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RED > L05: Endocrine Disorders Affecting Reproduction > Flashcards

L05: Endocrine Disorders Affecting Reproduction Flashcards

1
Q

What hormone does the anterior pituitary gland release to the ovaries

A

LH

FSH

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2
Q

Which cells in the ovaries produce androgen

A

Theca cells

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3
Q

What happens to the androgens that are produced by theca cells

A

Enter the follicles where the granulosa cells are and get converted to oestrogen

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4
Q

Which hormone has a negative feedback to the pituitary gland

A

Inhibin

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5
Q

What type of feedback does oestradiol give

A

Negative feedback

Positive feedback

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6
Q

When does oestradiol give negative feedback

A

In the early cycle when there is high moderate levels of it which suppresses LH/FSH

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7
Q

When does oestradiol give a positive feedback

A

In the mid cycle when there is high levels and this causes LH/FSH surge

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8
Q

What hormone from the hypothalamus causes the secretion of LH/FSH

A

GNRH

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9
Q

What type of secretion does GNRH have

A

Pulsatile secretion

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10
Q

If there is continuous secretion of GNRH what happens to the GNRH receptors

A

They become downregulated

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11
Q

So if there is continuous secretion of GNRH what happens to LH/FSH

A

Decreases

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12
Q

What are the 3 areas of problems that can arise in the HPG axis in females

A

1) central damage: lack of LH/FSH
2) gonadal damage: failure of germ cell production or lack of LH and FSH
3) PCOS: gonadal damage but high level of oestrogen

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13
Q

What does hypogonadal mean

A

Decreased gonadal function and decreased sex hormones

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14
Q

What makes you hypergonadal

A

High levels of FSH and LH due to a problem with the gonads so they are not responding to LH/FSH and the pituitary is secreting more to get a response

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15
Q

What does oligomennorhea mean

A

Less than 9 cycles in a year or periods that last more than 42 days

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16
Q

What is ammenorhhea

A

Absence of periods for more than 6 months

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17
Q

What are the 2 types of ammenorhhea

A

Primary

Secondary

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18
Q

What is primary ammenorhhea

A

Patient has never had periods before, indicated failure of menarche after age of 16

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19
Q

What is secondary ammenorhhea

A

Patient had periods but stopped for more than 6 months

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20
Q

What are the consequences of oestrogen deficiency

A

Hot flushes
Poor libido
Painful sex

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21
Q

What are the 3 categorical causes of ammenorhhea

A

Pregnancy
Central
Ovarian

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22
Q

If someone presents with ammenorhhea what do we first need to exclude

A

Pregnancy

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23
Q

What are the central causes of ammenorhhea

A

hypothalamic ammenorhhea
Hyperprolactinemia (lactation)
Pituitary tumours
Hypogonadotrohic hypogonadism (low FSH and LH)

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24
Q

What are the ovarian causes of ammenorhhea

A

Turners syndrome
Premature ovarian failure
PCOS

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25
Q

What are is hypothalamic ammenorhhea due to

A

Anorexia
Exercise
Bulimia

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26
Q

What is the treatment for hypothalamic ammenorhhea

A

Weight gain

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27
Q

What other hormones does the anterior pituitary gland release

A 
ACTH
GH
TSH 
LH 
FSH 
Prolactin
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28
Q

What is prolactin involved in

A

Breast milk production

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29
Q

Which cells produce prolactin

A

Lactotrophs

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30
Q

What is prolactin suppressed by

A

Dopamine

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31
Q

What does prolactin inhibit

A

LH

FSH

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32
Q

What other hormone causes the increased release of prolactin

A

TRH

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33
Q

What are the clinical features of high prolactin in pre-menopausal women

A 
Oligo/ammenorhhea 
Oestrogen deficiency- vaginal dryness 
Spontaneous galactorhhea (milk production)
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34
Q

What are the pathological causes of high prolactin (hyperprolactinaemia)

A
  • prolactin secreting pituitary tumours (prolactinomas)
  • loss of dopamine so loss of inhibitory effect by dopamine due to compression of infundibulum by a pituitary tumour
  • dopamine antagonist drugs
  • hypothyroidism
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35
Q

What are the 2 types of prolactin secreting pituitary tumour that you can get

A

Microadenoma

Macro adenoma

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36
Q

What is the difference between micro and macro adenoma

A

Microadenoma: less than 1cm in diameter

Macro adenoma: greater than 1cm in diameter

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37
Q

Why do you get high levels of prolactin when there is hypothyroidism

A

1) hypothyroidism means low TH
2) low thyroid hormone mean less negative feedback to the hypothalamus
3) hypothalmus therefore produces more TRH
4) high TRH causes high prolactin

38
Q

What are the clinical features of premature ovarian insuffiency

A

Ammenorhhea
Oestrogen deficiency
High levels of FSH/LH- due to lack of negative feedback

39
Q

What are the causes of premature ovarian insuffiency

A

Turners syndrome
Autoimmune such as graves, addition
Iatrogenic: Chemotherapy, Radiotherapy and surgery
Mutation in FSH receptor in ovary ( FMR1 gene)

40
Q

What are the common features of turners syndrome (44 XO)

A 
Short stature 
Low hairline 
Shield shaped thorax 
Widely spaced nipples 
Elbow deformity 
Gonadal streaks 
No menstruation
41
Q

What is the autoimmune disease that cause premature ovarian insuffiency

A

Graves’ disease
Addisons
Diabetes

42
Q

What is the likely mechanism for autoimmune disease causing premature ovarian insuffiency

A

Production of anti ovarian antibodies
Apoptosis
Atrophy

43
Q

What mutations leads to changes in FSH receptor that leads to premature ovarian insufficiency

A

FMRI gene mutations (fragile X)

44
Q

How do we diagnose for fragile X FRMI mutation

A

Karyotype and FRMI mutation analysis

45
Q

How do we diagnose for autoimmune premature ovarian insuffiency

A

Screen for autoimmune disease such as anti ovarian antibodies

46
Q

What is the management of Premature ovarian failure

A

Oestrogen replacement and progesterone (if there is a uterus)

47
Q

What are the features of PCOS

A 
Oligomennorhea 
Hirtusim 
Obesity 
Infertility 
Polycystic ovaries on ultrasound
Hypernadrogenism
48
Q

What are the levels of hormones like in PCOS

A

Increased testosterone, DHEA
Increase LH more than FSH
No oestrogen deficiency

49
Q

What does PCOS increase the risk of during pregnancy

A

Gestational diabetes

50
Q

What is the treatment for PCOS for obesity and oligo/amennorhea specifically

A

Metformin

Lifestyle changes

51
Q

What is the treatment in PCOS for anovulatory infertility

A

Metformin and clomiphene or letrozole

Metformin and IVF

52
Q

What is the treatment in PCOS for hirtusim

A

Yasmin or Dianette(contraceptive pill that reduces androgen)
Vaniqua cream
Cosmetic removal
Sprinolactone

53
Q

What are the anti- and organic oral contraceptives

A

Yasmin

Dianette

54
Q

What does diannete contain

A

35ug thinly estradiol

Cyproterone acetate

55
Q

What does Yasmin contain

A

30ug ethinyl estradiol

Drospirenone

56
Q

What does CAH stand for

A

Congenital adrenal hyperplasia

57
Q

What are the 3 forms of CAH

A

Classical salt wasting CAH
Classical simple virilizing CAH
Non classical CAH

58
Q

What is the cause of CAH

A

21 hydroxylase deficiency (enzyme)

59
Q

Which 2 groups of hormone is 21 hydroxylase enzyme involved in producing

A

Aldosterone

Cortisol

60
Q

When there is 21 hydroxylase deficiency i.e CAH what are the levels of hormone like

A

High androgen
Low cortisol
Low aldosterone

61
Q

What is androgen insensitivity syndrome

A

A spectrum of disorder due to mutation in the androgen receptors

62
Q

What does complete androgen insensitivity result in

A 
poorly virilized infertile mean with complete testicular feminisation 
Female external genitalia 
Short blind ending vagina 
No uterus 
Absent prostate 
Breast development
63
Q

What is the common presentation of androgen insensitivity

A

Inguinal hernia which is actually the testis

64
Q

What doe blood test levels of androgen insensitivity show

A

High levels of testosterone

High LH

65
Q

What is 5 alpha reductase involved in

A

Converting testosterone to DHT

66
Q

Which is the most androgenic form: DHT or testosterone

A

DHT

67
Q

If there is 5 alpha reductase deficiency what happens to testosterone

A

Unable to be converted to DHT

68
Q

What happens to the patients with 5 alpha reductase deficiency

A

They are genetically male (46xy) but appear female

69
Q

In males when LH is released what cell does it act on in the testis

A

Leydig cells

70
Q

What does leydig cells produce

A

Testosterone

71
Q

In males when there is FSH what cell does it act on in the testis

A

Sertoli cells cells within the seminiferous tubules

72
Q

What does Sertoli cells produce in repsonse to FSH

A

Inhibin

73
Q

What type of feedback does inhibin have to the pituitary gland

A

Negative feedback

74
Q

What type of feedback does testosterone have on the pituitary gland and hypothalamus

A

Negative feedback

75
Q

What happens to the levels of testosterone as you age

A

Decrease

76
Q

What is the normal adult male testicular volume in ml

A

15-25ml

77
Q

What are the 2 main categories of male hypogonadism

A

Primary causes of hypogonadism

Secondary causes of hypogonadism

78
Q

What can cause primary hypogonadism in males

A 
Trauma 
Chemotherapy 
Undescended testis 
Infections 
Klinefelters syndrome (chromosomal abnormality)
Systemic disease
79
Q

What can cause secondary gonadal failure

A 
Pituitary tumour 
Hypothalamus disorders
Hyperprolactinemia 
Systemic disease
Obesity 
Androgen use and abuse
80
Q

What does high levels of LH and FSH indicate

A

Primary gonadal failure as the testis are not responding to LH and FSH

81
Q

What does low levels of FSH/LH indicate

A

Secondary gonadal failure as the higher centres are not producing LH/FSH for testosterone to be stimulated for production

82
Q

What is klinefelters syndrome

A

When you have an extra X chromosome (47xxy)

83
Q

What are the features of klinefelters syndrome

A 
small testis 
No sperm 
No hair 
Osteoporosis 
Tall and slim
84
Q

What is the treatment for primary and secondary gonadal failure

A

Testosterone replacement

85
Q

Why can androgen use and abuse cause hypogonadism

A

Extra testosterone inhibits LH and FSH (negative feedback) so you do not get sperm production

86
Q

To assess male infertility what do we look at

A

Seminal fluid
LH
FSH
Testosterone levels

87
Q

If the FSH levels are high what does this indicate

A

Germ cell failure

88
Q

Why does high FSH indicate germ cell failure

A

The testis are nor producing spermatocytes and you are not getting a feedback

89
Q

What does a normal FSH indicate

A

Obstructive disease

90
Q

What does low FSH, LH and testosterone indicate

A

Endocrine causes of pituitary and hypothalamus

91
Q

What is the treatment for low FSH and low LH

A

Replacement therapy of LH and FSH

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