Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrinology > Reproductive Endcrinology > Flashcards

Reproductive Endcrinology Flashcards

1
Q

Hypothalamic-Pituitary-Gonadal Axis

A

Hypothalamus: Makes GnRH

Pituitary: Makes LH & FSH

Gonads: Make Androgens, Progesterones, Testosterones, Estrogens, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Endocrine Cells of the Testes

A
  1. Leydig cells – secrete testosterone and other androgens, estrogens and progestins
  2. Sertoli cells – spermatogenesis
    - secrete inhibin
    - form tight junctions to create a “blood-testis” barrier
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Seminal Fluid/Ejaculate Composition

- Composition comes mostly from where?

A
  • 60% Seminal vesicles: fructose, phosphorylcholine, ascorbic acid, prostaglandins
  • 20% testes: Sperm
  • 20% prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Semen analysis & parameters

A
  • Three or more samples obtained by masturbation
    after 48 hours of abstinence

Parameters:

  • Concentration
  • Motility
  • Morphology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If abnormal sperm analysis, what is the first test you run?

A

Measure:

  1. Testosterone
  2. LH
  3. FSH

Primary testicular failure: High LH & FSH, but low T

Hypogonadotrophic Hypogonadism: Low LH, FSH and T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What 2 hormones are derived from testosterone?

A
  1. Dihydrotestosterone

2. Estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What enzyme converts Testosterone to DHT?

A

5-alpha-reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Roles of DHT

A
  • Greater affinity for androgen receptor than T (more potent androgen)
  • In embryogenesis, formation of male external genitalia (low DHT can cause ambiguous genitalia)
  • Male pattern hair loss (alopecia)
  • Benign prostatic hypertrophy
  • Prostate cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Proteins that bind circulating testosterone

A

Sex Hormone Binding Globulin (SHBG): tight binding (not bioavailable, but included in total testosterone measurement)

Albumin: weak binding (testosterone is bioavailable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Testosterone Measurement

A
  • Variable throughout the day b/c of pulsatile LH release
  • Highest levels of testosterone in the morning
  • Multiple measurements recommended
  • Free Testosterone decreases with age b/c of increased production of SHBG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Signs & Symptoms of Low Testosterone

A

Common:

  • decreased libido
  • erectile dysfunction
  • regression of secondary sex characteristics

Other:

  • osteoporosis
  • decreased muscle strength
  • depression, lethargy, inability to concentrate, sleep disturbance, irritability, decreased interest in activities
  • incomplete sexual development
  • breast discomfort, gynecomastia
  • very small or shrinking testes (< 5 ml)
  • infertility
  • mild anemia
  • decreaed spontaneous erections
  • hot flushes, sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Causes of Primary Hypogonadism in Males

**What test should your perform if suspect primary hypogonadism?

A
  • Klinefelter’s Syndrome
  • Mumps orchitis
  • Testicular trauma (bicycle accident)
  • Radiation
  • Autoimmune disease
  • Drugs (cyclophosphamide, chemotherapy)

** If low T with high LH/FSH: KARYOTYPE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Characteristics of Klinefelter’s Syndrome

A

Karyotype: XXY

  1. Sparse facial & body hair
  2. Gynecomastia
  3. Small, firm testes: seminiferous tubules undergo fibrosis and hyalinization
  4. Female body habitus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of Secondary Hypogonadism in Males

**What test should your perform if suspect secondary hypogonadism?

A
  • Pituitary disorders:
    tumor, trauma, infiltrative
    hemochromatosis (iron deposition)
    hyperprolactinemia
    hypopituitarism
  • Hypothalamic tumor/trauma
  • Critical illness: ** if acute or subacute, do not make diagnosis of androgen deficiency
  • Congenital disorders of gonadotropin secretion (i.e. Kallmann’s Syndrome with anosmia)
  • Drugs (marijuana, heroin, opiates, progesterone)

** if low T, LH/FSH: measure PROLACTIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adverse Effects of Testosterone Therapy

A
  1. Erythrocytosis: Increase in RBC mass
    - up to 44% with IM injections
  2. Skin reactions: high incidence with patch; low incidence with gel
  3. Acne (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Gynecomastia (definition & mech)

A
  • Enlargement of glandular breast tissue

Mechanism: imbalance between free androgen and estrogen in breast tissue
- Can have either low androgen, or too much estrogen

17
Q

Pseudogynecomastia

A

Subareolar fat

18
Q

Aromatase

A

Enzyme that converts testosterone to estradiol

19
Q

Hypothalamic Regulation & GnRH

A
  • GnRH is released in a pulsatile manner
  • varies throughout menstrual cycle
    • estradiol (low), norepinephrine: increase GnRH release
    • progesterone, dopamine, opioids, serotonin: decrease GnRH release

GnRH agonists (continuous GnRH release) suppresses reproductive axis. You want want to do this for:

  • precocious (early) puberty
  • endometriosis (ectopic endometrial tissue)
  • prostate cancer – androgen blockade

Clomiphene – antiestrogen; removes negative feedback
- Ovulation induction by ↑ FSH and LH

20
Q

Polycystic Ovarian Syndrome

  • classic presentation?
  • treatment?
A

Presentation:

  • Obese young woman
  • Infertility
  • Oligomenorrhea
  • Hirsutism
  • May develop Type 2 Diabetes Mellitus

Characterized by increased LH, but low FSH
** increased frequency of GnRH pulses favors LH > FSH

Definition: At least 2 out of 3: (diagnosis of exclusion)

  1. amenorrhea or oligomenorrhea (<9 menses/year)
  2. hyperandrogenemia (high testosterone levels) or clinical hyperandrogenism (hirsutism, acne, male-pattern hair loss)
  3. polycystic ovaries on ultrasound

Treatment:
- start with weight loss

21
Q

Match Condition with Lab Test:

  1. Hyperprolactinemia
  2. Non-classical congenital adrenal hyperplasia
  3. Cushing’s
  4. Androgen secreting tumor
  5. Acromegaly
A

Lab Test:

  1. Prolactin
  2. 8 am 17-OH Progesterone
  3. 24 hour urine of free cortisol
  4. Testosterone, DHEA-S
  5. IGF-1
22
Q

Primary Amenhorrhea

  • Definition
  • Causes
A

Definition: Lack of menses by age 16

  1. Pregnancy: ✓ Serum hcg
  2. Turner’s Syndrome ✓ Karyotype (XO)
  3. Ovarian Failure ✓ High FSH
  4. Hyperprolactinemia ✓ Prolactin
  5. Hypothyroidism ✓ TSH
23
Q

Turner’s Syndrome

A

Physical:

  • Streak–like gonads
  • short stature
  • webbed neck
  • shield chest
  • low set ears
  • ptosis
  • short 4th metatarsals/carpals

Karyotype: XO or mosaic

Treatment

  • Estrogen at age 12-13
  • Progesterone added at age 14
  • Growth hormone (increased height)
24
Q

Congenital Adrenal Hyperplasia

A
  • Due to enzymatic deficiency of 21-Hydroxylase
  • 21-Hydroxylase is required for conversion of:
    1. Progesterone to Mineralocorticoids (Aldosterone)
    2. 17-OH Progesterone to Glucocorticoids (Cortisol)

Clinical:

  1. Ambiguous Genitalia: b/c Hormone production is shunted to the sex hormones
  2. “Salt losers”: insufficient aldosterone
    - hyponatremia (Na+)
    - hyperkalemia (K+)
    - acidosis
    - dehydration
    - vascular collapse
  3. Impaired cortisol biosynthesis
25
Q

Hirsuitism

  • definition
  • cause
  • labs
A
  • Excessive terminal hair in a male pattern on a woman (abdomen, back, chest)
  • results from the interaction between androgens and the hair follicles w/ increased androgen sensitivity

Labs:

  • no labs for idiopathic: mild, w/ regular menses
  • FREE TESTOSTERONE is the best initial lab (because androgens and insulin lower SHBG, such that the total testosterone may be normal)
26
Q

Hypertrichosis

A
  • generalized excessive hair growth in a non-sexual pattern due to hereditary or medications (glucocorticoids, phenytoins, minoxidil or cyclosporine)
    • not caused by excessive androgen
27
Q

Endocrine Treatment for Transexual Females

- i.e., Male to Female

A

TREATMENT
- Estradiol valerate (transdermal E2 less thrombogenic)
± Antiandrogens (spironolactone, cyproterone acetate)
± Medroxyprogesterone acetate 5-10 mg/d

LAB MONITORING

  • Testosterone
  • Estradiol
  • Lipids and LFTs
  • Prolactin

SCREENING
± PSA
- DXA bone density
- consider mammogram (breast cancer 1 in 2200)

28
Q

Endocrine Treatment for Transexual Males

- i.e., Female to Male

A

TREATMENT

  • Testosterone esters 200 mg IM q 2 weeks
  • Transdermal testosterone 5 g/day ± progesterone

LAB MONITORING

  • Testosterone
  • Lipids
  • LFTs
  • Glucose
  • Hematocrit

SCREENING

  • Pelvic exam with Pap smears
  • Endometrial ultrasounds
  • DXA bone density
29
Q

Legitimate uses of Anabolic Androgenic Steroids

A
  1. Osteoporosis: ↑ bone mineral density
  2. Hematopoietic:
    - Anemia of end-stage renal disease (ESRD); erythropoietin dependent and independent
    - Aplastic anemia
    - Fanconi anemia
  3. Growth: Constitutional delay of growth and puberty
  4. Muscle wasting disorders: AIDS and cancer
30
Q

How AAS can improve athletic performance

A 
1. Muscle Hypertrophy:
↑ muscle fiber diameter
↑ lean body mass
- Positive nitrogen balance
- Retention of potassium, phosphates and sulfates
  1. Blood Volume: ↑ red cell mass
  2. Glucocorticoid Receptor Antagonists: Inhibit catabolism
  3. Central Nervous System: Function of androgen receptors in the brain is unclear
31
Q

Physiological/Hormonal Effects of AAS

A
  • Testosterone increased
  • SHBG: dereased
  • Estradiol: increased
  • LH & FSH: shut down
  • Hematocrit: slight increase

Liver Function Tests:

  • ALT: increased
  • AST: increased

Lipids:
- HDL: decreased

32
Q

Adverse effects of AAS

A
  • Acne
  • Oily skin
  • Infertility
  • Liver toxicity
  • Mood swings & cognitive impairment

Women:

  • Anovulation
  • Amenorrhea

Men:

  • Testicular atrophy
  • Gynecomastia

Serious but rare:

  • Hepatocellular adenoma and carcinoma
  • Peliosis Hepatis: blood-filled cysts in liver or spleen
  • High doses can induce mania or severe depression
33
Q

Detecting AAS in Urine Samples

A
  • use chromatograph or mass spectrum of substance

- measure Testosterone:Epitestosterone (T:E) Ratio (Normal is 1:1; elevated to 8:1 after injection)

Endocrinology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions