Reproduciton and sex steroids Flashcards
which hormone does ‘ovulation tests’ measure
LH
which layer of the uterus sheds during menstruation
endometrium
where does fertilisation occur
ampulla
first step of fertilisation, when receptors on egg undergo exocytosis
chemotaxis
what is it called when 1 sperm binds and polyspermy is prevented
what does it involve
zona reaction
increased Ca and enzymes
in males and females;
hypothalamus secrete GnRH which stimulates the production of … (2)
where
LH and FSH
anterior pituitary
in males
LH stimulates which cells
leydig cells
Lh = Leydig
in males
what do leydig cells secrete in response to LH
what is it used for
where
testosterone
spermatogenesis in the setoli cells
in males
FSH stimulates which cells
setoli cells
fSh = Setoli
in males
what happens in setoli cells in response to FSH
which hormone is needed for this to happen
where does it come from
spermatogenesis
testosterone
leydig cells (stimulated by LH)
dihydrotestosterone definition
presentation
too much testosterone production
enlargement of male sex organs, anabolism
oligomenorrhoea definition
<9 periods in a year (either irregular or infrequent >35 day cycles)
primary amenorrhoea definition
female >16 thats never had a period
secondary amenorrhoea definition
no period for >6months but has previously had a period
what must you always do for a female presenting with amenorrhoea
pregnancy test! (hCG)
aetiology of primary amenorrhea (3)
turners syndrome (XO)
congenital adrenal hyperplasia (CAH)
kallmans syndrome
genetics of turners syndrome
XO (one X chromosome only)
aetiology of secondary amenorrhoea (7)
menopause
pregnancy
polycystic ovarian syndrome (PCOS)
premature ovarian failure
hyperprolactinaemia
hypopituitarism (non functioning pituitary tumour)
hypothalamic dysfunction (over exercise, weight loss, low BMI, stress, illness)
most common aetiology of secondary amenorrhea (if pregnancy and menopause ruled out)
polycystic ovarian syndrome (PCOS)
how does hypothalamic dysfunction (from over exercise, weight loss, low BMI, stress, illness) cause amenorrhoea
loss of pulsatile production of GnRH from hypothalamus = no FSH/LH production
which aetiology of primary amenorrhoea presents with lack of sense of smell (anosmia)
kallmans syndrome (lack of GnRH)
presentation of primary amenorrhoea
absence of puberty (no breast development)
presentation of secondary amenorrhoea
loss of libido
painful intercourse
hirsutism (male facial hair pattern in females)
what is oestrogen levels in amenorrhoea
low
what hormones (other than oestrogen) do you want to measure in amenorrhoea (2)
why
LH and FSH
to figure out if hypogonadism is primary or secondary
LH and FSH in primary hypogonadism causing amenorrhoea (eg premature ovarian failure, polycystic ovarian syndrome
high
the problem is at the gonads
LH and FSH in secondary hypogonadism causing amenorrhoea eg pituitary tumour, hyperprolactinaemia
low
the problem is that no LH and FSH are made in the first place
apart form LH and FSH levels, what test can you do to see if amenorrhoea is caused by primary or secondary hypogonadism
explain the test
what are the results for primary and secondary hypogonadism in this test
progesterone challenge test
give progesterone for 5 days and see if you can cause a menstrual bleed
primary hypogonadism = positive (no bleeding occurs, problem is the ovaries)
secondary hypogonadism = negative (bleeding occurs, problem is further up)
what MSK condition is low oestrogen associated with
osteoporosis
is premature ovarian failure the same as early menopause
no
they may still have eggs in premature ovarian failure its the ovary thats stopped working
in menopause there are no eggs left
aetiology of premature ovarian failure (4)
idiopathic
autoimmune (addisons)
genetic
chemo/radiotherapy
hormone levels in premature ovarian failure (LH, FSH, oestrogen)
high LH
high FSH
low oestradiol
treatment for premature ovarian failure
hormone replacement therapy (oral contraceptive)
treatment of someone with osteoporosis (from premature ovarian failure)
vit D supplements
Ca
bisphosphonates (alendronic acid)
treatment of premature ovarian failure that has caused infertility (and they want kids)
egg donation, IVF
adoption
does turners syndrome present in males or females
females (only one X chromosome)
kidney defect in turners syndrome (XO)
horseshoe kidney
nipples in turners syndrome (XO)
wide spaced
‘pearl necklace’ on ovaries
polycystic ovarian syndrome (PCOS)
risk factor for PCOS
diabetes (hyperinsulinaemia)
if you aren’t a diabetic, why else can you get polycystic ovarian syndrome (PCOS)
genetics
in PCOS the things on the ovary surface aren’t actually cysts, what are they
immature follicles
what does immature follicles in PCOS mean about progesterone
what normally happens
no progesterone is released = low progesterone in blood
mature follicles release progesterone
in PCOS decreased progesterone release from follicles (bc they are immature not mature) results in what clinical presentation (3)
amenorrhoea
hirsutism (male facial hair pattern in females)
infertility
initial pathophysiology of PCOS (high something affects something cells)
high LH or high insulin = affects theca and granulosa cells
Rotterdam criteria for PCOS, need 2/3 of;
oligomenorrhoea clinical hyperandrogenism (hirsutism, acne) polycystic ovaries on US
oestrogen in PCOS
normal (should be low but high insulin + androgens = oestrogen secretion = brings it back to normal)
progesterone in PCOS
low
androgens/testosterone in PCOS
high
PCOS lifestyle change
loose weight, diet
PCOS first line treatment
why
antioestrogens (clomifene citrate) to improve fertility
PCOS second line treatment after weight loss and antioestrogens (3 - one a step up from weight loss, the other 2 is a step up from antioestrogens (one drug, one not))
metformin
gonadotrophins (LH and FSH injections)
surgery (drill holes) to induce ovulation
side effect of gonadotrophin therapy (LH and FSH injections used in PCOS)
multiple pregnancy with complications
male primary hypogonadism aetiology (1)
klinefelters (XXY)
male secondary hypogonadism aetiology (3)
pituitary disease
kallmans
prdaer willi syndrome
male hypogonadism with no sense of smell aetiology
kallmans
presentation of genetic male hypogonadism in teenager
no puberty (ask about shaving)
presentation of pituitary male hypogonadism in adult (2)
loss of libido (ejaculations, erections)
infertility
testosterone, LF, FSH in primary hypogonadism
is it hyper or hypogonadotrophic hypogonadism
low testosterone
high LF
high FSH
hypergonadotrophic hypogonadism
testosterone, LF, FSH in secondary hypogonadism
is it hyper or hypogonadotrophic hypogonadism
low testosterone
low LF
low FSH
hypogonadotrophic hypogonadism
treatment of hypogonadism in men >50
nothing
treatment of hypogonadism in men <50
testosterone replacement
when wouldnt you give testosterone in men with hypogonadism (2)
if >50
if prostatic cancer (can make it worse)
gynaecomastia definition
enlarged breasts in men (different from fat!)
oestrogen in gynaecomastia
high
treatment of gynaecomastia (3)
treat underlying cause
reassurance!
anti-oestrogens
definition of infertility
failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child
primary infertility definition
infertility in a couple who have never conceived
secondary infertility definition
infertility in a couple who have previously conceived by pregnancy unsuccessful (miscarriage or ectopic pregnancy)
aetiology of infertility in females (8)
menopause anorexia kallmans hypogonadotrophic hypogonadism (pituitary tumour) PCOS premature ovarian failure (POF) infection endometriosis (narrowing of tubes)
what is endometriosis
when womb lining sheds and goes backwards into fallopian tubes = blocks them (retrograde menstruation)
aetiology of male infertility (5)
drugs - alcohol, tobacco idiopathic hypogonadotrophic hypogonadism (pituitary tumour, kallmans) klinefelters (XXY) chemo/radiotherapy
LOADS MORE!
what BMI is a risk factor for infertility (hence part of management plan)
high BMI
want them to loose weight
investigations for female infertility
pelvic exam
pelvic transvaginal ultrasound
look at tubes (radiograph or laparoscopy)
investigation for male infertility
semen analysis (sperm count)
azoospermic definition
no sperm in semen
treatment for male infertility (2)
sperm bank
surgical sperm aspiration
treatment for female infertility for POF
egg donation
treatment for tubal disease causing female infertility
surgery to open up tube or IVF
treatment for hypothalamic/pituitary cause of female infertility
hormone replacement therapy
what type of hormone is oestrogen
steroid hormone
apart from theca/granulosa cells, where else can oestrogen be made
(= cause of erectile dysfunction in men)
fat cells
where is progesterone made in female
corpus luteum
in females
what does LH production cause
where does this happen
androgen production
theca cells
in females
what cells do FSH stimulate
what happens as a result
granulosa cells
androgen production
apart from androgen production from granulosa cells, what else does FSH do in females
stimulates follicle maturation
LH and FSH cause androgen (then oestrogen) production and follicle maturation
what does this overall result in
egg release
what does low oestrogen (start of follicular phase of menstrual cycle) do to LH
by which mechanism
decrease it
negative feedback
what does low oestrogen (start of follicular phase of menstrual cycle) do to FSH
by which mechanism
increase it
negative feedback
what does oestrogen do to the endometrium
when
thickens it
increasing oestrogen in follicular phase = preparing endometrium for ovulation
what does the LH spike in menstrual cycle trigger
ovulation
what is a ‘dead follicle’ called
corpus luteum
in which menstrual cycle phase is there follicles
follicular phase
in which menstrual cycle phase is there a corpus luteum
luteal phase
which 3 hormones does the corpus luteum produce
inhibin
oestrogen
progesterone
what does inhibin do to FSH (comes from the corpus luteum so in the luteal phase)
decreases it (= stops more follicles being stimulated to become leading follicles)
what does progesterone do to the hypothalamus (comes form the corpus luteum so in the first half of the luteal phase)
decreases secretion of GnRH
what does lutenising hormone (LH) do in the menstrual cycle
stimulate ovulation = cause the LUTEAL phase to occur (bc of the corpus LUTEUM)
in the second half of the luteal phase there is decreases progesterone bc the corpus luteum is degenerated
what does this do to GnRH
what is the overall result of this (generally speaking)
increase GnRH
stimulated new ovulation cycle
why does the endometrium shed if no fertilisation (in terms of hormones)
all hormones are decreased = it cannot be maintained
what is the main thing that happens in the follicular phase of the menstrual cycle
development of stimulation follicle
FOLLICULAR phase = FOLLICLE stimulation
what is the main thing that happens in the luteal phase of the menstrual cycle
corpus luteum develops then degenerates
LUTEAL phase = corpus LUTEUM
what do follicles secrete that peaks at the end of the follicular phase of the menstrual cycle
oestrogen
what is the main hormone change in the follicular phase of the menstrual cycle
what does this cause
LH peak
ovulation (egg release)
what is the follicle without an egg called (after ovulation)
corpus luteum
