Endocrinology of Pregnancy

Question 1

gestational diabetes mx

Answer 1

pre-pregnancy counselling, folic acid (5mg), lifestyle, metformin +/- insulin

Question 2

how many weeks postpartum do you check fasting glucose or do a GTT on gestational diabetic mum

Answer 2

6 weeks, if +ve consider T2DM

Question 3

hypothyroid mums should have their thyroxine doses inc by…

Answer 3

25mg - aim is TSH <3mU/l

Question 4

hyperthyroidism in pregnancy- why does it occur

Answer 4

HCG in thyroxine levels

Question 5

when does HCG related hyperthyroidism usually subside

Answer 5

20weeks gestation

Question 6

which rx do you give pregnant hypothyroid mum

Answer 6

low dose PCU 1st semester of pregnancy, carbimazole later in pregnancy

Question 7

post partum thyroiditis

Answer 7

transient hyperthyroidism followed by hypothyroidism at 3 months- associated to postpartum depression

Question 8

what are the 3 general causes of infertility

Answer 8

hypothalamic: excessive exercise
pituitary: tumours
ovarian: PCOS

Question 9

mx for infertility

Answer 9

lifestyle: stop smoking
rx: pulsatile GnRH, FSH/LH
surgery: aim is to enhance IVF outcome- pelvic adhesions etc

Question 10

what is male hypogonadism

Answer 10

testosterone deficiency

Question 11

types of hypogonadism

Answer 11

1y- testes affected

2y- hypothalmic/pituitary pathology

Question 12

1y hypogonadism is known as ______ and is because…

Answer 12

hypergonadotrophic hypogonadism- dec testosterone so dec -ve feedback resulting in high LH/FSH secretion

Question 13

2y hypogonadism is known as ____ and is because…

Answer 13

hypogonadotrophic hypogonadism- testes work so problem lies with GnRH secretion from H or LH/FSH from P

Question 14

what are 2 causes of hypergonadotrophic hypogonadism

Answer 14

Klinefelter’s syndrome (47 chromosomes + 3 sex chromosomes), cryptochondrism

Question 15

what are 2 causes of hypogonadotrophic hypogonadism

Answer 15

Kallman’s syndrome (GnRH def, diminished smell, colour blindness and cleft lip), acquired pituitary damage

Question 16

s/s of hypogonadism

Answer 16

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

Question 17

ix for hypogonadism

Answer 17

measure early morning testosterone, if +ve measure LH/FSH

high LH/FSH: 1y
low LH/FSH: 2y

Question 18

mx for hypogonadism

Answer 18

testosterone replacement: nebido, sustanon

Question 19

groups of ovulation disorders

Answer 19

G1: stress, exercise etc
G2: PCOS*
G3: menopausal, chemo

Question 20

s/s of ovulation disorders

Answer 20

oligomenorrhoea (<8 periods in a year), amenorrhea

Question 21

ix for ovulation disorders

Answer 21

progesterone challenge test: bleed 7-10 days after= oestrogen levels ok

bloods, imaging

Question 22

what is the classification for PCOS

Answer 22

rotterdam classification

Question 23

mx of ovulation disorders

Answer 23

optimise pre-tx
G1: rx-GnRH, gonadotrophin injection

G2: PCOS- ovulation induction

G3: hormone replacement therapy

Question 24

what can occur as a result of ovarian overstimulation

Answer 24

multiple pregnancies