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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
Peripheral Congenital causes of delayed puberty
1. Turner's Syndrome (X0) 2. Klinefelter's syndrome (XXY) 3. Anorchia 4. Sex steroid biosynthesis problem 5. Myotonic dystrophy
26
Peripheral Acquired causes of delayed puberty
1. Surgery 2. Radiation 3. Chemo 4. Bilateral gonadal torsion 5. Orchitis/oophoritis
27
Investigations for delayed puberty`
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
Treatment for delayed puberty
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
Precious puberty definition
Appearance of secondary sex characteristics in Girls less than 8 Boys less than 9
30
Central causes of precious puberty
1. Idiopathic (*most common) 2. CNS tumors 3. CNS disorders (meningitis, trauma)
31
Peripheral causes of precocious puberty
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
Investigations for precious puberty
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
Thelarche
Isolated breast developement in girls
34
Adrenarche
Early pubic hair due to premature (benign) androgen secretion
35
McCune Albright Sydrome
Activating mutation causes ovarian estrogen production | Cafe au lait spots, polyostotic fibrous dysplasia, early breasts
36
Familial testotoxicosis
activating mutation of LH receptor
37
46 XX DSD
Virilized female due to: 1. 21-OH deficiency-CAH 2. Ovarian neoplasm (rare) 3. Maternal androgen (PCOS, steroids, neoplasm)
38
46 XY DSD
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
What changes Sex Hormone Binding Globulin levels and what is the effect?
1. Increase: oral estrogen, pregnancy. In men: cirrhosis, hyperthyroid 2. Decrease: Androgens, obesity, insulin ``` Decrease= more free T= hirsutism Increase= less free T ```
40
Causes of hirsutism in women
1. *Virilizing adrenal adenoma 2. * Adrenal carcinoma 3. * Cushing's 4. Exogenous androgen 5. Endogenous decrease in SHBG
41
How are PCOS and Cushing's Differentiated?
1. Cushings= Anabolic disease - thin skin - myopathy - osteoporosis 2. PCOS= catabolic disease - thick skin - no myopathy - no osteoporosis
42
Investigations hirsutism
1. Free androgen index (can calc free T) 2. DHEAs- if suspicious adenoma 3. Cortisol- if suspicious Cushing's
43
Treatment Hirsutism
1. Anti-androgens: block DHT binding (Spironolactone) 2. Ovarian suppression (OCP) 3. Weight loss 4. Block conversion T (finasteride)
44
Causes of androgen deficiency in men
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
Most specific hx features for androgen deficiency in men
Decreased ejaculate volume | Decreased libido
46
Treatment low androgens in men
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
What causes gynecomastia in men?
1. Increase in estrogen 2. Decrease testosterone 3. Androgen receptor defect 4. Increase SHBG

Endocrine (12 decks)

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