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Pathophysiology > L23: Repro - Shortened > Flashcards

L23: Repro - Shortened Flashcards

1
Q

A patient comes in with elevated androstenidone levels, LH, and hyperinsulinemia. Which of the following conditions do they likely have?

A

PCOS

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2
Q

True or False: In PCOS, there is a FSH>LH ratio

A

False - LH>FSH

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3
Q

In PCOS, there is an elevated GnRH, which increases LH. How does this affect kisspeptin secretion and plasma progresterone?

A

Elevated GnRH….
- Elevated Kisspeptin
- Low plasma progesterone

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4
Q

In PCOS, insulin increases the transcription of which gene, leading to elevated LH?
A. 17-B-HSD gene
B. FSH-B gene
C. LH-B gene

A

C. LH-B gene

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5
Q

How does PCOS affect the adrenal gland?
A. Increases insulin
B. Decreases DHEAS synthesis
C. Increases testosterone synthesis
D. Increases DHEAS synthesis

A

D. Increases DHEAS synthesis

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6
Q

Which enzyme converts testosterone to DHT?
A. 17-B-HSD
B. 5a-reductase
C. Aromatase

A

B. 5a-reductase

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7
Q

In PCOS, there is high androstenidone. How does this affect testosterone, DHT, and E2 levels?

A

Testosterone: Excess
DHT: Excess
E2: Normal

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8
Q

Excess of ___ in hair follicles play a key role in hirsuitism
A. Testosterone
B. DHT
C. 5-a-reductase

A

B. DHT

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9
Q

Which four factors cause insulin resistance in PCOS?
- Ovary
- Adrenal
- AP
- Hepatic

A
  • Ovary: ↑ androstenidone
  • Adrenal: ↑ DHEAS
  • AP: ↑LH
  • Hepatic: ↓ SHBG
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10
Q

A patient comes in with irregular menses and hirsuitism. Upon testing, there is elevated androgens and serum 17-OHprogesterone.

What condition do they likely have?

A. PCOS
B. Non-classical congenital adrenal hyperplasia
C. Athlete Triad

A

B. Non-classical congenital adrenal hyperplasia

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11
Q

Non-classical congenital adrenal hyperplasia is due to partial deficiency in which gene?

A

21-hydroxylase (CYP21A2)

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12
Q

Where is androstenidone converted to testosterone? By which enzyme?

A

Peripheral Tissues
- 17B-HSD

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13
Q

True or False: The majority of testosterone is made in peripheral tissues, not the ovary

A

True

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14
Q

DHEA is converted to ___ and ___ in the ovary

A

Androstenidone, then Testosterone

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15
Q

All of the following are made in the adrenal zona reticularis except:
A. Androstenedione
B. DHEAS
C. DHEA
D. Testosterone

A

D. Testosterone

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16
Q

What are two ways that stress inhibit GnRH secretion?

A
  1. Beta endorphins activate opioid receptor
  2. Stressors increase CRH
17
Q

How does estrogen affect GnRH and LH?

How does progesterone affect GnRH and FSH?

A

Estrogen = ↑ GnRH = ↑ LH

Progesterone = ↓GnRH = ↑ FSH

18
Q

How are the following affected if one has the Athlete Triad?
- GnRH pulse generator
- LH pulse freq
- Estrogen
- Ovulation
- Leptin/Ghrelin

A
  • GnRH pulse generator: Inhibited
  • LH pulse freq: too slow
  • Estrogen: ↓
  • Ovulation: None
  • Leptin(↓)/Ghrelin (↑)
19
Q

Which condition is an example of Functional Hypothalamic Amenorrhea (Secondary Amenorrhea)?

A

Female Athlete Triad

20
Q

True or False: 1/2 amenorrhea, as well as osteoporosis, and disordered eating are features of the Female Athlete Triad

A

True

21
Q

Three features of Functional Hypothalamic Amenorrhea?
- Estrogen?
- LH/FSH?
- Secondary Sexual Features?

A
  • Estrogen: ↓
  • LH/FSH: ↓
  • Secondary Sexual Features: Normal
22
Q

How do you restore normal LH/FSH levels in Functional Hypothalamic Amenorrhea?

A

Exogenous GnRH

23
Q

Four major causes of secondary amenorrhea?

A
  1. Functional Hypothalamic Amenorrhea
  2. Androgen Excess
    - PCOS
  3. 1 Ovarian Insufficiency
  4. Endocrine Pathology
24
Q

Which two conditions would you expect to be associated with Tanner Staging 1?

A

-Mullerian agenesis (no uterus)
-Delayed puberty

25
Q

True or False: Gonadal dysgenesis is associated with normal Tanner staging

A

True

26
Q

Three major sites of E2 biosynthesis?

A
  1. Ovary
  2. Estrogen Target Tissue
  3. Skin (Peripheral Tissues)
27
Q

Which enzyme converts androstenidone to E1?

Which enzyme converts E1 to E2?

A

androstenidone to E1: Aromatase
E1 to E2: 17-B-HSD

28
Q

True or False: Androstenidone is converted to E1 and E1 is converted to E2 in peripheral and estrogen target tissues

A

True

29
Q

True or False: Estrogen peaks at age 35

A

True

30
Q

FSH is normal if you don’t have ovary (mullerian agenesis) or have a blockage, but is elevated if you have abnormal uterine development, known as: ___ ___

FSH is LOW under which two conditions?

A

gonadal dysgenesis

1) Delayed puberty
2) GnRH deficiency

31
Q

True or False: There’s an abrupt increased in FSH/LH in menopause

A

True

32
Q

How do you evaluate for GnRH deficiency or delayed puberty?

A

Secondary sex characteristics

33
Q

Estradiol is associated with the ___ phase while estradiol + progesterone is associated with the ___

A

Follicular; Luteal

34
Q

True or False: Estrogen can cause (+) or (-) feedback AP/Hypothalamus while progesterone only exerts (-) feedback on AP/Hypothalamus

A

True

Pathophysiology (26 decks)

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