Female endocrinology

Question 1

What is the role of FSH in the ovarian cycle?

Answer 1

Recruits primordial ovarian follicles and stimulates the granulosa cells, which convert androgens to oestrogens

Question 2

What is the role of LH in the ovarian cycle?

Answer 2

Supports the proliferation of theca cells to produce androgens. LH surge causes ovulation.

Question 3

What is the production and role of oestrogen in the menstrual cycle?

Answer 3

• Produced by the growing follicle (androgens produced by theca converted by aromatase from granulosa cells)
• Causes thickening of endometrium during the proliferative phase

Question 4

What is the production and role of progesterone in the menstrual cycle?

Answer 4

• Produced by the corpus luteum (remnant of the ovulated follicle
• Develops the secretory endometrium in preparation for pregnancy

Question 5

What is Rokitansky (MRKH) syndrome and the main indicator?

Answer 5

The congenital underdevelopment or absence of the uterus/vagina. Indicated by primary amenorrhoea (never having a period)

Question 6

What is Turners Syndrome?

Answer 6

A chromosomal abnormality where a female is born with only 1 X chromosome. Can result in amenorrhoea, infertility, stunted growth and sexual development, and other associated conditions.

Question 7

What is Kallmans Syndrome?

Answer 7

A genetic condition causing the failure of the hypothalamus to release GnRH. Causes primary amenorrhoea and underdevelopment of secondary sex characteristics.

Question 8

What is Ashermans syndrome?

Answer 8

The presence of scar tissue or adhesions in the uterus, usually caused by uterine surgery. Can cause amenorrhoea.

Question 9

What is hirtuism and its causes?

Answer 9

Excess hair growth and in a male pattern due to and increase in androgens

• Usually due PCOS
• Can be due to congenital adrenal hyperplasia or adrenal adenoma

Question 10

What is the clinical presentation of PCOS?

Answer 10

• Amenorrhoea/oligomenorrhoea
• Hirsutism
• Acne
• Obesity
• Type 2 diabetes

Question 11

What is the pathogenesis of PCOS?

Answer 11

Multifactorial relating to an impaired HPG axis and obesity

• Elevated LH:FSH ratio
• Overstimulation of androgen production by theca cells which cannot be converted to esterogens by follicular cells
• Ovarian follicles do not reach maturation and form cysts

There is peripheral insulin resistance causing hyperinsulinaemia, increasing theca androgen production

Question 12

What is the diagnostic criteria for PCOS?

Answer 12

2 of the 3:

• Amenorrhoea/oligomenorrhoea
• LH:FSH ratio > 2:1
• Elevated DHEA/andrestedione
• Polycystic ovaries