Repeoductive Flashcards
Adrenal glands
DHEAS
Work up for hirsutism
Shea’s - adrenals
Testosterone- ovaries
17 OH P - CAH
Work up for nonclassic adrenal hyperplasia
17-OHP
21 hydroxylase deficiency
Treatment of hirsutism
OCPs Spirinolactone Cyproterone acetate Finasteride Flutamide Metformin and thiazolinediones
Action of finasteride
Inhibits 5alpha reductase activty
Flutamide reduction in ferriman gallwet score
41.3%
Spirinolactone teduction in ferriman gallwet score
38.4%
Most direct evidence of androgen excess
Total testosterone more than 2 ng/mL
Measurement of estradiol in serum
Picograms per mL
Measuremenr if testosterone
Nanograms per mL
Most strikingly elevated steroid in PCOS
Androstenedione of ovarian
PCOS dose of metformin
Metformin 500 1-1-1
Post menopausal FSH levels
> 100 IU/L
Define amenorrhea
Absence of menses by age 15
Failure to menstruate 3 yrs after peak growth velocity
How does high insulin cause pcos?
Highinsulin
Enumerate the different criteria for pcos
- rotterdam
- NIH
- androgen council
Defective neuronal proteins in Kallmann syndrome
Anosmin1 (encoded by KAL1 gene)
FGF Type I (encoded by FGFR)
Neurotransmitter effect on GnRG
NE- stimulates
Dopa- inhibitory
Endorphins- inh
Opioids- inhibitory
What is the role of kisspeptin
—- makes mutations of, cause hypogonadotropic hypogonadism
Binding of kisspeptin to G protein coupled Kiss1R Stimulates gnRH release in the hypothalamus
Mechanism of action of Gonadotropin releasing hormone agonists
Initial flare
Downregularion of axis in 1-3 weeks due to 1) desensitization 2) loss of receptors
% of thw anterior pit cells that are gonadotrophs
7-15%
Inhibin secreted by the ovarian granulosa cells during the folliculae phase
Inhibin B
Inhibin secreted by the corpus puteum during the luteal phase
Inhibin B
Negatively regulates function of activin
Follistatin
Activin- stimulate FSH
Inhibin- inhibit FSH (along with estrogen)
Responsible for the slower clearance of FSH
Sialic acid more in FSH
Gene mutation of this causes ovarian dysgenesis
A growth and differentiation cactor expressed in oocyre stimulated folliculogenesis
Bone morphogenetic protein
BMP15 gene
Mutation causes familial ovarian dysgenesis
Bmp15
Germ cells present at birth
1-2 x 10^6
of germ cells at puberty
300,000
Stage of promary oocyte until ovulation
Prophase of twb forst meiotic division
Marks transition primordial ro prkmary follicle
Morphologic change in granulosa cells from squamous to cuboidal
Produced by the granulosa cells of growing follicles
Inhibits the growth of primordial follicles
Faster depletion if it is absent
Anti mullerian hormone
A useful marker of ovarian reserve
Serum AMH
In ovary produces the C19 steroid
Theca interna
Theca externa- macrophages
Folliculae rupture after LH surge
34-36 hrs after LH surge
Major steroid product of the ovary which is not biologically active
Andostenedione
Biologically active ovarian seroida
Estradiol
Progesterone
Major estrogen products of thw corpus luteum
Progest
17OHP
Most potent anti HIV drug to cause gynecomastia
Efavirenz
How does thyrotoxicosis affect repro hormones
Increases SHBG which binds more to testosterone than estradiol
Gunecomastia with
Normal FSH
High testosterone and LH
Androgen resistance
Gynocomastia
Decrease testosterone
High FSH than LH
Primary hypogonadism
Hormones that regulate spermiogenesis
AMH
Inhibit B
Both secrered by sertoli
Amle henotypic devt complete by
15 wks age of gestation
When to do hematocrit monitoring in patients with testosterone treatment
Baseline, 3-6 mi, then yearly
Half life of GnRH
2-4 mins
Amplitude and pulsatility of GnRH
60-90 mins
Slower gnrh- DAH
Rapid fequency favors
LH
% of pituitary cells gonadotrophs
7-15%
Most active steroidogenic tissue of humans
Corpus luteum
Rate limiting step of prigesterone
Entry of LDL into mitochondria regulated by star protein
Define primay amenorrhea
Ansence of menses by age 15
Surrogate market of GnRH
LH
Most common primary amenorrhea
Ovarian dysgenesis
Complete androgen insensitivity syndrome
46 XY
Female ohenotype
Rx of turner
Recombinant GH
Oxandrolone height
Estrogen at 14 yrs
Secondary amenorrhea
Absence of menses more than 3 mos in women who had normal menses
Signs fetal androgen deficiency
Ambiguous genitalia Notmal female Microphallus Hypospadias Bifid scrotum Cryptorchidism
Eunochoidiam
Arm span longer than height by 5 cm
HIV most potent drig to cause gynecomastia
Efavirenz