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Clinical Chemistry 3 > Lecture 6: Gonadism > Flashcards

Lecture 6: Gonadism Flashcards

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1
Q

Define hypogonadism

A

designates a deficiency in ovary or testicular function.

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2
Q

In men hypogonadism is presented by..

causing…

A

In men, hypogonadism is presented by a deficiency in testicular function.

This concerns sperm production and the testosterone secretion.

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3
Q

In women, hypogonadism manifests in three forms:

A

Primary hypogonadism
Secondary hypogonadism
Menopause.

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4
Q

Reproductive hormones regulation hormonal axis description and drawing

A

In both sexes, the hypothalamus monitors and causes the release of hormones from the pituitary gland. When the reproductive hormone is required, the hypothalamus sends agonadotropin-releasing hormone (GnRH)to the anterior pituitary.

This causes the release offollicle stimulating hormone (FSH)andluteinizing hormone (LH)from the anterior pituitary to gonads that release estrogen and testerone that have a NEG feedback loop.

Lecture slide for diagram

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5
Q

Reproductive Hormones: Male Hormones (FSH, LH, Testosterone) and their functions

What hormone is responsible for the secondary sex characteristics, and what are they?

A

At the onset of puberty, the hypothalamus causes the release of FSH and LH into the male system for the first time.

FSH enters the testes and stimulates theSertoli cellsto begin facilitating spermatogenesis using negative feedback.

LH also enters the testes and stimulates theinterstitial cells of Leydigto make and release testosterone into the testes and the blood.

Testosterone, the hormone responsible for the secondary sexual characteristics that develop in the male during adolescence, stimulates spermatogenesis.

These secondary sex characteristics include a deepening of the voice, the growth of facial, axillary, and pubic hair, and the beginnings of the sex drive.

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6
Q

Reproductive Hormones: Female Hormones (FSH, LH, Estrogen, Progesterone) where are they released from and their functions

What hormone is responsible for the secondary sex characteristics, and what are they?

A

the anterior pituitary hormones cause the release of the hormones FSH and LH. In addition, estrogens and progesterone are released from the developing follicles.

Estrogenis the reproductive hormone in females that assists in endometrial regrowth, ovulation, and calcium absorption; it is also responsible for the secondary sexual characteristics of females. These include breast development, flaring of the hips, and a shorter period necessary for bone maturation.

Progesteroneassists in endometrial re-growth and inhibition of FSH and LH release.

In females, FSH stimulates development of egg cells, called ova, which develop in structures called follicles.
Follicle cells produce the hormone inhibin, which inhibits FSH production.

LH also plays a role in the development of ova, induction of ovulation, and stimulation of estradiol and progesterone production by the ovaries.

Estradiol and progesterone are steroid hormones that prepare the body for pregnancy.

Estradiol produces secondary sex characteristics in females, while both estradiol and progesterone regulate the menstrual cycle.

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7
Q

2 effects of male hypogonadism

A

A decrease in either of the two major functions of the testes:

  1. sperm production
  2. testosterone production
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8
Q

Testosterone function

A 
Male sexual differentiation
Secondary sex characteristic in puberty and adult
Spermatogenesis
Muscle strength, Muscle volume
Bone density
Erythropoeisis
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9
Q

Androgen Deficiency Symptoms: Male

A
  1. Muscoskeletal
    - Decreased vigour and physical energy
    - Diminished muscle strength
  2. Sexuality
    - Decreased interest in sex
    - Reduction in frequency of sexual activity
    - Poor erectile function/arousal
    - Loss of nocturnal erections
    - Reduced quality of orgasm
    - Reduced volume of ejaculate
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10
Q

Testosterone, FSH, LH levels in primary and secondary hypogonadism and where the issue is

A 
Primary hypogonadism
Testes
Serum Testosterone↓, FSH & LH ↑
Secondary hypogonadism 
Pituitary gland or Hypothalamus
Serum Testosterone↓, FSH & LH ↔ , ↓
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11
Q

Male hypogonadism: Onset

Prepubertal onset: Eunuchoidism Symptoms

A
  1. Lack of adult male hair distribution
    - Sparse axillary, pubic hair
    - Lack of temporal hair recession
  2. High-pitched voice
  3. Infantile genitalia
    - Small penis, testes and scrotum

4.↑ fat deposition in pectoral, hip, thigh and lower abdomen

5.Eunuchoidal proportion
Arm span > Height > 5 cm
Upper/ lower segment ratio < 1

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12
Q

Male hypogonadism: Onset: Postpubertal onset Symptoms

A

Loss of libido
Impotence
Infertility

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13
Q

General Hypogonadism symptoms (Male)

A
  1. small testes
  2. breast development
  3. Female type pubic hair growth
  4. poor beard and chest hari growth
  5. Tall
  6. Osteoporosis
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14
Q

Primary hypogonadism:
Cause: Post pubertal onset

A

Infections

Radiation

Drugs

Trauma

Autoimmune damage

Chronic systemic diseases: Cirrhosis, Chronic renal failure, HIV

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15
Q

Secondary hypogonadism:
Cause: Prepubertal onset

A
  1. Isolated idiopathic hypogonadotropic hypogonadism
  2. Kallmann’s syndrome
  3. Idiopathic hypogonadotropic hypogonadism associated with mental retardation
  4. Abnormal ß-subunit of LH
  5. Abnormal ß-subunit of FSH
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16
Q

Secondary hypogonadism:
Cause: Postpubertal onset (male)

A
  1. Sella or suprasellar tumor
  2. Infiltrative disease
  3. Sarcoidosis, eosinophilic granuloma → hypothalamic hypogonad
  4. Hemochromatosis → pituitary hypogonad
  5. Infection: meningitis
  6. Trauma
  7. Critical illness: surgery, MI, head trauma
  8. Chronic systemic illness : cirrhosis, CKD, HIV
  9. Drugs
17
Q

Investigation tests for hypogonadism: Male

A

1.Serum Testosterone, FSH,LH
2.Semen analysis
3.Others
Peripheral leukocyte karyotype
Other pituitary hormones
Serum prolactin
Iron saturation
MRI brain

18
Q

Flowchart to diagnose primary and secondary hypogonadism in males

A

Lecture Slide

19
Q

Testosterone replacement options

A 
Intramuscular preparations
Transdermal patch
Transdermal gel
Oral agent
Testosterone pellet
Buccal testosterone tablets
20
Q

What is Female hypogonadism and Primary vs Secondary

A

Describes the inadequate function of the ovaries, with impaired production of germ cells (eggs) andsexhormones (oestrogenandprogesterone).

Primaryhypogonadism refers to a condition of the ovaries (primary ovarian insufficiency/hypergonadotropic hypogonadism).

Secondary hypogonadism refers to the failure of thehypothalamusorpituitary gland(hypogonadotropic hypogonadism).

21
Q

Primary ovarian insufficiency

effects, what is low, what is high?

What levels of hormones diagnose it?

Potential genetic causes of it?

A

Ovaries do not regularly release eggs and do not produce enough sex hormones despite high levels of circulating gonadotropins (especially follicle-stimulating hormone [FSH]) in women<40.

Diagnosis is by measuring FSH andestradiollevels.

Genetic disorders that can cause premature ovarian insufficiency include

  1. Turner syndrome(45,X or mosaic 45,X/46,XX or 45,X/47,XXX)
  2. Fragile X syndrome(caused by a premutation in theFMR1gene)
22
Q

Hypogonadotropic hypogonadism (females) what levels of specfic hormones diagnose it

A

Also called primaryhypogonadism, is a disorder of abnormal function of gonads with decreased estradiol infemales, which results in delayed sexual development.

Diagnosis is by measuring FSH andestradiollevels.

23
Q

Primary vs secondary amenorrhoea

A

Primary amenorrheais failure of menses to occur by age 15 years in patients with normal growth and secondary sexual characteristics.

However if patients have had no menstrual periods by age 13 and have no signs of puberty (eg, any type of breast development), they should be evaluated for primary amenorrhea.

Secondary amenorrheais the absence of menses for ≥ 6 months or the length of 3 cycles after the establishment of regular menstrual cycles.

However, patients with previously regular cycles are evaluated for secondary amenorrhea if menses have been absent for ≥ 3 months, and patients with previously irregular cycles are evaluated for secondary amenorrhea if menses have been absent for ≥ 6 months.


24
Q

Pathophysiology (Hormonal axis of ovaries)

A

Hypothalamus: GnRH
Pit: FSH, LH
Ovaries: estrogen and progesterone

25
Q

Role of the following hormones:

Follicle-stimulating hormone

Estrogen

Luteinizing hormone

Progesterone

A
  1. Follicle-stimulating hormoneactivates aromatase in granulosa cells around the developing oocytes to convert androgens toestradiol.
  2. Estrogenstimulates the endometrium, causing it to proliferate.
  3. Luteinizing hormone, when it surges during the menstrual cycle, promotes maturation of the dominant oocyte, release of the oocyte, and formation of the corpus luteum, which producesprogesterone.
  4. Progesteronechanges the endometrium into a secretory structure and prepares it for egg implantation (endometrial decidualization).
26
Q

Flowchart to diagnose primary amenorrhoea

A

Lecture Slide

27
Q

phases of menopause

A

In late reproductive life, menopause occurs after 12 months of amenorrhea and represents the near complete cessation of ovarian hormone secretion.
The Menopausal Transition (MT) is the time in each woman’s reproductive life that precedes the final menstrual period (FMP).

28
Q

Hormone (what ones) changes in meonopause (what one decreases first and followed by)

A

Follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH), inhibin B and estradiol represent the four primary hormone measures of these investigations.

AMH appears to be the first marker to change, followed by FSH and inhibin B.
Estradiol declines in late MT.

29
Q

Relationship between FSH and inhibin B

A

FSH is secreted by the anterior pituitary gonadtrophes and is regulated in part through negative feedback by inhibin B and estradiol, hence an “indirect measure”.

As inhibin B and estradiol vary through each menstrual cycle, FSH levels fluctuate accordingly.

With ovarian aging, lower inhibin B also results in decreased negative feedback to the pituitary, resulting in increased FSH secretion and higher early follicular FSH.

30
Q

Diagnose peak, late reproductivity, early MT, late MT, post menopause

A

Lecture Slide

31
Q

Estrogen, FSH and LH for primary and secondary hypogonadism

A

Primary:
Estrogen: ↓
FSH/LH: ↑

Secondary:
Estrogen: ↓
FSH/LH” ↓

Clinical Chemistry 3 (11 decks)

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