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Endocrine > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Features of PCOS

A 
Oligomenorrhoea/amenorrhoea
Hyperandrogenism (hirsutism, acne, alopecia)
Polycystic ovaries
Obesity
Acanthosis nigricans
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2
Q

What triggers menarche?

A

Increases in GnRH

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3
Q

Theca cells produce:

A

Androgens (stimulated by LH)

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4
Q

What do granulosa cells do?

A

Convert androgens to oestradiol (via aromatase, stimulated by FSH)

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5
Q

FSH is inhibited by:

A

Oestrogen

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6
Q

Effects of progesterone

A

Prepares endometrium
Increases basal body temperature
Increases thickness of mucus
Inhibits FSH and LH

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7
Q

Cause of PCOS

A

Hyperinsulinaemia due to obesity

Insulin causes theca cells to secrete androgens, = increased androgens and oestrogen = disordered FSH/LH release

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8
Q

Investigations for PCOS

A 
Transvaginal US
Endocrine profile (FSH, LH, GnRH, oestrogen, TSH, T4, androgens, BG)
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9
Q

Management of PCOS

A

Weight loss, Metformin
Ovulation induction - clomifene citrate (stimulates release of FSH)
Ovarian drilling
OCP/anti-androgen

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10
Q

Effect of being underweight on GnRH:

A

Hypothalamic pituitary axis disturbed = less GnRH = less FSH and LH = no ovulation

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11
Q

Investigating anorexia and amenorrhea:

A 
Hormone levels (LH, FSH, TSH, T4, PRL, androgens)
Pregnancy test
FBC and iron studies
U&Es
Ca and Vit D
BG
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12
Q

Causes of POF

A

Idiopathic, Turner’s, adrenal insufficiency, thyroid disease, iatrogenic, FRAX

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13
Q

POF

A

Menopause

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14
Q

Investigations for POF

A

Endocrine profile (FSH, LH, TSH, T4, PRL, androgens, oestrogen)

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15
Q

Management of POF

A

HRT (prevents osteoporosis and CVD)
Assisted conception
IVF

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16
Q

Define Infertility

A

Failure to conceive after 12 months in a couple who have never had a child

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17
Q

Primary infertility

A

Never conceived in the past

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18
Q

Secondary infertility

A

Conceived in the past

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19
Q

Rubella syndrome

A

Rash, low birth weight, small head, cataracts, patent ductus arteriosus, bulging fontanelle

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20
Q

Treatment of chlamydia

A

Azithromycin OR doxycycline

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21
Q

When does progesterone peak?

A

8 days after LH surge

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22
Q

How do you assess presence of ovulation?

A

Midluteal serum progesterone

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23
Q

Type I ovulatory disorder

A

Hypogonadotropic hypogonadism - lesion in hypothalamus or pituitary failure = decreased GnRH = decreased FSH and LH = low oestrogen
Stress, anorexia, exercise, Kallman’s, drugs

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24
Q

Type II ovulatory disorder

A

Normogonadotropic hypogonadism - hypothalamic/pitutiary dysfunction. High LH, normal oestrogen
PCOS

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25
Q

Type III ovulatory disorder

A

Hypergonadotropic hypogonadism - Ovarian failure = high FSH and LH, low oestrogen
Turne’s syndrome, POF

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26
Q

Which types of ovulatory disorder can you induce ovulation?

A

Types I and II

III needs egg donation/IVF

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27
Q

Ovulation induction

A

Clomifene citrate (anti-oestrogen - 5 days)
Tamoxifen (anti-oestrogen)
Letrozole (aromatase inhibitors)
Metformin
Gonadotrophin therapy
Laparoscopic ovarian diathermy (normalies LH)

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28
Q

Obstructive causes of male infertility

A

Vasectomy, infection (Chlamydia, gonorrhoea), absence of vas deferens

29
Q

Non-obstructive causes of male infertility

A

undescended testes, orchitis (mumps), torsion, trauma, Klinefelter’s, Kartageners, chemo, radio

30
Q

Hormonal causes of male infertility

A

Hypogonadotrophic hypogonadism (anorexia, Kallman’s), hypothyroidism, hyperprolactinaemia, testicular cancer, acromegaly, Cushing’s

31
Q

Treatment of male infertility

A

Surgery (obstruction), Intrauterine insemination, donor insemination

32
Q

Causes of ovarian tubal disease

A

PID (chlamydia, gonorrhoea, syphilis, TB), transperitoneal spread, iatrogenic
Endometriosis, iatrogenic, polyps, congenital

33
Q

Good prognosis for infertility

A

Less than 30 years
Short duration of infertility
Secondary infertility

34
Q

Bad prognosis for infertility

A

Male infertility, endometriosis, tubal factor infertility

35
Q

Symptoms of POF

A

Hot flushes, night sweats, Atrophic vaginitis, amenorrhoea

36
Q

Endometriosis

A

Endometrial glands outside uterine cavity = dysmenorrhoea, dyspareunia, painful defecation, pelvic pain, retroverted uterus

37
Q

Features of obstructive male infertility:

A

Normal testicular volume, secondary sexual characteristics, vas deferens may be absent
Normal LH, FSH and testosterone

38
Q

Features of non-obstructive male infertility:

A

Low testicular volume, reduced secondary sexual characteristics, vas deferens present
High LH and FSH, low testosterone
(Klinefelter’s, undescended testes)

39
Q

Define oligomenorrhoea

A

Cycle over 35 days

40
Q

Functions of FSH

A

Follicle development
Endometrial thickening
Spermatogenesis

41
Q

Functions of LH

A

Stimulates ovulation and corpus luteum development
Thickens endometrium
Testosterone production

42
Q

Where is oestrogen secreted?

A

Ovaries, adrenal cortex, placenta

43
Q

Functions of oestrogen

A

Thickens endometrium
Fertile cervical mucus
Inhibits FSH and PRL
Stimulates LH

44
Q

Where is progesterone secreted?

A

Corpus luteum, placenta

45
Q

Functions of progesterone

A 
Maintains thickness of endometrium
Infertile (thick) cervical mucus
Increases basal body temperature
Relaxes smooth muscles
Inhibits LH
46
Q

How do you test oestrogen deficiency in hypothalamic-pitutiary failure?

A

Negative progesterone challenge test (no bleed)

47
Q

Treatment of Type I infertility

A

Stabilise weight over 18.5 BMI
Pulsatile GnRH
FSH and LH injections

48
Q

Risks of ovulation induction

A

Multiple pregnancy = increased complications (miscarriage, hyperemesis, pre-eclampsia, low birth weight, prematurity, stillbirth, TTTS)
Ovarian cancer

49
Q

Signs in monochorionic and dichorionic twins

A

Monochorionic - T sign

Dichorionic - Lambda sign

50
Q

TTTS

A

Unbalance vascular communications in placental bed - recipient gets oligohydramnios, growth restriction

51
Q

Findings in hyperprolactinaemia

A

Amenorrhoea, galactorrhoea
Normal FSH, LH
Low oestrogen
Raised PRL

52
Q

Treatment of hyperprolactinaemia

A

Dopamine agonist, e.g. cabergoline or bromocriptine

Stop in pregnancy

53
Q

Define primary amenorrhoea

A

Failure of menarche by 16 years

54
Q

Define secondary amenorrhoea

A

Cessation of periods for >6 months, previously menstruated

55
Q

Causes of amenorrhoea

A

Pregnancy, post-menopause, Turner’s, PCOS, POF, anorexia, stress, exercise, high PRL, hypopituitarism

56
Q

What stimulates GnRH secretion?

A

Kisspeptin

57
Q

Kallman’s syndrome

A

Secondary hypogonadism - loss of GnRH and anosmia
Males
No olfactory bulbs

58
Q

Features of Turner’s

A

Webbed neck, short stature, normal adrenarche, amenorrhoea, underdeveloped breasts, constriction of aorta, lymphoedema, IBD, osteoporosis, OM

59
Q

Features of Klinefelter’s

A

Reduced testicular volume, gynaecomastia, azoospermia, low testosterone, high FSH/LH

60
Q

Benefits of testosterone replacement

A

Improved sexual function, Improved bone health, Improved muscle strength

61
Q

Where do primordial germ cells migrate to?

A

Genital ridge by week 6

62
Q

When are 1st and 2nd polar bodies formed?

A

1st - meiosis

2nd - fertilisation, 2nd meiosis

63
Q

How many oocytes are ovulated?

A

400-500

64
Q

Primary follicle

A

Single layer of granulosa cells

65
Q

Corpus luteum

A

If not fertilised dies after 14 days -> corpus albicans
If fertilisation, produces oestrogen and progesterone until placenta takes over
Maintained by HCG

66
Q

What inhibits FSH?

A

Inhibin

Oestrogen

67
Q

What inhibits LH?

A

Progesterone

Testosterone

68
Q

What cells secrete sperm?

A

Sertoli cells

69
Q

Risks of testosterone replacement

A

Prostate enlargement, polycythaemia (Hb), hepatitis

Endocrine (13 decks)

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