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Repro > Repro Endocrinology > Flashcards

Repro Endocrinology Flashcards

1
Q

What are some requirements for a normal progression to puberty?

A
  • adequate sleep (GnRH first secreted at night, GH secreted at night)
  • adequate body fat
  • consistent source of estrogen (need to have properly functioning end organ = ovaries)
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2
Q

Define precocious puberty

A

Premature sexual development

-defined as

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3
Q

What is gonadotropin-dependent precocious puberty?

A

Central or true precocious puberty

  • early maturation of the H-P-gonadal axis
  • so GnRH initiated early, the cycle is normal but just turned on too early
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4
Q

What is gonadotropin-independent precocious puberty?

A

Not real puberty b/c no FSH/LH or GnRH involved

  • caused be excess secretion of sex hormones (estrogens or androgens) from either the gonads or the adrenal glands
  • this hormone secretion if independent of both GnRH or gonadotrophs
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5
Q

Is precocious puberty more common in boys or girls?

A

5 x more common in girls

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6
Q

What is the most common cause of precocious puberty? What are some other causes?

A

More common is idiopathic (we never find out why)

  • estrogen, androgen, or HCG producing neoplasm
  • CNS lesion
  • McCune-Albright syndrome
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7
Q

What is McCune-Albright syndrome?

A

Mutation in a receptor on granulosa cells that renders them constantly activated to make estrogen

=> excess estrogen => precocious puberty and bone abnormalities
-also associated w/ cafe-au-lait skin pigmentation

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8
Q

Define delayed puberty

A

Absence of incomplete development of secondary sex characteristics > 12 in girls, > 14 in boys (in the US)

-problem can be anywhere in the system: hypothalamic, pituitary, thyroid, chromosomal, autoimmune

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9
Q

Genotype of Turner’s syndrome

A

50% 45, XO
other 50% 46,XX or 46,XY

-need to X chromosomes for ovaries to develop properly, so even tho the H-P part of the axis is acting normally, there’s no ovaries => no estrogen produced

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10
Q

What are the two phases of the menstrual cycle when referring to the

(a) ovary
(b) uterus

A

Menstrual cycle split into 2 phases

(a) Ovary: Follicular phase (follicles develop) –> Luteal phase (after ovulation the corpus luteum remains and makes hormones)
(b) Uterus: Proliferative (endometrium growing) –> Secretory

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11
Q

Adrenarche

A

Activation of the adrenal medulla

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12
Q

Gonadarche

A

Activation of the gonads (ovaries/testes)

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13
Q

Pubarche

A

Appearance of pubic hair

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14
Q

Thelarche

A

Appearance of breast tissue (in females)

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15
Q

Menarche

A

Onset of first bleed, aka your first period

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16
Q

Can one use Tanner staging of pubic hair to assess ovarian function? Why?

A

Pubic hair is dependent on adrenarche, or activation of the adrenal gland, NOT the activation of the HPA axis => pubic/axillary hair doesn’t tell you anything about ovarian function

17
Q

What is the typical age of adrenarche?

A

Around 6 yoa
-When the adrenal glands start producing androgens

-This is NOT the activation of the HPA axis (so don’t confuse the two!)

18
Q

Name some factors that can determine the onset of puberty

A

Genetics (common ages in families, may be associated w/ KISS1R), physiologic and psychologic stress, body fat (overweight => period may come early, underweight => period may come late), geographic region, country’s development status

19
Q

What gene is the gatekeeper of puberty?

A

KISS 1R = Kisspeptin receptor

  • thought to be key to turning on GnRH secretion
  • indicated in the genetic link btwn age of menarche
20
Q

What is considered a normal length for a menstrual cycle?

A

Normal ranges from 25-35 days w/ 28 days being the average

21
Q

What is considered a normal duration for menstruation?

A

Normal cycle lasts for 3-7 days, average is 5 days

22
Q

How long are the two phases of the menstrual cycle?

A

On average, follicular/proliferative is 14 days. The luteal/secretory phase is more stringent and is always 14 days

=> in a 30 day cycle, ovulation occurs on day 16

-it can vary how long it takes for a follicle to develop, but it is more exact on how long the corpus luteum will survive and make progesterone/estrogen

23
Q

How can blood work help you distinguish if a woman is in the proliferative or secretory phase of the menstrual cycle?

A

Estrogen is present in both phases, but progesterone is ONLY present in the secretory phase once the corpus luteum is around to secrete it

=> if progesterone is detectable (> 2) the woman is in the secretory/luteal phase

24
Q

How can you tell if a woman has ovulated?

A

If progesterone is present

25
Q

Which cells in the ovary are under the influence of LH?

A

Theca cells- catalyze the first reaction of estradiol synthesis

26
Q

Which cells in the ovary are under the influence of FSH?

A

Granulosa cells- takes androstenedione and testosterone (made in the theca cell) and aromatizes them to estrone (inactive) and estradiol (active) respectively

27
Q

What is inhibin?

A

Member of the TGF-beta family that inhibits FSH

28
Q

What is activan?

A

Member of the TGF-beta family that activates FSH

29
Q

What can be measured as an indirect marker of ovarian reserve?

A

AMH = anti-Mullerian hormone = MIF (released in males to cause degeneration of the paramesonephric ducts)

  • AMH is expressed in the granulosa cells of the recruited primordial follicles => higher the AMH = the higher the primordial cell reserve
  • higher ovarian reserve = more fertile
30
Q

Why is tracking body temperature not that helpful for women trying to conceive?

A

B/c the progesterone that is released from the corpus luteum which makes the temperature rise is only present AFTER ovulation occurs => by the time you see the rise in the body temp it’s about 2 days after ovulation has already occurred

31
Q

What is the most reliable predictor of when ovulation will occur?

A

The estrogen peak!!! The estrogen peak is what causes the LH surge, then ovulation occurs 10-12 hours after the LH surge

32
Q

What happens to the granulosa cells after ovulation?

A

They become luteinized into the corpus luteum and start secreting progesterone

33
Q

What happens to the cervical mucous throughout the cycle?

A

Rise in estrogen increases the production and causes thinning of the cervical mucus => makes it easy for the sperm to penetrate the cervix

34
Q

What is spinnbarkeit?

A

The ability of the cervical mucus to stretch (um ew)

35
Q

What is a corpus alibcans?

A

The scar that the corpus luteum involutes into if fertilization/implantation does not occur => there is no HCG to maintain the corpus luteum

36
Q

When does progesterone peak?

A

About one week after ovulation

-corpus luteum is at its largest, then starts degrading when it gets no signal from HCG to stay

37
Q

What phase of the menstrual cycle is this 30 yo F in:

  • irregular cycles ranging from 35-60 days
  • estradiol 100 pg/ml, LH: 8 IU/ml, progesterone 8.4 ng/ml
A

Luteal

-has to be luteal/proliferative b/c it’s after ovulation since progesterone is so high (> 2)

38
Q

On what day of the cycle will this 20 yo F ovulate?

-cycle length: 27 days
Labs on day 4 show: 
-estradiol: 45 pg/ml
LH: 3 IU/ml
progesteron
A

27 - 14 = 13, day 13

The luteal phase is fixed at 14 days

  • it’s the follicular phase which is variable
  • so ovulation is ALWAYS 14 days before the end of a cycle
39
Q

On what day of her cycle is this 27 yo F on?

  • cycle length: 28 days
  • estradiol 260, LH 28, progesterone .2
A

Day 14!

  • already had her peak of estradiol (>300) that caused the LH surge
  • hasn’t ovulated yet b/c no progesterone

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