Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 > Ovulation disorders and male hypogonadism > Flashcards

Ovulation disorders and male hypogonadism Flashcards

1
Q

Briefly describe the hypothalamic-pituitary-gonadal axis

A

Hypothalamus secretes gonadotrophin releasing hormone >
GnRH acts upon the anterior pituitary >
Anterior pituitary secretes LH and FSH >
LH and FSH stimulate gamete formation (FSH only in males) directly and via the production of steroid and peptide hormones within the gonads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of hormones are oestrogens?

A

Steroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where and by which cells does glandular oesteogen synthesis occur?

A

Ovaries - theca and granulosa cells

Corpus luteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which type of cells does LH stimulate? Which hormone production does it induce?

A

Granulosa

Pregnenolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the process of oestradiol production

A

Pregnenolone diffuses form the granulosa cells to theca cells >
Theca cells convert pregnenolone to androstenedione using 17,20-lyase and 3beta-HSD >
Androstenedione returns to the granulosa cells where it is converted to oestrone by aromatase >
Oestrone is further converted to oestradiol by 17beta-HSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does FSH do? How does it do this?

A

Stimulates the conversion of androstenedione to oestrone via aromatase
Stimulates the conversion of oestrone to oestradiol via 17beta-HSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where and how does extra-glandular oestrogen synthesis occur?

A

Aromatase expression in fat and bone allows conversion of androstenedione to oestrone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain progesterone synthesis

A

3beta-HSD converts pregnenolone to progesterone in the corpus luteum, placenta (during pregnancy) and adrenals (pathway to androgen and mineralocorticoid synthesis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What receptors numbers increase in the presence of oestrogen?

A

Intracellular progesterone receptor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do the products of hormone synthesis vary with the menstrual cycle?

A

Follicular phase - oestradiol

Luteal phase - progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When are LH and FSH highest?

A

Just before and during ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does oligomenorrhea mean?

A

Less than 9 periods a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does primary amenorrhea mean?

A

Failure of menarche before age 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does secondary amenorrhea mean?

A

Cessation of periods for over 6 months in an individual who has previously menstruated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What categories do the causes of amenorrhea fall under?

A

Physiological
Primary (genetic)
Secondary (ovarian, uterine, hypothalamic, pituitary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should amenorrhea be investigated?

A

LH/FSH
Oestradiol
Thyroid function
Prolactin

Ovarian ultrasound
Testosterone
Pituitary function
MRI
Karyotype
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is female hypogonadism?

A

Low levels of oestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does the problem lie with primary and secondary hypogonadism respectively?

A

Primary - ovaries

Secondary - hypothalamic or pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is hypergonadotrophic hypogonadism?

A

Low oestradiol

High FSH/LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is hypogonadotrophic hypogonadism

A

Low oestradiol

Low FSH/LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is premature ovarian failure?

A

Amenorrhea, oestrogen deficiency and elevated gonadotrophs occurring before the age of forty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the diagnostic criteria for premature ovarian failure?

A

FSH > 30 on two separate occasions at least 1 month apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the causes of premature ovarian failure?

A

Chromosomal
Genetic mutation (FSH/LH receptor)
Iatrogenic
Autoimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the chromosomal causes of premature ovarian failure?

A

Turner’s

Fragile X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the iatrogenic causes of premature ovarian failure?

A

Surgery

Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the autoimmune causes of premature ovarian failure?

A

Addison’s

Thyroid disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is kallman’s syndrome a problem with?

A

Hypothalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Wilson’s syndrome can cause hypogonadism. T/F

A

False - haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is idiopathic hypogonadotrophic hypogonadism?

A

Absent/delayed sexual maturation with low gonadotrophs in the absence of anatomical or functional problem with the hypothalamic-pituitary-gonadal axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where is the problem with idiopathic hypogonadotrophic hypogonadism?

A

Hypothalamus - inability to activate GnRH secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

There are a number of genetic defects associated with idiopathic hypogonadotrophic hypogonadism. T/F

A

True - GnRH secretion is pretty complex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the role of kisspeptin in the regulation of GnRH production?

A

Kisspeptin binds to the KISS1P gene to induce GnRH secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the effects of kisspeptin?

A

Gatekeeper of puberty
Regulator of male and female fertility
Involved in feedback control of oestrogen and therefore menstruation and ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is Kallman’s syndrome?

A

A genetic disorder causing the loss of GnRH secretion and anosmia/hyposmia due to failure of hypothalamic migration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How is the pituitary affected in Kallman’s syndrome?

A

Normal apart from reduced LH/FSH due to lack of stimulation from GnRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What does a brain MRI show in Kallman’s syndrome?

A

Normal pituitary

No olfactory bulbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which sex is affected by Kallman’s most often?

A

Male

38
Q

Is Kallman’s associated with a family history or nah?

A

Sometimes

39
Q

How can you differentiate between Kallman’s syndrome and idiopathic hypogonadotrophic hypogonadism?

A

Presence or absence of anosmia

40
Q

How are the hormone levels affected in pituitary dysfunction?

A

Low/normal LH/FSH

Low oestradiol

41
Q

What causes of pituitary dysfunction can cause hypogonadism?

A

Non-functioning adenoma
Pituitary infarction
Prolactinoma
Dopamine antagonists

42
Q

What are the causes of hyperprolactinemia?

A 
Prolactinoma 
Pituitary pathology 
Anti-psychotics
Dopamine antagonists 
Hypothyroidism 
Idiopathic
43
Q

What are the ovarian causes of amenorrhea?

A

PCOS
Ovarian failure
Congenital problem

44
Q

What is the rotterdam criteria for PCOS?

A

Menstrual irregularity
Hyperandrogenism
Polycystic ovaries
(>2/3)

45
Q

What are the signs of hyperandrogenism?

A

Hirsutism

Elevated free testosterone

46
Q

What types of congenital problems can cause amenorrhea?

A 
Absent uterus 
Vaginal atresia
Turner's
Testicular feminisation 
Congenital adrenal hyperplasia
47
Q

Describe the pathophysiology of polycystic ovarian syndrome?

A

Genetic predisposition to excess androgen secretion >
Increased testosterone >
Hirsutism ; increased LH ; insulin resistance + hyperinsulinaemia >
Increased LH & hyperinsulinaemia further increase testosterone and cause anovulation ; hyperinsulinaemia causes the liver to secrete less sex hormone binding globulin propagating hirsutism

48
Q

What is hirsutism?

A

Excess hair in the male pattern distribution in females

49
Q

What causes hirsutism?

A

Excess androgen at hair follicles caused by increased circulating androgen and increased peripheral conversion at the hair follicle

50
Q

Where is androgen synthesised?

A

Ovaries and adrenals

51
Q

What are the causes of hirsutism?

A 
PCOS
Familial
Idiopathic
Non-classical adrenal hyperplasia
Adrenal tumour
Ovarian tumour
52
Q

How can adrenal/ovarian tumours causing hirustism be differentiated from other causes?

A

Tumours - short history, virilisation

Other causes - long history, testosterone not crazy high, no virilisation

53
Q

What is virilisation?

A

Deep voice

Clitomegaly

54
Q

What is congenital adrenal hyperplasia?

A

Group of genetic disorders causing a deficiency in an enzyme essential for cortisol synthesis

55
Q

What is the most common enzyme responsible for congenital adrenal hyperplasia?

A

21 alpha hydroxylase

56
Q

Is congenital adrenal hyperplasia dominant or recessive?

A

Recessive

57
Q

When is classical CAH diagnosed?

A

Infancy

58
Q

When is non-classical CAH diagnosed?

A

Adolescence or adulthood

59
Q

How does classical and non-classical CAH present respectively?

A

Classical - virilisation, salt-wasting

Non-classical - hirsutism, menstrual disturbance, infertility

60
Q

What should be particularly elevated in CAH after synacthen?

A

Progesterone (ACTH drives androgen production)

61
Q

How do androgen secreting tumours present?

A

Short history
Virilisation
Testosterone >5mmol/l

62
Q

What can be done to investigate a suspected androgen secreting tumour?

A

MRI adrenals and ovaries

63
Q

How is PCOS treated?

A

Oral contraceptive pill
Anti androgens (cyproterone acetate)
Local anti-androgens (efflornithine cream)
Cosmesis (laser, electrolysis)

64
Q

How is non-classical CAH treated?

A

Low dose glucocorticoid

65
Q

What is the chromosomal abnormality in Turner’s syndrome?

A

Only one X chromosome

66
Q

Which sex is affected by turner’s syndrome?

A

Females

67
Q

How does turner’s syndrome present?

A

Short stature
Webbed neck
Shield chest w/ wide spaced nipples
Cubitus valgus

68
Q

What is XX gonadal dysgenesis?

A

Absent ovaries with no chromosomal abnormality

69
Q

What is testicular feminisation/androgen insensitivity syndrome?

A

Genetically XY but phenotypically female (pseudohaemaphrodite)

70
Q

What is primary male hypogonadism?

A

Low testosterone

High LH/FSH

71
Q

What is secondary male hypogonadism?

A

Low testosterone

Low LH/FSH

72
Q

What are some causes of primary hypogonadism?

A

Congenital

Acquired (cirrhosis, testicular trauma, radiation, mumps, etc)

73
Q

What aspects of a history are important to cover in male hypogonadism?

A 
Sexual function (libido, erections & ejaculation)
Age of puberty 
Fertility 
Symptoms of pituitary disease
Duration of symptoms
74
Q

What signs may be found in male hypogonadism?

A

Lower than expected stage of puberty
Small testicular volume
Features of pituitary disease (e.g visual field defects)

75
Q

How should male hypogonadism be investigated?

A

Testosterone (free and total)

LH & FSH

76
Q

What is klinefelter’s syndrome?

A

Congenital form of primary hypogonadism caused by chromosomal abnormality XXY

77
Q

Which sex is affected by klinefelter’s syndrome?

A

Male

78
Q

What are the features of klinefelter’s?

A 
Reduced testicular volume
Gynecomastia
Eunuchoidism  
Intellectual dysfunction
Azoospermia
79
Q

How should klinefelter’s syndrome present biochemically?

A

Low testosterone
High LH/FSH
High sex hormone binding globulin
High oestradiol

80
Q

What are the causes of secondary male hypogonadism?

A

Hypothalamic

Pituitary

81
Q

When should testosterone level be measured?

A

9am

82
Q

What are the congenital causes of secondary male hypogonadism?

A

Idiopathic hypogonadotrophic hypogonadism
Kallman’s
Congenital adrenal hyperplasia

83
Q

When is testosterone therapy indicated?

A

Hypogonadism in young men (>50 seek specialist advice)

84
Q

Does testosterone therapy restore fertility?

A

No. May even act as a contraceptive

85
Q

What are the benefits of testosterone therapy?

A

Improved sexual function (young > old)
Improved bone health (IM > transdermal)
Improved muscle strength and decreased fat
Minimal affect on diabetes

86
Q

How does gynecomastia result?

A

Increase oestrogen effect on breast tissue

87
Q

What are the causes of gynecomastia?

A 
Physiological
Spironolactone
Digoxin
Hypogonadism
Adrenal tumours
Testicular tumours
Endocrine pathology (thyrotoxicosis, cushing's)
Systemic illness
Hereditory disorders
88
Q

Which aspects of a history are important in gynecomastia?

A 
Duration
Pain 
Hypogonadism
Systemic illness
Drugs
Alcohol
89
Q

Which aspects of an examination are important in gynecomastia?

A 
Breast tissue vs fat
Unilateral vs symmetrical
Lumps
Testicular examination
General examination (liver disease)
90
Q

How should gynecomastia be investigated?

A 
Testosterone 
LH/FSH
Oestradiol
Prolactin
AFP/HCG
LFT
SHBG
Breast imaging
Adrenal imaging 
Testicular imaging
91
Q

How is gynecomastia treated?

A

Underlying cause
Reassurance
Cosmetic surgery
Medication (anti-oestrogens)

Year 2 (72 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions