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Endocrine > Endocrinology of reproductive system > Flashcards

Endocrinology of reproductive system Flashcards

1
Q

Where is FSH produced and what is it’s function?

A

follicle stimulating hormone
produced in anterior pituitary gland
acts on granulosa cells of ovary to stimulate follicle development

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2
Q

Where is LH produced and what is it’s function?

A

luteinising hormone
produced in anterior pituitary gland
acts on theca cells in ovary to cause ovulation

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3
Q

Where is oestrogen produced and what is it’s function?

A

produced in follicle in response to FSH
stimulates endometrial proliferation
responsible for development of secondary sexual characteristics

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4
Q

Where is progesterone produced and what is it’s function?

A

produced by granulosa cells in response to LH surge
triggers endometrial transition to secretory phase ie thickening of endometrium in preparation for implantation of fertilised egg

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5
Q

What happens in the follicular phase of the menstrual cycle?

A

FSH stimulates growth of several follicles
dominant follicle secretes oestrogen
oestrogen inhibits growth of other follicles and FSH
oestrogen stimulates development of endometrium

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6
Q

What happens in ovulation?

A

surge in LH causes ovulation (egg release)
rupturing of follicle creates a corpus luteum

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7
Q

What happens in the luteal phase of the menstrual cycle?

A

corpus luteum secretes progesterone (and oestrogen)
progesterone stimulates development of endometrium
oestrogen and progesterone inhibit FSH and LH
corpus luteum degrades over time
when corpus luteum degrades, progesterone levels drop
without progesterone, endometrium cannot be maintained
endometrium is sloughed away (menstruation)
no longer inhibited, FSH can start menstrual cycle again

if fertilisation of egg occurs, the zygote releases a hormone (hCG) which maintains the corpus luteum

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8
Q

Common presenting features of reproductive endocrine conditions in women

A

oligo/amenorrhoea
infertility
hirsutism
virilisation (male physical characteristics in a woman)
hot flushes, night sweats
galactorrhoea

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9
Q

Define primary amenorrhoea

A

no periods by 16

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10
Q

Define secondary amenorrhoea

A

no periods for >6 months in a woman who has previously had a period

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11
Q

Define oligomenorrhoea

A

<9 periods in a year

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12
Q

Define infertility

A

failure of pregnancy after 1 year of regular unprotected intercourse

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13
Q

Physiological amenorrhoea causes

A

pre-pubertal
pregnancy
lactation
menopause

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14
Q

Primary amenorrhoea causes

A

chromosomal (eg. Turner’s)
hypothalamic-pituitary failure
vaginal outflow tract and uterine disorders

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15
Q

Secondary amenorrhoea causes

A

ovarian - PCOS, primary ovarian failure

hypothalamic - weight loss, excessive exercise, stress, craniopharyngioma, hypothalamic lesions

pituitary - hyperprolactinaemia, hypopituitarism

uterine -intrauterine adhesions, Asherman’s syndrome

other endocrine disorders - thyroid dysfunction, Cushing’s, congenital adrenal hyperplasia

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16
Q

What are the 3 male reproductive hormones?

A

follicle stimulating hormone
luteinising hormone
testosterone

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17
Q

FSH function in men

A

stimulates sperm development

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18
Q

LH function in men

A

acts on interstitial cells (Leydig cells) to secrete testosterone

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19
Q

Testosterone function in men

A

promotes sperm development and development of secondary sex characteristics

20
Q

Testosterone target organs and function

A

skin - facial + body hair growth, supports collagen

male sex organs - sperm production, prostate growth, erectile dysfunction

muscle - muscle mass and strength

brain - sex drive, positive feelings, aids cognition and memory

bone marrow - red blood cell production

bone - bone density maintenance

21
Q

Common presenting features of reproductive endocrine conditions in men

A

absence or regression of secondary sexual characteristics

sexual dysfunction (erectile dysfunction, reduced libido, difficulty attaining orgasm + reduced ejaculate)

reduced energy, muscle wasting, reduced bone mass, osteoporosis

infertility

22
Q

Primary hypogonadism hormone levels (men)

A

high FSH, LH
low Testosterone

23
Q

Secondary hypogonadism hormone levels (men)

A

low FSH, LH
low testosterone

24
Q

What is primary hypogonadism?

A

testicular failure

25
Q

Primary hypogonadism causes

A

congenital
acquired - testicular trauma, surgical removal, chemo, infection
complication of illness - diabetes, CKD, haemochromatosis, liver cirrhosis

26
Q

Secondary hypogonadism causes

A

Kallmann syndrome
Idiopathic hypogonadotrophic hypoginadism
functional - exercise, weight loss, stress, recreational drugs, anabolic steroids

structural - tumours, infiltration, head trauma, radiotherapy, pituitary surgery

miscellaneous - congenital adrenal hypoplasia, Prader willi syndrome

27
Q

Define puberty

A

period of transition between childhood and adulthood characterised by:
- development of secondary sexual characteristics
- gonadal maturation
- attainment of reproductive capacity

28
Q

Describe Tanner staging

A

also known as sexual maturity rating (SMR)
objective classification system used for tracking the development and sequence of secondary sexual characteristics of children during puberty

29
Q

What causes Turner syndrome

A

complete (45XO) or partial (46XX/45XO) absence of one X chromosome (monosomy)

30
Q

Turner syndrome symptoms

A

low set ears
short stature
webbed neck
micrognathia
widely spaced nipples
cubitus valgus
primary amenorrhoea
congenital heart defects (coarctation of aorta)
hypothyroidism
osteoporosis
lymphoedema
congenital renal abnormalities
hearing defects

31
Q

What is Klinefelter syndrome?

A

karyotype 47XXY
nondisjunction mutation resulting in an extra X chromosome

32
Q

Clinical symptoms Klinefelter syndrome

A

tall stature (long legs)
gynaecomastia
small, firm testes
signs of hypogonadism
sparse beard growth
loss of libido
erectile dysfunction
osteoporosis
infertilirt

33
Q

Klinefelter syndrome psychosocial problems

A

limited verbal development
attention deficit
learning difficulties
social maladjustment

34
Q

Klinefelter syndrome treatment

A

lifelong androgen replacement

35
Q

What is Kallmann’s syndrome?

A

form of hypogonadotrophic hypogonadism
low FSH/LH
low oestrogen/testosterone
failure of episodic GnRH secretion with anosmia

36
Q

Kallmann’s syndrome treatment

A

hormonal replacement therapy to induce puberty, and later, fertility

37
Q

Pathophysiology of PCOS

A

strong genetic basis
altered GnRH pulse frequency in hypothalamus
increased production of androgens by ovaries

insulin resistance - drives ovarian androgen production

38
Q

PCOS diagnosis

A

2/3 of:
- oligo/amenorrhoea
- hyperandrogenism
- polycystic ovaries on USS

39
Q

PCOS management

A

hirsutism - vaniqua, COCP, spironalactone, cyproterone

oligo/amenorrhoea - weight loss, progesterone, metformin, COCP

subfertility - weight loss, metformin, clomiphene

insulin resistance/IGT - weight loss, orlistat

40
Q

When is testosterone testing indicated in men?

A

height loss, low trauma fracture, confirmed low bone mineral density

hot flushes/sweats

gynaecomastia

incomplete/delayed sexual development

reduced libido

decreased spontaneous erections

loss of body hair, reduced shaving

<5ml or shrinking testes

low or zero sperm count

41
Q

When is testosterone therapy contraindicated?

A

haematocrit >52%
actively seeking fertility
uncontrolled heart failure
untreated severe obstructive sleep apnoea

42
Q

Why are patients with Turner’s syndrome at risk of osteoporosis?

A

oestrogen is bone-protective

43
Q

What skin condition is a sign of insulin resistance?

A

acanthosis nigricans

44
Q

Biochemistry results for a patient with PCOS

A

high LH/FSH ratio
low SHBG (sex hormone binding globulin)
high testosterone
high DHEAS (dehydroepiandrosterone sulfate - male sex hormone found in men and women)
high triglycerides + cholesterol

45
Q

What hormone is bone-protective in men?

A

testosterone

46
Q

How and when should bloods be monitored when a patient is taking testosterone?

A

monitor bloods after 4 weeks
testosterone, Hb, Hct, LFTs
want to hit mid range of T
can cause haematocrit to rise - if this happens you lower dose whether T is in the right range or not due to clot risk

47
Q

Why should a patient actively seeking fertility not start testosterone treatment?

A

giving testosterone causes FSH to be turned off, so no sperm can be produced

Endocrine (21 decks)

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