Repro 1a Flashcards
FSH acts on ______ to induce aromatase that converts androgens to ________?
a. Granulosa Cells
b. Estrogen
LH works on what to produce androgens?
Theca cells.
Tell me about Turner’s.
a. Primary hypogonadism in phenotypic female
b. Presents: short, shield chest, streak ovaries, amenorrhea
c. Dx: karyotype, high FSH:LH bc of low estrogen
Tell me about MRKH Syndrome,- aka Mullerian Agenesis.
a. variable uterus development, but no vagina
b. 2nd most common cause of primary amenorrhea
c. vagina may be short or absent… clit and labia are normal
d. Tx: progressive dilation.
e. no children, but does have ovary and eggs for if can find a surrogate
Tell me about Congenital Adrenal Hyperplasia.
a. 21-hydroxylase deficiency, high 17beta-hydroxylase, HTN and HyperK.
b. ambiguous genitals, large labia/clitoris, normal uterus and higher
c. can carry kids, but might be hard.
What are the most common vaginal neoplasms?
Squamous Cell Carcinoma > Adenocarcinoma > Malignant Melanoma
Tell me about Squamous Cell Carcinoma.
a. keratin pearls on histology
b. most often HPV 16, 18, 45
c. PAP: HSIL (high grade squamous intraepithelial lesion), nuclear atypia and scant cytoplasm
Tell me about Adenocarcinoma.
a. Hist: malignant glandular epithelium
b. HPV 16, 18, 45
c. PAP: nuclear atypia, glandular cytoplasm
Walk me thru from CIN1 to Carcinoma in Situ.
CIN I: involves basal 1/3 of epithelium
CIN II: involves basal 2/3 of epithelium
CIN III: involves > 2/3 of epithelium
Carcinoma in Situ: involves entire thickness of epithelium
Which cells secrete AMH to make the fetus a man?
Sertoli
What is the only contraception proven to prevent HIV?
male condom
Breastfeeding as contraception, what does prolactin suppress?
It suppress GnRH pulsatility resulting in hypothalamic amenorrhea.
What are 8 contra-indications for OCPs?
a. migraine with aura
b. Hx of breast cancer
c. Hx of VTE
d. diabetes and associated CVD
e. smokers > 35 y/o
f. severe hyperlipidemia
g. uncontrolled HTN
h.
What is Hysteroscopic Sterilization?
- wire coil in fallopian tubes
- less invasive, but irreversible contraception (as opposed to other forms of sterilization)
- can be done in office
- requires backup contraception for 3 months
Give me the order of the stages of development.
a. boobs
b. pubes
c. spurt
d. squirt
(hair, then boobs)
Describe sequence of events in pubarche.
a. pre-pube
b. long/straight
c. short/curly
d. cover labia
e. spread to thighs
What is the hallmark of a mature hypothalamic-pituitary gonadal axis?
E2 can give positive feedback on pituitary leading to LH surge and ovulation.
Where is leptin made, and why is it important?
Made from adipocytes. Leptin-deficient people (congential) exhibit hypogonadotropic hypogonadism. Thought to be one reason why obesity might lead to earlier puberty.
What are the two ways that precocious puberty can occur?
a. Central- premature maturation of HPG axis, full-on puberty
b. Peripheral- “ovaries go rogue”, no GnRH, but exposure to sex steroids from gonads, adrenals or environment
What are the causes of Central Precocious Puberty?
a. CNS tumor must be excluded, always do a head MRI
b. can be triggered by peripheral steroid production
c. Profound Hypothyroidism- only cause of precocious puberty with DELAYED bone age.
What is McCune Albright Sydrome?
- Precocious puberty.
- cafe au lait spots, polyostotic fibrous dysplasia
- GnRH independent, autonomous ovarian fxn of FSH receptor
How do you treat Central/Peripheral precocious puberty?
Central: long-acting GnRH agonist to suppress pulsatility, lupron in a 6y/o can add 10cm of height.
Peripheral:
- gonad tumor = surgery
- CAH = glucocorticoids
- McCune-Albright = aromatase inhibitor
