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3D week 2 - Hormones > endocrinology of the reproductive system > Flashcards

endocrinology of the reproductive system Flashcards

1
Q

hypothalamus-pituitary-ovarian axis

A

Hypothalamus -> GnRH -> LH and FSH released (ant pit gland) -> oestrogen + progesterone release (from ovaries) -> negative feed back to down regulate hormone production from hypothal + ant.pit

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2
Q

what are the 4 female reproductive hormones

A
  1. follicle stimulating hormone
  2. lutenizing hormone
  3. oestrogen
  4. progesterone
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3
Q

where is FSH produced and what does it act on in women?

A
  1. produced in the anterior pit gland
  2. acts on granulosa cells of ovary to stimulate follicle development
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4
Q

where is LH produced and what does it act on in women?

A
  1. produced in the anterior pit gland
  2. acts in Theca cells in overy to cause ovulation
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5
Q

where is oestrogen produced and what does it do?

A
  1. produced by follicle in response to FSH
  2. stimulates endometrial proliferation
  3. responsible for development of secondary sex characteristics
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6
Q

where is progesterone produced and what does it do?

A
  1. produced in granulosa cells in response to LH surge
  2. triggers endometrial transiion to secretory phase (i.e. thickening of endometrium in preparation for implantation of fertilized egg)
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7
Q

what happens in the follicular phase of the menstrual cycle (4)

A
  1. FSH stimulates growth of several follicles
  2. dominant follicle secrete oestrogen
  3. oestrogen inhibits growth of other follicles and FSH
  4. oestrogen stimulates development of endometrium
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8
Q

draw out the menstrual cycle graph

A

see lect notes

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9
Q

what happens in the ovulation phase of the menstrual cycle (2)

A
  1. surge in LH causes ovulation
  2. rupturing of the follicle creates a corpus luteum
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10
Q

what happens in the luteal phase of the menstrual cycle (8)

A
  1. corpus luteum secretes progesterone and oestrogen
  2. progesterone stimulates develpment of endometrium
  3. oestrogen and progesterone inhibit FSH/LH secretion
  4. corpus luteum degrades over tume, progesterone levels drop
  5. endometrium cannot be maintained without progestrone
  6. endometrium is sloughed away (mestruation)
  7. FSH is no longer inhibited and the menstrual cycle starts again
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11
Q

what hormone is released if fertilisation of the egg occurs and why

A

Human chorionic gonadotropin (hCG) -> maintains the corpus luteum

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12
Q

what is oliogmenorrhoea

A

<9 periods in a yearwh

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13
Q

what is amenorrhea

A

primary amenorrhoea - no periods by the age of 16
secondary amenorrhoea - no periods for >6 months in a women who has previously had a period

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14
Q

infertility definition

A

failure of pregnancy after 1 year of regular unprotected intercourse

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15
Q

what is hirsutism

A

presence of excessive terminal hair in androgen dependent areas of a womans body (mustache and beard, buttocks etc.)

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16
Q

what is virlilisation

A

male physical characteristics (muscle bulk, body hair, deep voice etc.) in a female

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17
Q

6 common presenting features of reproductive endocrine conditions in women

A
  1. oligo/amenorrhoea
  2. infertility
  3. hirstuism
  4. virilisation
  5. hot flushes/nigh sweats
  6. galactorrhoea (milk production from the breast unrelated to pregnancy or lactation)
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18
Q

3 physiological causes for amenorrhoea

A
  1. pre-pubertal
  2. pregnancy + lactation
  3. menopause
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19
Q

4 causes of primary amenorrhoea

A
  1. chromosomal (turner’s syndrome)
  2. hypothalamic pituitary failure (Kallman’s syndrome/pituritary disease)
  3. vaginal outflow tract and uterine disorders (congentical absence of vagina/uterus etc.)
  4. other (androgen insensitivity syndrome, congenital adrenal hyperplasia etc.)
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20
Q

5 causes of secondary ammenorrhoea

A
  1. ovarian -70% (PCOS, primary ovarian failure)
  2. hypothalamic (weight loss, excessive exrrcise, stress, craniopharyngioma, hypothalamic lesions etc.)
  3. pituritary (hyperprolactinaemia, hypopituitarism etc.)
  4. uterine (asherman’s syndrome, intrauterine adhersions etc.)
  5. other (thyroid dysfunction, cushing’s, CAH etc.)
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21
Q

hypothalamus-pituritary-testicular axis

A

hypothalamus -> GnRH -> LH and FSH released (from ant. pituitary gland -> testosterone release (from testes) -> -ve feed back to down regulate hypothal and pit. gland action

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22
Q

where is FSH produced and what is its action in males

A
  1. produced in the anterior pit gland
  2. target organ is the testes sertoli cells, it acts to stimulate development of sperm
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23
Q

where is LH produced and what is its action in males

A
  1. produced in the anterior pituritary gland
  2. acts on interstitial cells of the testes (leydig cells) to secrete testosterone
24
Q

where is testosterone produced and what is its action in males

A
  1. produced in the testes
  2. promotes sperm development and development of secondary sex characteristics
25
Q

what is testosterone converted to in peripheral tissues

A

dihydrotestosterone (DHT)

26
Q

what is testosterone converted to in adipsoe tissue

A

oestradiol (converted by aromatase enzyme)

27
Q

6 target organs of testosterone and its function there

A
  1. skin - growth of facial/body hair
  2. brain - sex drive, positive feelings, aids cognition and memory
  3. bone marrow - red blood cell producton
  4. male sex organs - sperm production, prostate growth, erectile function
  5. muscle - muscle mass and strength
  6. bone - bone density maintenance
28
Q

4 common presenting features of reproductive endocrine conditions in men

A
  1. absence/regression of secondary sexual characteristics
  2. sexual dysfunction (erectile dysfunction, reduced libido etc.)
  3. reduced energy, muscle wasting, osteoporosis etc.
  4. infertility
29
Q

hormone levels in primary hypogonadism

A

high FSH and LH, low Testosterone

30
Q

hormone levels in secondary hypogonadism

A

low FSH and LH, low Tesosterone

31
Q

3 causes of primary hypogonadism

A
  1. congential - chromosomal defect (e.g. klinefelter’s syndrome) or androgen receptor/enzyme defect
  2. acquired
  3. complications of illness (diabetes, CKD, haemochromatosis etc.)
32
Q

6 acquired causes of primary hypogonadism

A
  1. testicular trauma - torsion
  2. surgical removal
  3. chemotherapy/irradiation
  4. infection (mumps orchitis)
  5. cryptochism ( one or both of the testes fail to descend from the abdomen into the scrotum)
  6. drugs - high dose glucocorticoids, sulphasalazine, alcohol
33
Q

5 causes for secondary hypogonadism

A
  1. kallmann syndrome
  2. idiopathic hypogonadotrophic hypogonadism
  3. functional (exercise, weight loss, stress, anabolic steroids etc.)
  4. structural (tumours, infiltration (sacroid), head trauma etc.)
  5. misc - congenital adrenal hypoplasia, prader willi syndrome etc.
34
Q

what is puberty

A

the period of transition between childhood and adulthood characterised by:
1. development of secondary sexual charcteristics
2. gonadoal maturation
3. attainment of reproductive capacity

35
Q

what is tanner staging

A

sexual maturity rating -> objective classification system used for tracking the development and sequence of secondary sex characteristics of children during puberty

36
Q

3 common congenital reproductive disease

A
  1. turner syndrome (45XO)
  2. Kallman syndrome
  3. klinefelter syndrome (47XXY)
37
Q

what genetic mutation does turner syndrome have

A

monosomy - complete/partial absence of one X chromosome (aka 45XO)

38
Q

who does turner syndrome affect

A

females -> can survive with just one X chromosome

39
Q

physical appearance of someone w turner syndrome (6)

A
  1. short stature
  2. webbed neck
  3. micrognathia
  4. low set ears
  5. widely spaced nipples
  6. cubitus valgus
40
Q

what endocrine dysfunction may be seen in turner syndrom

A

primary amenorrhoea or POF

41
Q

what other codntions are associated with turner syndrome (6)

A
  1. congential heart defects
  2. hypothyroidism
  3. lymphoedema
  4. congential renal abnormalities
  5. hearing defects
42
Q

what genetic mutation causes klinefelter syndrome

A

nondijunction mutation resulting in an extra X chromosome -> XXY chromosomes present

43
Q

klinefelter syndrome presentation (9)

A
  1. tall stature (long legs)
  2. gynecomastia
  3. small, firm, testes
  4. signs of hypogonadism
  5. sparse beard growth
  6. loss of libido
  7. erectile dysfunction
  8. osteoporosis
  9. infertility
44
Q

4 psychosocial problems with klinefelter syndrome

A
  1. limited verbal development
  2. attention defecit
  3. learnig difficulties
  4. social maladjustments
45
Q

3 lab findings in klinefelter syndrome

A
  1. azoospermia (no sperm)
  2. oligoasthenoteratozoospermia (low sperm count, poor sperm motility and abnormal morphology of sperm)
  3. low testosterone, high LH and FSH
46
Q

mgx for klinefelter syndrome

A

lifelong androgen replacement

47
Q

what is kallman’s syndrome

A

a genetic form of hypogonadotrophic hypogonadism - a form of hypogonadism that is due to a problem with the pituitary gland or hypothalamus

48
Q

what hormone fails to be secreted in kallman’s syndrome

A

GnRH

49
Q

why is GnRH not produced in kallman’s syndrome

A

disordered migration of GnRH producing nuerons on hypothalamus

50
Q

what non endocrine symptom is seen in kallman syndrome and why

A

anosmia (can’t smell) -> due to defective formation of olfactory bulb

51
Q

kallman syndrome presentaion

A
  1. lack of smell
  2. absent or delayed puberty
  3. short fingers/toes
52
Q

kallman syndrome mgx (4)

A
  1. hormonal replacement therapy is used to induce puberty
  2. for men - testosterone and hCG injections (may be in combination with FSH) in order to achieve normal virilisation and increased testicular volume
  3. for females - oestrogen is adminstered to induce breast development and genital development along w progesterone to establish the menstrual cycle
  4. pulsatile GnRH administration or exogenous gonadotropins are used to induce folliculogenesis and ovulation to restore fertility
53
Q

what cells produce testosterone

A

leydig cells (in response to LH)

54
Q

when is testosterone testing indicated (9)

A
  1. heigh loss, low trauma fracture, osteoporosis
  2. hot flushes/sweats
  3. gynaecomastia
  4. incomplete/delayed sexual development
  5. reduced libido
  6. decreased spontaneous erections
  7. loss of body hair
  8. shinking testesof <5mL vol
  9. low sperm count
55
Q

when is treating testosterone deficiency contraindicated (5)

A
  1. haematocrit >52%
  2. actively seeking fertility
  3. uncontrolled heart failure
  4. untreated severe obstructive sleep apnoea
  5. sex hormone dependent cancer (caution not contraindicated)
56
Q

2 key factors for diagnosing hypogonadism in men

A
  1. symptoms and signs consistent with testosterone deficeny
  2. unequivocally and consitsently low serum T concentrations (repeat morning fasting T concentrations)

3D week 2 - Hormones (8 decks)

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