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Pathophysiology > L23: Reproductive Pathologies > Flashcards

L23: Reproductive Pathologies Flashcards

1
Q

___ amenorrhea: No history of menstruation

____ amenorrhea: Cessation of menses after a variable time

A

Primary
Secondary

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2
Q

Differentials for primary amenorrhea?

A
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3
Q

Testing to evaluate primary amenorrhea?

A
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4
Q

How to evaluate 1 amenorrhea w/o a uterus?

A
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5
Q

How to evaluate 1 amenorrhea w/a uterus?

A

Measure FSH
1) Is it high?
2) Is it low or normal?

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6
Q

True or False: There is an abrupt increase in gonadotropic hormones
(FSH, LH) at menopause in
females

A

True

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7
Q

A patient has primary amenorrhea. You measure their FSH and it is normal suggesting…
A. Anatomical blockage
B. GnRH Deficiency
C. Mullerian Angenesis

A

A. Anatomical blockage
C. Mullerian Angenesis

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8
Q

A patient has primary amenorrhea. You measure their FSH and it is elevated suggesting…
A. Anatomical blockage
B. GnRH Deficiency
C. Mullerian Angenesis
D. Gonadal Dysgenesis

A

D. Gonadal Dysgenesis

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9
Q

A patient has primary amenorrhea. You measure their FSH and it is low suggesting…
A. Anatomical blockage
B. GnRH Deficiency
C. Mullerian Angenesis
D. Gonadal Dysgenesis
E. Delayed Puberty

A

B. GnRH Deficiency
E. Delayed Puberty

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10
Q

What is Tanner Staging (a sexual maturing rating of secondary sexual characteristics) a reflection of?

A
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11
Q

True or False: LH, FSH, and Estrogen are low prior to Puberty

A

True

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12
Q

Three major sites of Estrogen (E2) Biosynthesis?

A
  1. Ovary
  2. Peripheral Tissues
  3. Estrogen Target Tissues
  • Androstenedione–originating from adrenal, ovary, or both–to E1 then to E2
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13
Q

In sexually active females, __ is greater than ___
A. E1>E2
B. E2>E1

A

B. E2>E1

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14
Q

What are two important enzymes for E2 biosynthesis from androgen precursor?

A

Aromatase
17BHSD

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15
Q

If a patient has normal tanner staging + 1 amenorrhea, it suggests…

A

Mullerian Agenesis and Anatomical Blockage

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16
Q

If a patient has pre-pubertal breast development + 1 amenorrhea, it suggests…

A
  1. Gonadal Dysgenesis
  2. Delayed Puberty
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17
Q

Four common causes of secondary amenorrhea?

A
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18
Q

True or False: Low FSH and LH, as well as an estrogen deficiency is associated with Functional Hypothalamic Amenorrhea (secondary amenorrhea)

A

True

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19
Q

True or False: Normal secondary sexual characteristics are typical in individuals with Functional Hypothalamic Amenorrhea (secondary amenorrhea)

A

True

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20
Q

How do you restore LH and FSH in Functional Hypothalamic Amenorrhea (secondary amenorrhea)?

A

Exogenous GnRH

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21
Q

Describe The Female Athlete Triad (Functional Hypothalamic Amenorrhea)

A
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22
Q

How does the Triad affect:
- GnRH
- LH pulse frequency
- estrogen
- ovulation
- leptin
- ghrelin

A
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23
Q

True or False: Many CNS substances regulate kisspeptin secretion and hence hypothalamic GnRH secretion.

A

True

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24
Q

Anterior pituitary gonadotrophs
synthesize and secrete __ and __

A

FSH/LH

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25
Q

True or False: Estrogen (positive feedback) decreases the GnRH pulse frequency

A

False - increases

26
Q

True or False: Low GnRH pulse frequency favors LH secretion → LH surge

A

False - high GnRH

27
Q

How does progesterone affect GnRH pulse frequency?

A

Progesterone decreases the GnRH
pulse frequency

28
Q

True or False: Low GnRH pulse secretion favors FSH secretion

29
Q

How can stress affect CRH?

A

Increases it

30
Q

____ activate opioid receptors to inhibit GnRH secretion
A. LH
B. Endorphins
C. Beta endorphins
C. CRH

A

C. Beta endorphins

31
Q

True or False: Stressors decrease hypothalamic CRH secretion to inhibit GnRH secretion

A

False - stressors INCREASE hypothalamic CRH secretion to inhibit GnRH secretion

32
Q

Treatment for Athlete Triad?

33
Q

Where is testosterone produced? androstenedione?

34
Q

Where is DHEA produced? DHEAS?

35
Q

All of the following are produced in the ovary except:
A. Testosterone
B. Androstenidone
C. DHEA
D. DHEAS

36
Q

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

A

A. Testosterone

37
Q

True or False: The majority of testosterone occurs in peripheral tissues (70-80%)

38
Q

In the peripheral tissues, which enzyme converts Androstenedione to Testosterone?

How do target cells convert testosterone to potent DHT?

A

17-B-HSD

5a-reductase

39
Q

What are the two causes of androgen excess in women of reproductive age?

A

1) PCOS
2) Non-classic congenital adrenal hyperplasia - deficient in CYP21A2

40
Q

What four features would you expect to see in a patient with Non-classic congenital adrenal hyperplasia?

A
  1. Irregular menses
  2. Elevated androgens
  3. Hirsuitism
  4. Elevated serum 17-hydroxyprogesterone
41
Q

____: Scoring system that uses visual grading of hair growth over 9 androgen-sensitive
body areas

A

Ferriman-Gallwey scoring system for hirsuitism

42
Q

How to evaluate 2 amenorrhea?

43
Q

How to further evaluate 2 amenorrhea?

44
Q

How to further evaluate 2 amenorrhea?

45
Q

How to further evaluate 2 amenorrhea?

46
Q

How to further evaluate 2 amenorrhea?

47
Q

How to further evaluate 2 amenorrhea?

48
Q

Three features of PCOS?

49
Q

____ potentiates adrenal DHEAS synthesis

A

Hyperinsulinemia

50
Q

True or False: PCOS is associated with androgen excess, which can be seen with: acne, androgenic alopecia, and hirsutism

51
Q

True or False: In PCOS patients, there is proliferative endometrium

52
Q

How to diagnose PCOS?

53
Q

True or False: Elevated LH/FSH supports PCOS and is diagnostic

A

False - elevated LH/FSH supports PCOS but is NOT diagnostic

54
Q

How are GnRH, FSH, and LH dysregulated in PCOS?

55
Q

How is the ovary affected by PCOS?

A
  1. Elevated androgen synthesis
  2. Increased LH/FSH ratio
  3. Dysregulation of these enzymes
56
Q

How does PCOS affect the adrenal glands?

A
  1. Dysregulation of synthetic enzymes
  2. Increased DHEAS synthesis
57
Q

In PCOS, there is high androstenedione, which leads to excess testosterone and DHT but normal ___

58
Q

Having a lot of DHT in hair follicles plays a role in ____

A

hirsuitism

59
Q

How does Insulin Resistance play a role in PCOS?

Pathophysiology (26 decks)

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