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Repro 2 F > Puberty & Disorders Of Dev And Menstrual Disorders (9) > Flashcards

Puberty & Disorders Of Dev And Menstrual Disorders (9) Flashcards

1
Q

What’s stored in the Post Pituitary?

A

Oxytocin

Vasopressin (ADH)

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2
Q

What are the phases of the ovarian cycle?

A

Follicular (estrogen dep)

Luteal (progesterone release)

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3
Q

Decreasing levels of estradiol and progesterone from regressing corpus luteum of preceding cycle does what?

A

Initiates inc in FSH

- FSH stimulates follicular growth and estradiol secretion

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4
Q

What are the 5 peptides that affect the reproductive cycle?

A 
GnRH -> FSH and LH
TRH -> TSH
SRIF (somatostatin) inh GH
CRF/H -> ACTH
PIF (dopamine) inh prolactin release
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5
Q

Where is GnRH synthesized? What does it stimulate? Estradiol usually inh FSH and LH, when doesn’t it?

A

Arcuate nucleus
Gonadotrophs and FSH/LH synthesis

When high enough levels of estradiol -> LH surge

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6
Q

Where does lots of progesterone present/occur in the menstrual cycle?

A

Prior to ovulation d/t unreuptured luteinizing graafian follicle, Corpus luteum (max 5-7 days after ovulation)

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7
Q

Describe follicular development:

A

Primordial follicles dev, differentiate, and mature > graafian follicle > graafian follicle ruptures releasing ovum > ruptured follicle produces corpus luteum

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8
Q

Preovulatory surge of LH causes what?

A

Biochemical and structural changes resulting in ovulation

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9
Q

What undergoes luteinization after ovulation?

A

Granulosa cells of ruptured follicle -> corpus luteum (produces lots of progesterone and some estradiol)

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10
Q

Normal functioning life span of corpus luteum is what? What’s it replaced by?

A

9-10 days

Corpus albicans

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11
Q

What zones is the endometrium divided into? What are some features of these zones?

A

Outer portion: functionalis

  • undergoes cyclic changes during menstrual cycle
  • sloughed off at menstruation
  • contains spiral aa

Inner portion: basalis

  • remains relatively unchanged during each cycle
  • houses stem cells to renew functionalis
  • basal aa
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12
Q

What are the stages of the histo-phys changes of the endometrium?

A
  1. Menstrual phase
  2. Proliferative/estrogenic phase
  3. Secretory/progestational phase
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13
Q

Describe the menstrual phase:

A

Only portion of cycle visualized externally

First day of menstruation is known as cycle day 1

During this phase: disintegration of endometrial glands and stroma, sloughing of functionalis layer, compression of basalis layer

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14
Q

What does one see histologically in the proliferative/estrogenic stage of the endometrium cycle?

A

Inc length o spiral aa + numerous mitoses

Endometrial growth

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15
Q

What does one see histologically in the secretory/progestational stage of the endometrium cycle?

A

Progesterone -> Mucous/glycogen secretion
Stroma is edematous
Mitoses are rare
Endometrial lining reaches max thickness

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16
Q

What day does the corpus luteum begin to regress?

A

Day 23 if conception doesn’t occur

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17
Q

What is imperative in regulating menstruation?

A

Intact coagulation pathway

Allows inured vessels to be repaired rapidly after menstruation

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18
Q

What’s the median age of menarche? Occurs how many years after thelarche/breast budding? How many females should have menarche by 15?

A

12.43

3 years

98%

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19
Q

Define primary amenorrhea:

A

No menstruation by 13 w/o secondary sex dev

No menstruation by 15 with secondary sexual dev

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20
Q

Can cycles be irregular during their first year or so?

A

Yes, often are, 21-45 days

By third year they’re normalized (21-35 days), 28+/- 7 days

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21
Q

What’s the average mean blood loss per menstrual period? How often are pads changed? What amount is associated w/ anemia?

A

30cc

3-6 times

80cc, pad change every 1-2h

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22
Q

Do obese kids have earlier onsets of puberty? Malnourished?

A

Yes

No, later onset

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23
Q

What hormone may stimulate puberty in females?

A

Leptin around 106 lbs

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24
Q

What’s the peak number of oocytes and when is it reached?

A

6-7 million

16-20w during gestation

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25
Q

What’s the hypothalamic-pituitary system regulating gonadotropin release called?

A

Gonadostat

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26
Q

What changes from 8-11 are associated w/ puberty from a biochemical standpoint? 11 onward?

A

Inc serum DHEA and androsenedione

  • zona reticularis begins producing andregens (adrenarch)
  • axillary and pubic hair (pubarche)

Gonadostat loses sensitivity

  • sleep induces GnRH secretions
  • GnRH -> sex steroid production
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27
Q

What does thelarche mean? Why is it significant? What are some features?

A

Breast dev
First physical sign of puberty
Requires estrogen
Unilateral dev in first 6 months not uncommon

28
Q

What does axially and pubic hair growth require?

A

Androgens

29
Q

What does menarche require?

A

Pulsatile GnRH > FSH and LH > estrogen and progesterone

30
Q

What’s the order of things in puberty? (TAPMM)

A 
Thelarche
Adrenarche
Peak height velocity
Menarche
Mature sexual hair and breasts
31
Q

What’s Tanner staging used for?

A

Staging normal female pubertal dev

32
Q

What is precocious puberty?

A

Early dev of sex characteristics

  • 8yo for girls
  • 9yo for boys

More likely in girls
75% of cases idiopathyic
Leads to premature fusion of long bones of the epephyses

33
Q

What are the 2 subgroups of precocious puberty?

A

Heterosexual and isosexual

Heterosexual is the dev of secondary sex characteristics opposite expected
- virulizing neoplasms, congenital adrenal hyperplasia, expsure to exogenous androgens

Isosexual: sex characteristic dev that’s appropriate for individuals phenotype

  • 10% organic brain dx, dg w/ MRI of head, pt p/w neurologic sxs
  • 75% idiopathic or constitutional, dg w/ administration of exogenous GnRH looking from LH rise
34
Q

What’s the common androgen secreting neoplasm of childhood?

A

Sertoli-Leydig cell tumor

35
Q

What’s the most common defect in Congenital adrenal hyperplasia? What’s the most severe form of CAH? What’s a late onset form?

A

21-hydroxylase causing excessive androgen production

Classical: females born w/ ambiguous genitalia

Non-classical: premature pubarche, PCOS-like disorder

36
Q

What’s the tx for isosexual precocious puberty?

A 
GnRH agonist (leuprolide acetate)
- suppresses FSH and LH release
37
Q

What is psuedoisosexul precocity?

A

Inc estrogen levels w/ sexual characteristic maturation w/o activation of the HPO axis (d/t an estrogen-excreting tumor)

  • McCune-Albright syndrome (polyostotic fibrous dysplasia): cafe au lait spots, adrenal hypercortisolism, bone defects
  • Peutz-Jeghers: sx cord tumor that secretes estrogen, GI polyposis and pigmentation
38
Q

What causes hypergonadotropic hypogonadism?

A

Gonadal dysgenesis (Turner syndrome)

39
Q

Difference between primary and secondary amenorrhea?

A

Primary: no menstruation by 15 w/ dev sexual characteristics or 13 w/ no dev of sec sex characteristics

Secondary: pt w/ prior menses as absent menses for > 6 months

40
Q

What’s the most common cause of primary amenorrhea?

A

Extreme exercise, constitutional (physiologic delay) is the most common

41
Q

Kallman syndrome is?

A

KAL gene mutation prevents migration of GnRH neurons into hypothalamus

42
Q

Turner’s syndrome is what? What are some signs?

A

Most common form of female gonadal dysgenesis, majority will show no signs of sec sex char

Webbing o the neck (pterygium colli), broad flat chest, short stature, streaked ovaries (functionless tissue), coarctation of the atorta

43
Q

Mullerian dysgenesis/agenesis is also associated w/ what anatomical findings? What’s the karyotype? What the abnormally high hormone?

A

Renal abnormalities/urinary system

No sexual hair

Absent uterus and upper vagina (mullerian dysgenesis/agenesis)

46XY, testosterone

44
Q

Whats Maryer-RKH syndrome?

A

Absent uterus and upper vagina

Normal external features
Normal testosterone
Karyotype, 46XX

45
Q

What’s a normal prolactin level? What causes hyperprolactinoma < 100 ng/mL? Hyperprolactinoma > 100 ng/mL?

A

< 20 ng/mL

Ectopic production (renal cell carcinoma), breast feeding or stimulation, excessive exercise, hypothyroidism, meds (OCs)

Pituitary adenoma, Empty sella syndrome

46
Q

What’s the size of a macroadenoma vs microadenoma? Tx?

A

Micro < 10mm

Macro > 10mm

Bromocriptine/Parlodel

47
Q

Amenorrhea w/ normal TSH and prolactin, what’s done next? How are results determined? What’s done after?

A

Progesterone challenge test

Positive = positive bleeding, PCOS most common etiology
Negative = no bleeding, inadequate estrogenization or outflow abnormality

Estrogen/progesterone challenge test (neg = outflow tract obstruction, postive = estrogen prob)

48
Q

Asherman syndrome causes? Due to?

A

Amenorrhea d/t scar tissue in the uterus from ablation procedures or a spontaneous abortion

49
Q

What are the positive PCT: normogonadotropic amenorrhea w/ hyperandrogenism issues associated w/?

A

Adrenal disorders: non-classic congenital adrenal hyperplasia, Cushings, Adrenal androgen secreting tumor (DHEA > 7000 ng)

Ovarian disorders: PCOS, androgen-secreting tumor (sertoli-leydig tumor)

Exogenous

50
Q

What’s the leading cause of female anovulatory infertility? What 3 criteria are involved in its diagnosis? What’re other common findings associated w/ this?

A

PCOS

Oligomenorrhea (less) or amenorrhea, biochemical or clinical signs of hyperandrogenism (LH to FSH is 2:1), ultrasound positive or small cysts on cortex of ovary

Insulin sensitivity is decreased -> insulin hypersecretion, reduced hepatic production of sex hormone binding globulins (SHBG) -> inc circulating testosterone

51
Q

What’s secreted in excess in PCOS? What’s not?

A

Estrogen

Progesterone

52
Q

What are some features of PCOS?

A

Anovulation, hyperandrognism, hirsuitism, acne, menstrual dysfunction, hyperinsulinemia, LH hypersecretion, elevated testosterone, obesity, sleep disorders, acanthosis nigricans, chronic anovulation (inc risk for endometrial CA)

53
Q

“Ring of pearls” on US associated w/?

A

PCOS

54
Q

Tx for PCOS?

A 
Wt loss (10% wt loss can re-stimulate cycles)
OCs
Clomiphene citrate
Spironolactone
Metformin
55
Q

What do you test for to confirm CAH?

A

17-hydroxyprogesterone levels (which builds up d/t lack of 21-hydroxylase enzyme)

56
Q

Define primary amenorrhea.

A

No menstruation by 13 yo w/o sec sexual characteristics OR no menstruation by 15 WITH sec sexual characteristics

57
Q

Define secondary amenorrhea.

A

Absence of menses for 6 months or more

58
Q

Define polymenorrhea.

A

Abnormally freq menses at intervals < 21 days

59
Q

Define monorrhagia (hypermenorrhea).

A

Excessive and/or prolonged bleeding (> 80mL and > 7 days) occurring at normal intervals

60
Q

Define metrorrhagia.

A

Irregular episodes of uterine bleeding

61
Q

Define menometrorrhagia.

A

Heavy and irregular uterine bleeding

62
Q

Deine Intermenstrual bleeding.

A

Scant bleeding at ovulation or 1 or 2 days

63
Q

Define Oligomenorrhea.

A

Menstrual cycles occurring > 35 days but less then 6 months

64
Q

DUB (dysfunctional uterine bleeding) is caused by what? When does it occur?

A

Aberrations in the HPO axis causing anovulation

Around years of menarche (11-1) or perimenopause (45-50)

65
Q

What’s the PALM (structural causes)-COEIN (non-structural causes) classification system for abnormal bleeding in reproductive-aged women?

A

P: polyp (AUB-P)
A: adenomyosis (AUB-A), boggy uterus
L: leiomyoma (AUB-L), subserosal, interstitial, submucosal
M: malignancy and hyperplasia (AUB-M)

C: coagulopathy (AUB-C), vWD
O: ovulatory dysfunction (AUB-O), unpredictable menses
E: endometrial (AUB-E), inection
I: iatrogenic (AUB-I), IUD/S, exogenous hormones
N: not yet classified (AUB-N)

Repro 2 F (8 decks)

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