this is poorly understood
  • Neurotransmitters implicated include glutamate, kisspeptin and leptin
  • Nocturnal GnRH pulse frequency increases first, leading to FSH release and the development of ovarian follicles
  • As puberty progresses, GnRH pulsatility extends to day time release as well; diurnal variation is eventually lost
  • GnRH receptors also become more sensitive
  • Increasing ovarian follicular activity results in oestrogen synthesis and development of sexual secondary characteristics
103
Q

What neurotransmitters are implicated in the activation of GnRH release at the onset of puberty?

A

Glutamate, kisspeptin and leptin

104
Q

Does GnRH release begin nocturnally or in the daytime at the onset of puberty?

A

Nocturnally

105
Q

Pre-puberty, what are the relative LH / FSH levels?

A

FSH>LH

106
Q

At puberty, what are the relative LH / FSH levels?

A

LH>FSH

107
Q

When does ovulation occur in puberty?

A

During early puberty, LH levels are insufficient to cause ovulation; the majority of cycles are therefore anovulatory

By 4-5 years post menarche, LH surges achieve dominant follicle rupture; the majority of cycles are ovulatory (>80%)

108
Q

Which Tanner stage marks the beguinning of puberty?

A

Tanner stage 2
Boys = testicular volume >3mls
Girls = breast bud development

109
Q

When is puberty considered delayed in boys?

A

Absence of testicular enlargement (<4mls) by age 14

110
Q

When is puberty considered delayed in girls?

A

Absence of breast bud development by age 13

111
Q

When is secondary referral required for girls with amenorrhoea?

A

Age ≥13 with absent menstruation and no secondary sexual characteristics

Age ≥15 and absent menstruation and with normal secondary sexual characteristics

112
Q

How is leptin related to puberty?

A
  • Leptin is believed to be one of the hormones associated with activating the HPG axis during puberty
  • Leptin is a protein hormone released by adipocytes
  • Some studies suggest a minimum body weight of around 47 kg is required to activate puberty
  • This may explain why girls with a higher body mass start experience menarche at an earlier age
  • Girls with low body mass (and therefore low leptin levels) often experience anovulatory cycles and a delay in menarche onset
113
Q

What is the average age of menarche in the UK?

A

12

114
Q

What many amenorrhoea, but cyclical pelvic pain suggest?

A

Haematocolpos, caused by a genital tract malformation

115
Q

What are the possible causes of hypothalamic dysfunction that may cause amenorrhoea?

A

Stress
Depression
Weight loss
Level of exercise
Chronic systemic illness

116
Q

What cause of amenorrhoea is associated with anosmia?

A

Kallman syndrome

117
Q

What are the signs of virilisation, that may indicate an androgen-secreting tumour as a cause of amenorrhoea?

A

Clitoromegaly
Hirsutism

118
Q

What are the clinical features of decreased endogenous oestroegn?

A

Reddened or thin vaginal mucosa
Breast development is a good marker for ovarian oestrogen production

119
Q

What are the clinical features of androgen insensitivity?

A

Absence of axillary and pubic hair with normal breast development
Testes may be palpable in the inguinal canal or labia

120
Q

What do high levels of testosterone warrent investigation for?

A

Androgen insensitivity (46XY genotype, female phenotype)
Late-onset congenital adrenal hyperplasia
Cushing’s syndrome
Androgen-secreting tumour
(moderate increase seen in PCOS)

Part 1 MFSRH 2024 (20 decks)

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