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life cycles > Reproductive Disorders > Flashcards

Reproductive Disorders Flashcards

1
Q

ratio of LH:FSH in early follicular phase

A

equal days 1-5

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2
Q

granulosa cells make….?

luteal cells make…?

A

estradial

androgens: DHEA, androstendione, test, progesterone

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3
Q

folliculogenesis growth factors produced by ovary?

A

inhibin –> inhibit FSH

activin –> activate FSH

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4
Q

Inhibin during different parts of cycle

A

inhibin a –> luteal phase

inhibin b –> follicular phase

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5
Q

How to evaluate a woman with distrubance in menstrual cycle? (5 things)

A
  • exclude pregnancy with BhCG
  • r/o prolactinoma
  • androgen levels if hirsutism/acne
  • GnRH stim only in precoicious puberty
  • Draw LH/FSH in first 5 days after menses
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6
Q

If there’s no menses, what can you use to induce bleeding?

A

medroxyprogesterone or estrogen + prog to trigger a follicular phase

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7
Q

hypogonadotropic hypogonadism (labs)

A
  • low LH, FSH, estradiol

- amenorrhea

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8
Q

hypothalamic amenorrhea

A
  • acquired GnRH def of pulses
  • most common
  • due to stress, exercise, poor nutrition
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9
Q

hypergonodotropic hypogonadism (labs)

A
  • high FSH and/or LH
  • low estradiol
  • amenorrhea
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10
Q

hypergonodotropic hypogonadism (types)

A
  • turners

- premature ovarian insufficiency

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11
Q

premature ovarian insufficiency

A

Ovarian failure before age 40

-req eventual HRT

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12
Q

signs and sx of POI

A
  • irregular menses without molimal sx
  • FSH rise BEFORE LH rise (loss of inhibin)
  • look for other AI d/os
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13
Q

hyperandrogenic anovulation - what can cause this?

A

PCOS
tumors
obesity induced anovulation

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14
Q

PCOS (labs)

A

timed gonadotropin levels on day 1-5 of cycle

  • labs show HIGH ratio of LH/FSH > 2.5/1
  • increased androgens: test (ovarian) and DHEAS (adrenal)
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15
Q

risks assoc with PCOS

A
  • endometrial cancer (estrogen unopposed by prog)
  • insulin resistance
  • htn
  • premature cardiac dz
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16
Q

goals in PCOS treatment

A
  • ensure endometiral shedding to prevent endometrial CA

- block effects of hyperandrogenization

17
Q

Tumors that cause hirsituism

A
  • virilizing tumors of ovary make testosterone (>200ng/dl)
  • virilizing tumors of adrenal make DHEA-s (>800 ng/dl)
  • RAPID ONSET/ pace of sx like male pattern balding, hair on chest and back, clitorromegally
18
Q

obesity induced anovulation

A
  • often misdx for PCOS
  • normal puberty cycle until they exceed weight set point –> develop acne and hirsituism
  • will have NORMAL/EQUAL LH/FSH
  • xsaromatase and 5areductase activity in fat tissue
19
Q

treatment for female hypogonadism

A
  • no treatment
  • estrogen
  • fertility drugs
  • pulsatile GnRH
20
Q

how long until bone loss occurs after onset of estrogen defeicits?

A

6 months

21
Q

Estrogen therapy

A

-BCP

22
Q

how is estrogen therapy used in congenital defects?

A

low dose E alone for 12-18 mo to develop breasts

-add prog in cyclic fashion to develop ductules

23
Q

progesterone alone therapy?

A

use for dysfunctional uterine bleeding and hyperandrogenic anovulation in pt who are not esstrogen deficient

24
Q

HRT in women with POI?

A

give est and prog in physiologic manner similar to menopausal hormone therapy

25
Q

clomiphene citrate (clomid)

A
  • fertility drug
  • mixed estrogen agonist/antagonist
  • augments folliculogensis in pts with muted GnRH pulse generator
  • fools repro axis into thinking there is est deficiency
26
Q

on what days of the cycle and at what dose d you give clomiphene citrate

A

5-9

50-150 mg/day

-must monitor for anti-est effects on cervical mucus and ovulation rates

27
Q

drug combo that stimulates folliculogenesis and ovulation for in vitro prp

A 
human gonadotropins (pergonal) or recombinant FSH (menotropin) + hCG (profasi)
-monitor with daily blood samples
28
Q

pulsatile GnRH tx

A
  • to induce ovulation in women with hypothalamic amenorrhea to replace bunk GnRH pulse generator
  • IV admin with mump to mimic cycle signals
29
Q

fertility drugs in women with PCOS

A
  • prog
  • GnRH agonist –> continuious Lupron to downreg GnRH receptor
  • give above for ONE MONTH to suppress endogenous GnRh
  • then give pulsative GnRH
  • metformin or thiazoladinedione to improve ovulation rates

life cycles (16 decks)

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