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endrocrine & reproduction ii exam #1 > Puberty and Disorders of Development > Flashcards

Puberty and Disorders of Development Flashcards

1
Q

Describe the follicular and luteal phases

A

Follicular: begins with onset of menses and ends in preovulatory surge of LH

Luteal: begins with onset of the preovulatory LH surge and ends first day of menses

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2
Q

What leads to an increase in FSH by negative inhibition?

A

Decreasing levels of estradiol and progesterone from the regressing corpus luteum

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3
Q

What is the “2 cell theory of ovarian follicular development and estrogen production”?

A

LH stimulates the theca cells - production of androgens

FSH stimulates the granulosa cells - converts androgens to estrogens

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4
Q

What causes the fall of LH and FSH in the luteal phase?

What happens if conception does not happen?

A

Negative feedbcak by estrogen and progesterone

Progesterone and estrogen decline and result in regression of corpus luteum. FSH will rise and initiate new follicular growth.

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5
Q

When do estrogens increase in the ovarian cycle? (2)

A

Approx. 1 week prior to ovulation (1 day before LH surge)

Again 6-7 days after ovulation, then returns to baseline before menses

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6
Q

What are the 2 sources of progesterone in the ovarian cycle?

A

Peripheral conversion of precursors

Graafian follicle (corpus luteum about 5-7 days after ovulation)

*ovary only secretes a little bit

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7
Q

What happens in the functionalis and basalis layers of the endometrium?

A

Functionalis: undergoes changes in mentruation and has spiral aa.

Basalis: remains unchanged and provides stem cells and contains basal aa.

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8
Q

What is the only phase of the menstrual cycle that is seen externally?

A

Mentrual phase

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9
Q

Median age of menarche

How close to telarche?

A

12.43 y/o

2-3 years post telarche at Tanner stage IV

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10
Q

Primary amenorrhea

A

No menstruation by 13 y/o without secondary sex characteristics OR by age 15 with secondary characteristics

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11
Q

How long is the first menstrual cycle?

How long are they in the first year?

Menstrual flow length?

How many tampons?

Mean volume of blood?

A

34 days

21-45 days

7 days or less

3-6 pads/day

30cc (>80cc is associated w/ anemia, especially if > 7 days)

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12
Q

Mean onset of puberty:

A

12.4 y/o (10-16 y/o)

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13
Q

How is puberty inhibited the prepubertal stage? (2)

A
  1. Gonadostat sensitivity to the negative feedback of low circulating estrogen
  2. Intrinsic CNS inhibition of GnRH secretion
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14
Q

What causes growth of axillary and pubic hair (adrenarche or pubarche)?

A

Androgens

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15
Q

Stages of normal pubertal development

A

TAPME

Thelarche (breast): first signs, UL development is normal, requires estrogen

Adrenarche/pubarche: occurs 2 years earlier in female and 1 year prior to onset of menses

Menses: requires GnRH from hypothalamus, FSH and LH from pituitary, estrogen and progesterone from ovaries

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16
Q

Tanner staging in pubic hair (5)

A
  1. Preadolescent: absence
  2. Sparse hair along labia; downy with slights pigment
  3. Hair spreads over junction of pubes; hair is coarser or darker
  4. Adult-type hair; no spread to medial thighs
  5. Adult-type with spread to medial thighs; inverted triangle pattern
17
Q

What constitutes precocious puberty?

75% of time it is…

A

Development of any sign of secondary sex characteristics prior to 2.5 SDs earlier than expected age

Idiopathic

18
Q

Heterosexual precocious puberty =

Causes (3)

A

Development of secondary sex characteristics in the opposite gender.

Virulization (Sertoli-Leydig tumors, etc.)
Congenital adrenal hyperplasia (CAD)
Exposure to exogenous angrogens

19
Q

Isosexual precocious puberty =

Cause

A

Premature sexual maturation appropriate for the phenotype.

Constitutional and organic brain disease: tumors, trauma, infection

20
Q

Enzyme associated with CAD =

A

21-hydroxylase, which leads to excess androgen production

21
Q

True vs. Pseudoisosexual precocity

A

True: arises from premature activation of normal development by HPO axis

Pseudoisosexual: exposure to estrogens independent of HPO axis (estrogen producing tumors)

22
Q

How is true isosexual precocious puberty diagnosed?

Treatment?

A

Give exogenous GnRH (GnRH stimulation test) and see a resulatnt rise in LH consistent with girls in puberty

GnRH agonist, which suppresses release of FSH and LH

23
Q

Puberty is considered delayed when… (4)

A

Secondary sexual characteristics have not appeared by age 13

If thelarche has not occurred by 14 y/o

No menarche by 15-16 y/o

Menses has not happened by 5 years after onset of thelarche

24
Q

3 categories for delayed puberty

A

Hypergonadotropic hypogonadism (FSH > 30): Turner’s syndrome

Hypogonadotropic hypogonadism (FSH+LH < 10): all else

Anatomic causes: Mullerian agenesis, imperforate hymen, transverse vaginal septum

25
Q

Secondary amenorrhea

A

Patient with prior menses has been absent for 6 mo. or more

26
Q

3 diseases/processes with primary amenorrhea with breast development and Mullerian anomalies

A

Androgen insensitivity syndrome (AIS): 46XY, male levels of testosterone, defect in androgen receptor, testes in abdominal wall.

Mullerian agensis (MRKH syndrome): primary amenorrhea, breast development, female levels of testosterone and 46XX karyotype.

Outflow tract obstruction: normal uterus, but imperforate hymen or transverse vaginal septum

27
Q

What 2 hormones are normal and abnormal in thyroid disease associated with secondary amenorrhea?

Mild hypothyroidism is associated with…

A

NL prolactin
ABN TSH

Hypermenorrhea or oligomnorrhea (not amenorrhea) - treatment should restore menses

28
Q

Abnormal prolactin levels can lead to…

Most common symptom?

A

Secondary amenorrhea

Galactorrhea

29
Q

What is done to test for secondary amenorrhea if TSH and prolactin levels are WNL?

A

Progesterone challenge test (PCT)
+ test = bleeding (PCOS most common)
- test = no bleeding

30
Q

What are 2 anatomic causes of secondary amenorrhea?

A

Asherman syndrome: scarring/contractures of uterus

Cervical stenosis: narrowing of the cervix

31
Q

What is a common associated with PCOS?

A

Insulin sensitivity, leading to insuling hypersecretion

32
Q

How is PCOS diagnosed? (2 of 3)

A

Need 2 of 3:

  • Oligomenorrhea or amenorrhea
  • Biochemical or clinical signs of hyperandrogenism (LH to FSH 2:1)
  • US revealing cysts beneath cortex of ovary
33
Q

2 major treatments of PCOS

A

Weight loss

OCs - suppresses FSH/LH which decreases overproduction of androgens in the ovary. Estrogen stimulates SHBG.

34
Q

Hisutism =

Virulization =

A

Hisutism = excess terminal hair in a male pattern distribution

Virulization = masculinization of female associated structures with an increase in circulating testosterone

35
Q

Polymenorrhea

Menorrhagia

Metrorrhagia

Menometroraggia

Oligomenorrhea

A

Polymenorrhea - abnormally frequent menses < 21 days

Menorrhagia - excessive and/or prolonged bleeding at normal intervals (>80mL and >7 days)

Metrorrhagia - irregular episodes of uterine bleeding

Menometroraggia - heavy and irregular uterine bleeding

Oligomenorrhea - menstrual cycles occurring > 35 days but less than 6 mo.

36
Q

What is PALM COEIN?

A

Acronym for DUB causes.

PALM = structural causes
Polyp
Adenomyosis
Leiomyosis
Malignancy and hyperplasia
COEIN = nonstructural cases
Coagulopathy (von Willebrand disease)
Ovulatory dysfunction (PCOS)
Endometrial (infection)
Iatrogenic (IUD, IUS, exogenous hormones)
Not yet classified
37
Q

Lab tests to evaluate if there is abnormal uterine bleeding (5)

A 
Pregnancy test
CBC
Targeted screening for bleeding disorders
TSH
Chlamydia trachomatis
38
Q

AUB treatment if:

Massive bleeding

Moderate bleeding

If unresponsive to conservative therapy

A

Massive bleeding - hospitalization and transfusions if unstable; 25 mg conjugated estrogens, then hormonal treatment

Moderate bleeding - combination OCPs

If unresponsive to conservative therapy - D and C, polypectomy, myomectomy, endometrial ablation, hysterectomy

endrocrine & reproduction ii exam #1 (17 decks)

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