Endocrinology of Pregnancy Flashcards
gestational diabetes mx
pre-pregnancy counselling, folic acid (5mg), lifestyle, metformin +/- insulin
how many weeks postpartum do you check fasting glucose or do a GTT on gestational diabetic mum
6 weeks, if +ve consider T2DM
hypothyroid mums should have their thyroxine doses inc by…
25mg - aim is TSH <3mU/l
hyperthyroidism in pregnancy- why does it occur
HCG in thyroxine levels
when does HCG related hyperthyroidism usually subside
20weeks gestation
which rx do you give pregnant hypothyroid mum
low dose PCU 1st semester of pregnancy, carbimazole later in pregnancy
post partum thyroiditis
transient hyperthyroidism followed by hypothyroidism at 3 months- associated to postpartum depression
what are the 3 general causes of infertility
hypothalamic: excessive exercise
pituitary: tumours
ovarian: PCOS
mx for infertility
lifestyle: stop smoking
rx: pulsatile GnRH, FSH/LH
surgery: aim is to enhance IVF outcome- pelvic adhesions etc
what is male hypogonadism
testosterone deficiency
types of hypogonadism
1y- testes affected
2y- hypothalmic/pituitary pathology
1y hypogonadism is known as ______ and is because…
hypergonadotrophic hypogonadism- dec testosterone so dec -ve feedback resulting in high LH/FSH secretion
2y hypogonadism is known as ____ and is because…
hypogonadotrophic hypogonadism- testes work so problem lies with GnRH secretion from H or LH/FSH from P
what are 2 causes of hypergonadotrophic hypogonadism
Klinefelter’s syndrome (47 chromosomes + 3 sex chromosomes), cryptochondrism
what are 2 causes of hypogonadotrophic hypogonadism
Kallman’s syndrome (GnRH def, diminished smell, colour blindness and cleft lip), acquired pituitary damage
s/s of hypogonadism
pre-pubertal: small size genitalia, non-broken voice, dec body hair, low libido, gynaecomastia, eunichoidal habits body type
post-pubertal: same but normal sexual organs
ix for hypogonadism
measure early morning testosterone, if +ve measure LH/FSH
high LH/FSH: 1y
low LH/FSH: 2y
mx for hypogonadism
testosterone replacement: nebido, sustanon
groups of ovulation disorders
G1: stress, exercise etc
G2: PCOS*
G3: menopausal, chemo
s/s of ovulation disorders
oligomenorrhoea (<8 periods in a year), amenorrhea
ix for ovulation disorders
progesterone challenge test: bleed 7-10 days after= oestrogen levels ok
bloods, imaging
what is the classification for PCOS
rotterdam classification
mx of ovulation disorders
optimise pre-tx
G1: rx-GnRH, gonadotrophin injection
G2: PCOS- ovulation induction
G3: hormone replacement therapy
what can occur as a result of ovarian overstimulation
multiple pregnancies