Lecture 5 - Endocrine Disorders Affecting Reproduction

Question 1

What is the pattern of release of GnRH and hence FSH and LH after puberty?

Answer 1

Released in a pulsatile fashion

Question 2

What is the result of continual GnRH release?

Answer 2

It causes decreased FSH and LH release.

Question 3

How is oestrogen produced in females?

Answer 3

Androgens are produced by the thecal cells in response to FSH and LH. These then move to the granulosa cells where they are converted to oestrodiol by aromatase.

Question 4

What is oligomenhorrea?

Answer 4

Irregular periods so less than 9 periods a year

Question 5

What is ammenhorrea and what are the types?

Answer 5

Stopping of periods.
Primary-failure of menarche after 16yrs
Secondary-no period for 6 months after menarche

Question 6

What are the signs and symptoms of oestrogen deficiency?

Answer 6

Hot flushes, poor libido, dispareunia (painful sex)

Question 7

What is the first test that must be done for amenorrhoea?

Answer 7

Pregnancy test

Question 8

What are the three main causes of central amenorrhoea?

Answer 8

Hypothalamic - caused by weight loss, excercise, stress
Pituitary - lactation, pituitary tumours
Hypogonadotrophic hypogonadism - lack of FSH and LH secretion

Question 9

What are the three ovarian causes of amenorrhoea?

Answer 9

Turners syndrome
Premature ovarian failure
Polycyctic ovary syndrome

Question 10

What are the clinical features of hyperprolactinaemia in pre-menopausal women?

Answer 10

Hypogonadism which causes oligo/ammenorrhoea and symptoms of oestrogen deficiency
Galactorrhoea- producing milk when shouldn’t

Question 11

What can cause pathological hyperprolacinaemia?

Answer 11

PRL-secreting pituitary tumours
Lack of negative feedback to pituitary from hypothalamus (pituitary stalk compression)
Dopamine antagonists as dopamine is the negative regulator.

Question 12

What are the signs and symptoms of premature ovarian insufficiency?

Answer 12

Amenorrhorea
Oestrogen deficieny- signs and symptoms
Eleated FSH and LH

Question 13

What are the causes of premature ovarian insufficiency?

Answer 13

Turners syndome
Autoimmune - thyroid, addisons
Iatrogenic - chemotherapy
Mutations in receptors e.g. FSH

Question 14

What is fragile X and what does this lead to?

Answer 14

It is a genetic change linked to the FMR1 gene which can lead to premature ovarian insufficiency.
It has an X linked dominant pattern.

Question 15

What are the signs and symptoms of Polycystic ovary syndrome?

Answer 15

Oligomenorrhea
Hirtuism
Obesity
Infertility
Polycyctic ovaries on ultrasound

Question 16

What hormone levels are seen with polycycstic ovary syndrome?

Answer 16

Hyperandrogenism
Increased testosterone and DHEA
Increased LH/FSH ratio
Not deficient in oestrogens

Question 17

Two out of three of which criteria must be present to diagnose PCOS?

Answer 17

Oligo/amenorrhoea
Polycystic ovaries
Hyperandrogenism

Question 18

How is PCOS treated?

Answer 18

Try to get them to lose weight, metforin given to help control blood sugar.
Hirtuism can be treted with Yasmin or other creams

Question 19

What are the main causes of androgen insensitivity syndrome?

Answer 19

Mutations in the androgen receptor resulting in the effects of the androgens not being transmitted to the cells.

Question 20

What does 5 alpha reductase deficiency result in?

Answer 20

5 alpha reductase is needed for conversion of testosterone to the more potent dihydrotestosterone. This means that with a deficiency there can be ‘females’ with XY chromosomes that have not been able to convert the testosterone and hence do not have male secondary characteristics.

Question 21

What are the results of male hypogonadism?

Answer 21

• Delayed puberty
• Psychological effects
– Loss of libido and reduced sexual behaviour
– Lack of sex drive versus erectile impotence
• Gynaecomastia
• Loss of body hair, reduced shaving frequency,
thin skin
• Decreased muscle mass, female fat distribution
• Osteoporosis

Question 22

What are the two main types of the causes for hypogonadism?

Answer 22

Primary hypogonadism - problem in gonads e.g. surgery or chemo
Secondary hypogonadism - problem in pituitary e.g. tumour

Question 23

What pattern of hormones suggest primary or secondary hypogonadism in males?

Answer 23

-High LH, FSH indicates primary gonadal failure

– Low LH, FSH suggests secondary cause