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Endocrine > Reproductive > Flashcards

Reproductive Flashcards

1
Q

What phases does the ovum go through

A
  1. Follicular recruitment
  2. Selection of the dominant follicle
  3. Ovulation
  4. Corpus luteum
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2
Q

FSH stimulates which cells to produce which substance?

A

Granulosa cells

Estradiol

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3
Q

LH stimulates which cells to produce which substance?

A

Theca cells

Androgen (precursor to estradiol)

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4
Q

What is the effect of granulosa cell activin secretion?

A

Suppresses LH action in ovary, so limited estrogen can be produced in first 5 days of cycle

This helps dominant follicle grow

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5
Q

What is the effect of inhibit secretion by granulosa cells?

A

Turn on LH in the ovary

Allows production of androgen precursors by theca cell, which allows estradiol production by granulosa cells

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6
Q

What does the corpus luteum secrete?

A

Progesterone

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7
Q

What are the two major functions of the ovary?

A
  1. Gamete maturation

2. Sex steroid synthesis

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8
Q

What important enzymes participate in sex steriod biosynthesis?

A

17-hydroxylase: first step in directing progesterone down androgren path

Aromatase: Converts androgen to estradiol

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9
Q

What is the major ADRENAL androgen?

A

DHEA: weak androgen

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10
Q

What gene determines if gonads develop into ovaries or testes?

A

SRY gene: presence means differentiation into testes

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11
Q

What is the precursor to internal female reproductive organs (not ovaries)

A

Mullerian Ducts

Development determined by ABSENCE of anti-Mullerian Hormone (produced by Sertoli cells)

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12
Q

What triggers ovulation

A

Brief surge in LH for ~2 days prior

Partially causes by POSITIVE feedback effect of high levels of estradiol

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13
Q

Which hormones influence the growth of the endometrium?

A

Estradiol from ovaries grows

Progesterone from corpus luteum arrests

Lack of progesterone & estrogen lead to degeneration

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14
Q

What are the five causes of amenorrhea

A
  1. Outflow tract obstruction
  2. Ovarian failure (premature or menopause)
  3. Hypothalamic amenorrhea
  4. Hyperprolactinemia
  5. Polycystic ovarian syndrome
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15
Q

Outflow tract obstruction

A
  1. Should pick up on history

2. If had some sort of bleed, RULES OUT

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16
Q

Hypothalamic amenorrhea

A
  1. Not enough GnRH to maintain pulses
  2. Causes: Nutrition, stress, exercise
  3. Low/Normal FSH/LH/prolactin
  4. No response to progesterone challenge (low estrogen)
  5. Treat underlying cause, can recover
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17
Q

Premature Ovarian Failure

A
  1. Cessation of menstruation prior to age 40
  2. Causes: immunological, Turner’s, fragile X
  3. High FSH, low estrogen
  4. May recover cycles
  5. Tx with physiological hormone replacement
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18
Q

Polycyclic ovarian syndrome

A

Cause: androgen too early, means estrogen too early, means FSH stopped too early, follicles arrested too early in cycle
Effect: chronic estrogenization

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19
Q

Clinical features PCOS

A 
Oligomenorrhea/amenorrhea
Insulin resistance 
Hirsutism
Acne
Alopecia
20
Q

Diagnostic criteria PCOS

A

Hyperandrogenism (clinical and lab)
Exlcusion of other causes: prolactin, pregnancy, 17-OH P, Cushings
Polycystic ovaries on ultrasound

21
Q

Treatment PCOS

A

Lifestyle modification (weight loss will help)
OCP if not wanting babies
Progesterone with goal of period every 3mo
If want babies induce ovulation using clomiphene

22
Q

Complications of PCOS

A

Prenatal: IUGR
Childhood: premature adrenarche, insulin resistance
Adolescence: menstrual chaos, hirsutism, acne, dyslipidemia
Repro: infertility, endometrial cancer
Post-meno: CV disease
Other: sleep apnea, depression, hepatic steatosis

23
Q

Delayed puberty definition

A

Girls: no secondary sex characteristics by age 13, amennorhea by age 16, greater than 5 years from puberty to menarche

Boys: no secondary sex characteristics by age 14, greater than 5 years from start to finish puberty

24
Q

Central causes of delayed puberty

A
  1. Constitutional: family hx
  2. Hypopituitarism: PROP-1 or lesion
  3. Gonadotrophin deficiency: Kallman, Prader-Willi
  4. Function/acquired: radiation/illness
25
Q

Peripheral Congenital causes of delayed puberty

A
  1. Turner’s Syndrome (X0)
  2. Klinefelter’s syndrome (XXY)
  3. Anorchia
  4. Sex steroid biosynthesis problem
  5. Myotonic dystrophy
26
Q

Peripheral Acquired causes of delayed puberty

A
  1. Surgery
  2. Radiation
  3. Chemo
  4. Bilateral gonadal torsion
  5. Orchitis/oophoritis
27
Q

Investigations for delayed puberty`

A
  1. FSH/LH (central issue?)
  2. Testosterone/Estradiol
  3. Bone Age: (rule in constitutional)
  4. Karyotype (Turners/Klinefelter’s)
  5. TSH/T4, morning cortisol, prolactin (hypopit)
  6. HCG stim in males (Do Leydig cells work?)
  7. GnRH stim: LH/FSH should only respond during puberty
  8. MRI head: (Kallman’s, mass)
  9. U/S pelvis
28
Q

Treatment for delayed puberty

A
  1. Reassurance!
  2. Hormone replacement
  3. Males: IM T with gradual increase (Watch for side effects)
  4. Females: estradiol till bleed, then progesterone- then OCP
29
Q

Precious puberty definition

A

Appearance of secondary sex characteristics in
Girls less than 8
Boys less than 9

30
Q

Central causes of precious puberty

A
  1. Idiopathic (*most common)
  2. CNS tumors
  3. CNS disorders (meningitis, trauma)
31
Q

Peripheral causes of precocious puberty

A
  1. HCG secreting tumor
  2. Familial testotoxicosis
  3. Exogenous sex steroid exposure
  4. Congential Adrenal Hyperplasia
  5. Cushing’s
  6. Ovarian tumors
  7. McCune Albright syndrome
32
Q

Investigations for precious puberty

A
  1. Bone age (if advanced, think idiopathic central or CAH)
  2. Growth velocity (if low think benign thelarche, adrenarche, if accelerating think central idiopathic, CAH)
  3. GnRH stim (blunted LH =peripheral, increase LH=central cause)
  4. Adrenal androgens: if very high, CAH, if mildly elevated, benign adrenarche
  5. BHCG: positive if tumor
  6. Estrogen/testosterone: high
    7.
33
Q

Thelarche

A

Isolated breast developement in girls

34
Q

Adrenarche

A

Early pubic hair due to premature (benign) androgen secretion

35
Q

McCune Albright Sydrome

A

Activating mutation causes ovarian estrogen production

Cafe au lait spots, polyostotic fibrous dysplasia, early breasts

36
Q

Familial testotoxicosis

A

activating mutation of LH receptor

37
Q

46 XX DSD

A

Virilized female due to:

  1. 21-OH deficiency-CAH
  2. Ovarian neoplasm (rare)
  3. Maternal androgen (PCOS, steroids, neoplasm)
38
Q

46 XY DSD

A

Undervirilized male

  1. Inadequate androgen production (LH receptor defect, Leydig cell hypoplasia, Testicular dysgenesis, anorchia)
  2. Defect of T biosynthesis
  3. Androgen receptor defect
  4. Anti-Mullerian Hormone Deficiency
39
Q

What changes Sex Hormone Binding Globulin levels and what is the effect?

A
  1. Increase: oral estrogen, pregnancy. In men: cirrhosis, hyperthyroid
  2. Decrease: Androgens, obesity, insulin
Decrease= more free T= hirsutism
Increase= less free T
40
Q

Causes of hirsutism in women

A
  1. *Virilizing adrenal adenoma
    • Adrenal carcinoma
    • Cushing’s
  4. Exogenous androgen
  5. Endogenous decrease in SHBG
41
Q

How are PCOS and Cushing’s Differentiated?

A
  1. Cushings= Anabolic disease
    - thin skin
    - myopathy
    - osteoporosis
  2. PCOS= catabolic disease
    - thick skin
    - no myopathy
    - no osteoporosis
42
Q

Investigations hirsutism

A
  1. Free androgen index (can calc free T)
  2. DHEAs- if suspicious adenoma
  3. Cortisol- if suspicious Cushing’s
43
Q

Treatment Hirsutism

A
  1. Anti-androgens: block DHT binding (Spironolactone)
  2. Ovarian suppression (OCP)
  3. Weight loss
  4. Block conversion T (finasteride)
44
Q

Causes of androgen deficiency in men

A
  1. Primary testes issue (High LH) Klinefelter, undescended, injured
  2. Pituitary issue (Low LH) tumor, prolactin, iron deposition
  3. Hypothalamic issue (Low LH) Kallman’s, infiltrate, head trauma
45
Q

Most specific hx features for androgen deficiency in men

A

Decreased ejaculate volume

Decreased libido

46
Q

Treatment low androgens in men

A
  1. Usually treat with TRT
  2. Risks of TRT= possible CV disease, polycythemia, gynecomastia
  3. Contra: prostate nodule, LUTS, heart failure, CV event, breast cancer
47
Q

What causes gynecomastia in men?

A
  1. Increase in estrogen
  2. Decrease testosterone
  3. Androgen receptor defect
  4. Increase SHBG

Endocrine (12 decks)

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