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203: Reproductive system, fetal development, pregnancy and birth > Ovarian disorders > Flashcards

Ovarian disorders Flashcards

1
Q

Female gonadal axis

- Include kisspeptin

A

High oestrogen levels stimulates kisspeptin and KND-gamma neurones
- Stimulates the production of GnRH

When oestrogen not high:
GnRH stimulates LH and FSH production
- GnRH realised in a pulsatile fashion

FSH stimulates primary follicle granulosa cells—> stimulates oestrogen and inhibin
- Increase LH receptors

At high oestrogen levels, LH secretion due to increased GnRH pulsatility
LH stimulates
- Ovulation
- Oocyte meiosis
- Granulosa to luteal cell maturation
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2
Q

Diagnosis of ovulation

  • Biochemistry
  • Imaging
A

Biochemistry
- Day 21 progesterone blood test

LH detection kit
- Urinary

Imagining
- Transvaginal pelvic ultrasound [at day 10, follicle size measured]

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3
Q

Hypothalamic causes of ovulation problmes

A

Rare [genetic]
- Kiss1/ GnRH gene deficiency

Weight loss/ stress/ excessive exercise

Bulimia

Anorexia

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4
Q

Amennorhoea

A

Lack of periods for more than 6 months

Primary
- Never had a first period [menarche]

Secondary
- Had periods before

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5
Q

Oligomenorrhoea

A

Irregular periods- more than 6 weeks apart

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6
Q

Clinical features of PCOS

A

Hyperandrogenism
- Hirsutism, acne

Chronic oligomenorrhoea/ amenorrhoea
- Subfertility

Obesity/ Overweight [65-75%]

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7
Q

Diagnostic focus for PCOS

A

2/3 features:

  • Polycystic ovaries
  • Androgen excess
  • Oligo/anovulation
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8
Q

USS appearance of polycystic ovaries

A

10 or more subcapsular follicles

  • 2-8 mm in diameter
  • In ovarian stroma [thickened]

Cysts are not required to have PCOS

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9
Q

Hormonal abnormalities that support diagnosis of PCOC

A

High LH, normal FSH

Increased androgens/ free testosterone

Decreased SHBG

Low/ normal oestrogen

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10
Q

SHBG

A

Sex hormone binding globulin
- produced by liver

Binds to testosterone and estradiol

  • Makes testo inactive
  • when levels decrease, there is more testosterone
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11
Q

Pathophysiology

A

Insulin resistance

  • Inhibits FSH action of granulosa cells
  • Increases androgens production from theca cells
  • Decreases SHBG in liver cells
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12
Q

PCOS and endometrial cancer

A

Increases risk of endometrial hyperplasia and cancer
- Due to lack of progesterone action

Promotes hyperplasia
Increased risk with gestational DM and T2 DM

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13
Q

Lifestyle treatment of PCOS

A

Diet/ exercise

Smoking cessation

Maintain normal weight

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14
Q

COCP and PCOS

  • Benefits
  • Adverse effects
A

Increases SHBG
- Decreases free testosterone

Increased oestrogen and progesterone
- Decreases FSH and LH

Regulates menstrual cycle- prevents endometrial hyperplasia

Adverse effects: can exacerbate metabolic syndrome risk factors

  • Weight gain
  • Venous thrombosis
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15
Q

Cyproterone acetate

  • Administration
  • Drug type
  • Mechanism
A

Anti-androgen used to treat PCOS
- Taken orally

Inhibits testosterone and 5-alpha DHEA to androgen receptor

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16
Q

Spironolactone

  • Drug type
  • Administration
  • Mechanism
A

Mineralocorticoid receptor antagonist.

Anti-androgen effect

  • Androgen receptor antagonist [inhibits TESTO and dihydrotestosterone binding]
  • Useful in treating PCOS
17
Q

Metformin and PCOS

A

Used to control insulin resistance

- Especially useful for obese patients

18
Q

Hair removal and PCOS

A

To treat hirsutism

Photoepilation/ electrolysis

Eflornithine cream

19
Q

Hirsutism differential diagnosis

A

95%

  • PCOS
  • Idiopathic

Non classical congenital adrenal hyperplasia

Cushing’s

Adrenal/ ovarian tumour

20
Q

Severe complications of PCOS

A

Sudden onset

Virilisation

Cushings’

21
Q

Primary ovarian insufficiency

- Presentation

A

Primary/ secondary amenorrhea
Includes premature menopause

Can present with hot flushes/ sweats, symptoms of menopause
- Secondary amenorrhoea

22
Q

Primary ovarian insufficiency

- Aetiology

A

Autoimmunity
- Association with other autoimmune endocrine conditions

X chromosome abnormalities

  • Turner syndrome
  • Fragile X

Genetic predisposition

Iatrogenic

  • Surgery
  • Radiotherapy
  • Chemotherapy
23
Q

Investigations : Primary ovarian insufficiency

A

LH and FSH levels [will be high]

Karyotype
- Turner’s syndrome?

Pelvic USS?

Screen for other AI endocrine conditions

24
Q

Treatment of POI

A

Psychological support

HRT
- Until 52

Monitor bone density
- DEXA scan

IVF

25
Q

Turner syndrome

  • Description
  • Prevalence
A

Complete/ partial X monosomy
- Can be in some or all cells

Occurs in 1:2000/2500 females

26
Q

Turner syndrome

- Presentation

A

Neonate
- Screening

Child/ adolescence
- Short stature

Adult
- Amenorrhoea

27
Q

Congenital adrenal hyperplasia

  • Aetiology
  • Diagnosis
A

Disruption in cortisol biosynthesis disorder

  • 21 alpha hydroxylase enzyme commonly affected
  • Causes possible deficiency in cortisol/ aldosterone
  • Leads to androgen excess

Measure 17-hydroxyprogesterone
- Confirmed with synACTHen test

28
Q

21 hydroxylase deficiency

A

Causes cortisol deficiency

- Raised CRH and ACTH= excess androgen production

29
Q

Congenital adrenal hyperplasia

- Presentation

A

Childhood

  • Salt wasting [2/3]
  • Virilisation [ambiguous in girls]
  • Precocious puberty
  • Abnormal growth

Adulthood [similar to PCOS]

  • Hirsutism
  • Oligo/ amenorrhoea
  • Acne
  • Subfertility
30
Q

CAH treatment

A

Glucocorticoid and mineralocorticoid replacement
- Suppresses CRH, ACTH

Supraphysiological dose

  • Suppresses adrenal androgen
  • But growth has to be monitored in childhood

Surgery
- Manages ambiguous genitalia

Non-classical CAH [adult]
- Can treat as PCOS with COCP/ antiandrogen

31
Q

Pituitary causes of ovulation problems

A

Anything that inhibits FSH/ LH

  • Pituitary tumours
  • Post-surgical
  • Radiotherapy
32
Q

Ovarian cause of ovulation problems

A

Premature ovarian insufficiency

Polycystic ovarian syndrome [most common]

33
Q

Polymenorrhoea

A

Having periods that are less than 3 weeks apart

34
Q

Hirsutism

A

Excess body hair in a male distribution

Androgen-dependant
- Endocrine abnormality

Hypertrichosis
- Familial/ ethnicity

35
Q

PCOS and metabolic syndrome

A

Insulin resistance

  • Increases androgen production in ovarian theca cells–> inhibits LH
  • Increases SHBG in liver
  • Decreased FSH–> prevents maturation of follicles

Impaired glucose
- Increases risk of gestational/ T2 DM

Dyslipidaemia

Vascular dysfunction

36
Q

Reproductive effects of PCOS

A

Increased risk of miscarriages

Increased risk of gestational diabetes

Infertility linked to lack of ovulation is most likely because of PCOS

37
Q

Turner syndrome associated problems

A

Short stature

CV problems

  • Coarctation of aorta
  • Bicuspid aortic valve
  • Aortic dissection
  • Hypertension

Renal
- Congenital abnormalities

Hypothyroid

Hearing probelms

Oestoporosis

38
Q

Hirsutism differential diagnosis

A

PCOS/ idiopathic

Congenital adrenal hyperplasia

Cushing’s

Adrenal/ ovarian tumour

39
Q

Virilisation

A

When women develop male-pattern hair growth and other masculine physical traits

Includes

  • Frontal balding
  • Deepening of voice
  • Male-type muscle mass
  • Clitoromegaly

203: Reproductive system, fetal development, pregnancy and birth (23 decks)

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