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My Endocrinology > Reproduction > Flashcards

Reproduction Flashcards

1
Q

What is the pathway for the production of the female reproductive hormones?

A

hypothalamus makes GnRH –> anterior pituitary makes LH and FSH –> ovaries release oestrogen and progesterone

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2
Q

What effect do progesterone and oestrogen have on hormone release?

A
  • oestrogen inhibits or encourages GnRh and LH/FSH release

- progesterone always inhibits

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3
Q

What replaces LH in pregnancy?

A

hCG

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4
Q

What does do LH and FSH do to the follicle?

A
  • cause it to increase in size and release the hormones

- LH changes the follicle into corpus luteum so progesterone increases

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5
Q

What is the pathway for reproductive hormone release in males?

A

hypothalamus releases GnRH –> anterior pituitary releases FSH and LH –> testes produce testosterone

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6
Q

What effect does testosterone have on the levels of other hormones?

A

negative feedback on the hypothalamus and the anterior pituitary

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7
Q

What does FSH do in women?

A

growth of ovarian follicles and ovary secretes oestrogen

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8
Q

What does LH do in women?

A

ovulation and progesterone production by corpus luteum

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9
Q

What does FSH do in males?

A

causes spermatogenesis

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10
Q

What does LH do in males?

A

causes testosterone secretion in testes

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11
Q

How is secretion of TSH and LH controlled in males?

A

GnRH is released from the hypothalamus in a pulsatile manner which is constant

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12
Q

How is secretion of TSH and LH controlled in females?

A
  • a high frequency is LH and a low frequency is FSH

- oestrogen increases frequency so FSH levels fall

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13
Q

How is the release of GnRH controlled?

A

regulates by oestrogen and progesterone at the Kisspeptins

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14
Q

How long is the menstrual cycle?

A

28 days

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15
Q

What are the phases of the menstrual cycle?

A
  • Phase 1= follicular phase is variable

- Phase 2= luteal phase is fixed at 14 days

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16
Q

What does the FSH increase in the cycle cause?

A

appearance of LH receptors on the follicle which causes an LH surge (ovulation) then increased progesterone

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17
Q

What follicle is used in each cycle?

A
  • many follicles grow but only one contributes to ovulation

- FSH decreases and the dominant follicle survives

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18
Q

How do the LH surge and ovulation correspond?

A

LH surge preceeds ovulation by 34-36 hours

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19
Q

How does follicular growth occur?

A
  • cells increase in number so increase fluid
  • LH stops progesterone so turns on enzymes for follicle breakdown
  • androgen is needed so LH causes cholesterol –> androgen
  • granulosa and theca cells become luteal cells
  • LH increases SER and mitochondria so androgen in made
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20
Q

What does androgen do?

A

needed for oogenesis

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21
Q

What is increased androgen suggestive of?

A

PCOS

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22
Q

What are the roles of oestrogen?

A
  • regulate LH surge
  • decrease vaginal pH through increased lactic acid (reduces infection risk)
  • increase vaginal wall thickness
  • decrease viscosity of cervical mucous (more fertile) and therefore sperm production
  • increased levels inhibit FSH and prolactin
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23
Q

What are the roles of progesterone?

A
  • thick infertile mucous so decreased infection
  • if removed, there is birth
  • maintains endometrial thickness
  • relaxes smooth muscle
  • inhibits LH secretion
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24
Q

How long is a sperm cycle?

A

40 days

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25
Q

What is the hormone role of testosterone?

A
  • taken up by Sertoli cells

- helps by producing factors for sperm development

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26
Q

What is infertility?

A

failure to get pregnant after 12 months

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27
Q

What are the types of infertility?

A
  • primary = never conceived

- secondary = have conceived before but may have been an unsuccessful pregnancy

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28
Q

What increases chance of conception?

A
  • over 30y
  • previous pregnancy
  • less than 3y trying
  • intercourse during ovulation
  • BMI between 18.5-30
  • non-smoker
  • no caffeine
  • no drugs
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29
Q

What can cause anovulation?

A
  • hypothalamic= anorexia, excessive exercise
  • pituitary= increased prolactin, tumours, Sheean
  • ovary= PCOS, premature ovary failure
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30
Q

What are the hormone levels in anorexia?

A

low FSH, LH and estradiol

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31
Q

What are the hormone levels in PCOS?

A

increased androgen, increased LH, impaired glucose tolerance

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32
Q

What are the risk factors for PCOS?

A
  • obesity
  • hirsutism
  • cycle abnormalities
  • infertility
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33
Q

What are the hormone levels for premature ovarian failure?

A

high FSH, high LH and low estradiol

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34
Q

What are the associations for premature ovarian failure?

A

associated with Turner’s and fragile X

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35
Q

What are the types of infective tubal disease?

A
  • STI
  • post-procedure
  • abdominal infection spread
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36
Q

What are the types of non-infective tubal disease?

A
  • polyps
  • congenital
  • surgery
  • endometriosis
37
Q

What is endometriosis?

A
  • endometrial glands outside the uterine cavity
  • pelvic pain before menstruation
  • painful defaecation
  • pain on sex
38
Q

What are the investigations for endometriosis?

A

laparoscopy

MRI

39
Q

What are the causes of male infertility?

A
  • low LH and FSH
  • low sperm count
  • torsion
  • obstruction eg CF no vas deferens
40
Q

What are the hormone levels in non-obstructive male infertility?

A

high FSH and LH and low testosterone

41
Q

What are the hormone levels in obstructive male infertility?

A

normal LH, FSH and testosterone

42
Q

What are the part of the examination for female infertility?

A
  • menstrual history
  • ovulation assessment
  • chlamydia
  • smear
  • laparoscopy
43
Q

What is the examination for male infertility?

A

semen analysis

44
Q

What length is a regular menstrual cycle?

A

28-35

45
Q

What are the two types of amenorrhea?

A
  • primary is never had periods

- secondary is had them and they stopped

46
Q

What does FSH do?

A

stimulates follicular development and thickens endometrium

47
Q

What does LH do?

A
  • surge causes ovulation
  • stimulates corpus luteum development
  • thickens endometrium
48
Q

When do oestrogen and progesterone peak?

A

oestradiol peaks before ovulation

progesterone peaks after

49
Q

Where does oestrogen get secreted from?

A

ovaries and adrenal cortex

50
Q

What secretes progesterone in pregnancy?

A

corpus luteum to maintain early pregnancy

51
Q

What hormone is used to assess ovulation?

A

progesterone peak which is after ovulation

52
Q

What is hypothalamic pituitary failure?

A

no/less GnRH is made so low FSH and LH which causes amenorrhoea

53
Q

What are the causes of hypothalamic pituitary failure?

A
  • stress
  • excessive exercise
  • anorexia/low BMI
  • brain/pituitary tumours
  • Kallman’s
  • drugs (steroid/opiate)
54
Q

What is the treatment for hypothalamic pituitary failure?

A

replace GnRH in a pulsatile way and daily injections of LH and FSH

55
Q

What must be done before treatment of hypothalamic pituitary failure?

A
  • stabilise weight
  • give folic acid
  • lifestyle
  • check semen, rubella and drugs
56
Q

What is hypothalamic pituitary dysfunction?

A
  • normal hypothalamus and pituitary but ovary doesn’t recognise this
  • nearly always this is PCOS
57
Q

What is PCOS diagnosed with?

A
  • oligo/amenorrhoea
  • polycystic on scan
  • clinical or biochemical androgenism
58
Q

What are the hormone changes in PCOS?

A
  • hyperinsulinaemia as insulin resistance but normal pancreas
  • high LH
  • high free testosterone as insulin lowers SHBG levels
59
Q

What is the management of PCOS?

A
  • lifestyle
  • loss of weight
  • Clomifene (or daily FSH)
  • laparoscopic daily ovarian diathermy (drilling under GA)
60
Q

What are the risks of ovulation induction?

A
  • ovarian hyperstimulation (don’t have sex)
  • multiple pregnancies- GDM, miscarriage, twin issues, prematurity
  • risk of ovarian cancer
61
Q

What does hyperprolactinaemia do?

A
  • causes amenorrhoea and galactorrhea
  • high serum prolactin but normal FSH and LH
  • give Cabergoline but stop when pregnant
62
Q

What are the features of ovarian failure?

A
  • no more eggs
  • uncommon <40y
  • causes are genetic so Turners, fragile X or autoimmune
63
Q

What is the treatment for ovarian failure?

A

HRT (combined pill)

64
Q

What is the investigation for ovarian failure?

A

progesterone challenge: menstrual bleed after 5 day progesterone so the oestrogen levels are normal

65
Q

What does increased weight do in terms of infertility?

A
  • increased risk of miscarriage
  • decreased fertility
  • decreased success of fertility treatments
66
Q

What are the medications that should be given in pregnancy?

A
  • folic acid 400micrograms during and before the 1st trimester
  • supplement 10micrograms vit D
67
Q

What should be screened for in those trying to conceive that seem infertile?

A

Rubella and Chlamydia

68
Q

What is hydrosalphinx?

A

water/fluid in the tube to blockage and distention of the tube so removal or undo the blockage with a coil

69
Q

What effect does hydrosalphinx have?

A

decreases IVF ability and increases miscarriage risk

70
Q

What surgery is done for endometriotic costs or polyps?

A

endometriotic cyst- laparoscopic surgery

polyp- myosure surgery

71
Q

What is the process of IVF?

A
  • ovarian stimulation and retrieval
  • sperm retrieval by epididymus extraction
  • IVF
  • embryo transport
72
Q

What is the function of the gonads?

A

to make sperm and release testosterone which is unbound

73
Q

Where is testosterone produced from?

A

by Leydig cells under the control of LH and most of it is bound to SHBG or albumin

74
Q

What can testosterone be converted to?

A

dihydrotestosterone and oestradiol (cardio protective)

75
Q

What is male hypogonadism?

A

low/reduced testicular function with testosterone deficiency

  • common with age
  • primary is a testes problem
  • secondary is a hypothalamus or pituitary problem
76
Q

What are the features of primary hypogonadism?

A
  • high LH and FSH but low testosterone production
  • so there is negative feedback
  • spermatogenesis is the most affected
  • is hypergonadotrophic hypogonadism
77
Q

What are the causes of primary hypogonadism?

A
  • Klienfelter’s syndrome
  • undescended testes
  • torsion
  • trauma
  • chemo
  • varicoele (enlarged testicular vein
  • haemochromatosis
78
Q

What are the features of Klienfelter’s syndrome?

A
  • non-inherited, caused by nondisjunction
  • presentation is variable
  • diagnosis is by karyotyping
  • increases risk of learning difficulties
79
Q

What are the symptoms of Klienfelter’s syndrome?

A
  • men are infertile due to tubular damage
  • small, firm testes
  • frontal baldness abscent
  • poor beard growth
  • wide hips and narrow shoulders
  • long arms and legs
  • female pubic hair distribution
80
Q

What are the features of secondary hypogonadism?

A
  • testes are capable of normal function but there is under stimulation as the hypothalamus and pituitary are affected
  • LH/FSH will be low or inappropriately normal despite low testosterone so not much negative feedback
  • hypogonadotrophic hypogonadism
  • spermatogenesis and testosterone production are affected equally
81
Q

What are the causes of secondary hypogonadism?

A
  • Kallmann’s syndrome
  • pituitary damage
  • hyperprolactinaemia
  • obesity and diabetes
  • medications
82
Q

What are the features of Kallmann’s syndrome?

A

isolated GnRH deficiency and reduced/no sense of smell

83
Q

What are the pre-pubertal symptoms of hypogonadism?

A
  • small male sex organs
  • decreased body hair, high voice, low libido
  • gynaecomastia
  • tall, slim, long arms and legs
  • decreased bone and muscle mass
84
Q

What are the post-pubertal symptoms of hypogonadism?

A
  • normal appearance
  • decreased erections and libido
  • decreased axillary hair
  • decreased testicular volume
  • increased boobs
  • decreased muscle and bone mass
85
Q

What are the biochemical tests for hypogonadism?

A
  • morning testosterone if symptomatic
  • if low, repeat
  • measure LH and FSH to check if it is primary or secondary
  • if high, primary
  • if low/inappropriately normal it is secondary
86
Q

What is the management of hypogonadism?

A
  • maintain sexual function
  • maintain secondary sexual characteristics
  • increase fertility
  • increased QoL
87
Q

How can testosterone replacement be given?

A
  • IM= Nebido which is long-acting or Sustain which is short-acting
  • TD= transfer
  • PO= need to be complient
88
Q

What are the contraindications for testosterone therapy?

A
  • cancer (hormone positive)
  • prostate cancer investigation
  • haemocrit >50%
  • sleep apnoea
  • HF

My Endocrinology (12 decks)

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