L23: Repro - Shortened Flashcards
A patient comes in with elevated androstenidone levels, LH, and hyperinsulinemia. Which of the following conditions do they likely have?
PCOS
True or False: In PCOS, there is a FSH>LH ratio
False - LH>FSH
In PCOS, there is an elevated GnRH, which increases LH. How does this affect kisspeptin secretion and plasma progresterone?
Elevated GnRH….
- Elevated Kisspeptin
- Low plasma progesterone
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
C. LH-B gene
How does PCOS affect the adrenal gland?
A. Increases insulin
B. Decreases DHEAS synthesis
C. Increases testosterone synthesis
D. Increases DHEAS synthesis
D. Increases DHEAS synthesis
Which enzyme converts testosterone to DHT?
A. 17-B-HSD
B. 5a-reductase
C. Aromatase
B. 5a-reductase
In PCOS, there is high androstenidone. How does this affect testosterone, DHT, and E2 levels?
Testosterone: Excess
DHT: Excess
E2: Normal
Excess of ___ in hair follicles play a key role in hirsuitism
A. Testosterone
B. DHT
C. 5-a-reductase
B. DHT
Which four factors cause insulin resistance in PCOS?
- Ovary
- Adrenal
- AP
- Hepatic
- Ovary: ↑ androstenidone
- Adrenal: ↑ DHEAS
- AP: ↑LH
- Hepatic: ↓ SHBG
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
B. Non-classical congenital adrenal hyperplasia
Non-classical congenital adrenal hyperplasia is due to partial deficiency in which gene?
21-hydroxylase (CYP21A2)
Where is androstenidone converted to testosterone? By which enzyme?
Peripheral Tissues
- 17B-HSD
True or False: The majority of testosterone is made in peripheral tissues, not the ovary
True
DHEA is converted to ___ and ___ in the ovary
Androstenidone, then Testosterone
All of the following are made in the adrenal zona reticularis except:
A. Androstenedione
B. DHEAS
C. DHEA
D. Testosterone
D. Testosterone
What are two ways that stress inhibit GnRH secretion?
- Beta endorphins activate opioid receptor
- Stressors increase CRH
How does estrogen affect GnRH and LH?
How does progesterone affect GnRH and FSH?
Estrogen = ↑ GnRH = ↑ LH
Progesterone = ↓GnRH = ↑ FSH
How are the following affected if one has the Athlete Triad?
- GnRH pulse generator
- LH pulse freq
- Estrogen
- Ovulation
- Leptin/Ghrelin
- GnRH pulse generator: Inhibited
- LH pulse freq: too slow
- Estrogen: ↓
- Ovulation: None
- Leptin(↓)/Ghrelin (↑)
Which condition is an example of Functional Hypothalamic Amenorrhea (Secondary Amenorrhea)?
Female Athlete Triad
True or False: 1/2 amenorrhea, as well as osteoporosis, and disordered eating are features of the Female Athlete Triad
True
Three features of Functional Hypothalamic Amenorrhea?
- Estrogen?
- LH/FSH?
- Secondary Sexual Features?
- Estrogen: ↓
- LH/FSH: ↓
- Secondary Sexual Features: Normal
How do you restore normal LH/FSH levels in Functional Hypothalamic Amenorrhea?
Exogenous GnRH
Four major causes of secondary amenorrhea?
- Functional Hypothalamic Amenorrhea
- Androgen Excess
- PCOS - 1 Ovarian Insufficiency
- Endocrine Pathology
Which two conditions would you expect to be associated with Tanner Staging 1?
-Mullerian agenesis (no uterus)
-Delayed puberty
True or False: Gonadal dysgenesis is associated with normal Tanner staging
True
Three major sites of E2 biosynthesis?
- Ovary
- Estrogen Target Tissue
- Skin (Peripheral Tissues)
Which enzyme converts androstenidone to E1?
Which enzyme converts E1 to E2?
androstenidone to E1: Aromatase
E1 to E2: 17-B-HSD
True or False: Androstenidone is converted to E1 and E1 is converted to E2 in peripheral and estrogen target tissues
True
True or False: Estrogen peaks at age 35
True
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?
gonadal dysgenesis
1) Delayed puberty
2) GnRH deficiency
True or False: There’s an abrupt increased in FSH/LH in menopause
True
How do you evaluate for GnRH deficiency or delayed puberty?
Secondary sex characteristics
Estradiol is associated with the ___ phase while estradiol + progesterone is associated with the ___
Follicular; Luteal
True or False: Estrogen can cause (+) or (-) feedback AP/Hypothalamus while progesterone only exerts (-) feedback on AP/Hypothalamus
True
