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Endocrinology > Reproductive > Flashcards

Reproductive Flashcards

1
Q

What is polycystic ovarian syndrome (PCOS)?

A

Disease characterised by excess ovarian androgen production

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2
Q

What is the pathophysiology of polycystic ovarian syndrome (PCOS)?

A

Poorly understood but related to insulin resistance

Insulin increases LH secretion

Insulin lowers sex-hormone binding-globulin increasing free testosterone

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3
Q

How is polycystic ovarian syndrome (PCOS) diagnosed?

A

2 or more of

  • oligo/amenorrhoea
  • polycystic ovaries on US
  • hyperandrogenism (acne, oily skin, hirsutism)
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4
Q

What would you expect to see with the following blood tests in polycystic ovarian syndrome (PCOS)?

  • LH
  • FSH
  • oestrogen
  • testosterone
  • progesterone
A 
LH: high
FSH: low
(high LH:FSH ratio)
Oestrogen: normal
Testosterone: high
Progesterone: high
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5
Q

What are the treatments for polycystic ovarian syndrome (PCOS)?

A
  1. Lifestyle modification
  2. Clomifene citrate + metformin
  3. Gonadotrphin injection or ovarian drilling
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6
Q

What risk does ovulation induction pose?

A

Multiple pregnancy (twin-twin-transfusion-syndrome, perinatal mortality, prematurity)

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7
Q

What is idiopathic hypogonadotrophic hypogonadism (IHH)?

A

Inability to activate GnRH secretion causing hypogonadism

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8
Q

What is Kallman’s syndrome?

A

Inability to activate GnRH secretion causing hypogonadism, delayed puberty and anosmia

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9
Q

What is Turner’s syndrome and what is its phenotype?

A

Genetic XO karyotype

Short, webbed neck, shield chest, low ears

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10
Q

How does Turner’s syndrome cause amenorrhoea?

A

Chromosomal abnormality (XO) causes gonadal dysgenesis resulting in non-functioning ovaries.

If this occurs in childhood = primary amenorrhoea

If this occurs in adulthood = secondary amenorrhoea

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11
Q

How does Turner syndrome affect pubertal development?

A

No breast development (if ovaries fail in childhood)

Pubic hair development spared as androgen production functioning

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12
Q

What is primary amenorrhoea and what does it raise suspicion of?

A

No periods by 16

Underlying genetic disorder

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13
Q

What gene is associated with idiopathic hypogonadoptrophic hypogonadism (IHH)?

A

Kisspepsin gene

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14
Q

What is secondary amenorrhoea and what causes it?

A

Cessation of periods

Problem with HPO axis (hypothalamus, pituitary, ovaries) or the uterus

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15
Q

What can cause functional hypothalamic amenorrhoea?

A

Stress
Excessive exercise
Low bMI

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16
Q

What pituitary problems can cause amenorrhoea?

A

Prolactinoma
Panhypopituitarism
Infarction (apoplexy, Sheehan)

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17
Q

What is premature ovarian failure and what can cause it?

A

Menopause before 40 years

Chromosomal abnormalities (e.g. Turners)

Pelvic radio/chemotherapy

18
Q

What blood test is used to confirm pregnancy?

A

Human chorionic gonadotrophin

19
Q

What blood test is used to confirm ovulation?

A

Mid-luteal (d21) progesterone

20
Q

What test confirms normal oestrogen levels?

A

Progesterone challenge test

menstrual bleed 5 days after progesterone course confirms normal oestrogen levels

21
Q

What are the three classifications of anovulation and what pattern would they show on blood tests?

A

Hypothalamic-pituitary failure (Group I)

  • low gonadotrophin
  • normal prolactin
  • low oestrogen

Hypothalamic-pituitary dysfunction (Group II)

  • abnormal gonadotrophin (e.g. high LH:FSH ratio in PCOS)
  • possible high prolactin (e.g. prolactinoma)

Ovarian failure (Group III)

  • high gonadotrphin
  • low oestrogen
22
Q

What blood tests would you do in a patient with irrefular menstrual cycles?

A

Pregnancy test (hCG)

Confirm if ovulation (mid-luteal progesterone)

If anovulatory, classify it with

  • gonadotorphin
  • prolactin
  • oestrogen

Measure thyroid status (thyroid dysfunction can cause ovulatory disorders)

23
Q

What can cause hypothalamic-pituitary failure anovulation (group I)

A

Physioloigcal stress

Pituitary tumour

Idiopathic hypogonadotrophic hypogonadism

24
Q

How can ovulation be induced in patients with hypothalamic-pituitary failure anovulation (group I)?

A

Pulsatile GnRH (subcutaneous pump)

Gonadotrophin injection

25
Q

What does gonadotrophin injection replacement therapy carry a risk of?

A

Multiple pregnancy

26
Q

What are symptoms of oestrogen deficiency?

A

Flushing
Painful sex
Fatigue
Amenorrhoea

27
Q

What is Klinefelter’s syndrome?

A

Karyotype 47 XXY resulting in primary hypogonadism

28
Q

How does Klinefelter’s present

  • clinically?
  • biochemically?
A

Tall
Gynaecomastia
Reduced testivular volume
Infertility to due azoospermia

High LH/FSH
Low testosterone

29
Q

How does Klinefelter’s syndrome affect pubertal development?

A

Normal puberty but low testicular volume

30
Q

What are indications for testosterone replacement?

A

Young men with hypogonadism

31
Q

Testosterone replacement will restore fertility if used early enough. True or false?

A

False

Does not restore fertility, may even have contraceptive action

32
Q

What risks does testosterone replacement therapy carry?

A

Exacrerbate prostate cancer (doesn’t cause, just worsens)

Polycythaemia risking blood clots

33
Q

What are the functions of

  • germ cells?
  • sertoli cells?
  • leydig cells?
A

Germ cells
- Undergo meiosis/differentation to form spermatozoa

Sertoli cells

  • Stimuletd by FSH to produce androgen binding globulin and inhibin
  • Support germ cells

Leydig cells
- stimulated by LH, produce testosterone

34
Q

What cells produce testosterone and what stimulates them to do it?

A

Leydig cells

LH

35
Q

Describe the steps involved in the formation of oestrogen.

A

LH acts on ovarian theca cells to uptake cholesterol and convert it to androgen
(activin - , inhibin +)

FSH acts on granulosa cells to activate aromatase which converts the androgen to oestrogen
(activin + , inhibin -)

36
Q

What are the functions of

  • inhibin
  • activin?
A

Inhibin
- inhibits oestrogen production in granulosa cells
- inhibits LH/FSH release
(- stimulates androgen production in theca cells)

Activin
- stimulates oestrogen production in granulosa cells
- stimulates LH/FSH release
(- inhibits androgen formation in theca cells)

37
Q

What stimulates ovulation?

A

LH surge

38
Q

What hormone rises after ovulation?

A

Progesterone

produced by coprus luteum

39
Q

What hormone rises first?

A

FSH

40
Q

What causes the LH surge?

A

Positive feedback of oestrogen on LH release

Endocrinology (10 decks)

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