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Endocrine > Reproductive Endocrinology > Flashcards

Reproductive Endocrinology Flashcards

1
Q

compare oogenesis and spermatogenesis in terms of how long the process takes till completion?

A

oogenesis: many years
spermatogenesis: 72 days

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2
Q

compare oogenesis and spermatogenesis in terms of where it begins?

A

oogenesis: in utero
spermatogenesis: in puberty

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3
Q

compare oogenesis and spermatogenesis in terms of cessation?

A

oogenesis: ceases at menopause
spernmatogenesis: doesnt cease

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4
Q

which process is cyclical- oogenesis or spermatogenesis?

A

oogenesis

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5
Q

what is the earliest recognisable germinal cell?

A

primordial germ cell

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6
Q

are primordial germ cells capable of mitosis or meiosis?

A

mitosis

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7
Q

where do primordial germ cells migrate to by week 6 of embryo development?

A

genital ridge

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8
Q

what female germ cells are the first cells able to undergo meiosis?

A

oocytes

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9
Q

what germ cells complete the last pre-meiotic division in order to become oocytes?

A

oogonia

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10
Q

what cells are formed when oocytes undergo their first meiotic division?

A

pirmary oocyte + first polar body

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11
Q

what cells are formed when primary oocytes undergo their second meiotic division?

A

secondary oocyte + two polar bodies

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12
Q

when does the primary oocyte undergo its second meiotic division?

A

after sperm entry

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13
Q

do sperm have equal or unequal meiosis?

A

equal

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14
Q

do oocytes have equal or unequal meiosis?

A

unequal

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15
Q

compare oocytes and sperm in terms of presence of stem cell pool?

A

oocytes- no stem cell pool

sperm- stem cell pool

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16
Q

how long is the average ovarian cycle?

A

28 days

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17
Q

what are the 2 phases of the ovarian cycle?

A

1st phase: follicular

2nd phase: luteal

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18
Q

what marks the end of the follicular phase and the beginning of the luteal phase in the ovarian cycle?

A

ovulation

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19
Q

what is the name of the single layer of granulosa cells which surrounds the primary oocyte?

A

primary follicle

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20
Q

what cells is the primary follicle made of?

A

single layer of granulosa cells

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21
Q

what is atresia of the primary follicle?

A

degeneration of follicle to scar tissue

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22
Q

the atrum is a section within the secondary follicle, what does this contain?

A

follicular fluid

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23
Q

what is lutenisation?

A

transformation of the follicular cells left behind after ovulation into the corpus luteum

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24
Q

what hormone does the corpus luteum secrete?

A

progesterone

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25
Q

how long will the corpus luteum survive if no fertilisation takes place?

A

14 days

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26
Q

what phase of the ovarian cycle does degeneration of the corpus luteum indicate?

A

the start of the follicular phase

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27
Q

what hormone produced from the hypothalamus stimulates the anteiror pituitary to secrete FSH and LH?

A

gonadotrophin releasing hormone

GnRH

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28
Q

As the follicle develops in the follicular phase, what hormone level noticeably rises?

A

oestrogen

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29
Q

what cells within the follicles produce androgens which are converted to oestradiol?

A

theca cells

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30
Q

what cells within the follicles convert the androgens into oestradiol?

A

granulosa cells

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31
Q

what hormone does oestrogen have negative feedback over?

A

FSH from the anterior pituitary gland

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32
Q

what cells within the dominant follicle express LH receptors?

A

granulosa cells

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33
Q

after the LH peak, how long is it before ovulation occurs?

A

on average 38 hours

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34
Q

what test can be done to look for ovulation using LH?

A

LH profile

-using urinary dipsticks over a few days

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35
Q

what test can be donw to look for ovulation using progesterone?

A

day 21 progesterone

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36
Q

the lack of which hormone causes the degeneration of the corpus luteum?

A

hCG

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37
Q

what is formed by the degeneration of the corpus luteum?

A

corpus albicans

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38
Q

what hormone stimulates the interstitial Leydig cells of the seminiferous tublules to produce testosterone?

A

LH

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39
Q

what hormones stimulate spermatogenesis?

A

FSH

testosterone

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40
Q

what hormones does testosterone have negative feedback control of?

A

GnRH

LH

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41
Q

where is pregnenolone produced in the ovaries? (from cholesterol)

A 
granulosa cells (oestrogen production)
corpus luteum (progesterone production)
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42
Q

what is the effect of oestrogen on the intracellular progesterone receptor?

A

increases numbers of the receptor

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43
Q

what is oligomenorrhoea?

A

reduction in frequency of periods to less than 9 per year

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44
Q

what is primary amenorrhoea?

A

by the age of 16 individual has not ever menstuated

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45
Q

what is secondary amenorrhoea?

A

cessation of periods for over 6 months in an individual who has previously menstruated

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46
Q

what are the 2 physiological causes of amenorrhoea?

A

pregnancy

post-menopausal

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47
Q

what must you consider in an individual with primary amenorrhoea?

A

congenital problem

eg Turner’s

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48
Q

what are the 4 subgroups of causes of secondary amenorrhoea?

A

ovarian cause
uterine cause
pituitary cause
hypothalmic cause

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49
Q

what are the 3 main causes of secondary amenorrhoea of ovarian cause?

A
  • polycystic ovarian syndrome
  • premature ovarian failure
  • congenital problem with ovarian development
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50
Q

what is the main cause of secondary amenorrhoea of uterine cause?

A

uterine adhesions

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51
Q

why might uterine adhesions cause secondary amenorrhoea?

A

unable to shed lining

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52
Q

what are the 2 main causes of amenorrhoea of pituitary cause?

A

high PRL

hypopituitarism

53
Q

what are the 4 mains causes of amenorrohea of hypothalmic cause?

A

weight loss
over exercise
stress
infiltrative

54
Q

what is the name of the syndrome in which individuals have an absence of periods and an inability of smell?

A

Kallmann’s syndrome

55
Q

what tests must be done in all patients with oligomenorrhoea or amenorrhoea?

A

LH, FSH, oestradiol

thyroid function, prolactin

56
Q

what is female hypogonadism?

A

low levels of oestrogen

57
Q

what is premature ovarian failure?

A

when the ovaries have become depleted of eggs early

58
Q

what are the differences between primary and secondary hypogonadism in terms of hormone levels?
(in females)

A

both have low oestrogen level

primary: high LH/FSH (hypergonadotrophic hypogonadism)
secondary: low LH/FSH (hypogonadotrophic)

59
Q

what age must amenorrhoea occur below for it to be classed as premature ovarian failure and not just post-menopause?

A

below 40 years of age

60
Q

if a patient has FSH higher than 30, what does this suggest?

A

the woman is post menopausal

61
Q

what is idiopathic hypogonadotrophic hypogonadism?

A

absent or delayed sexual development associated with low levels of gonadotrophin and sex hormones in the absence of anatomical/functional defects of hypothalamic-pituitary gonadal axis

62
Q

what is the major defect in idiopathic hypogonadotrophic hypogonadism?

A

the inability to activate pulsatile GnRH secretion during puberty

63
Q

what is kisspeptin?

A

an upstream regulator of GnRH which stimulates it’s secretion

64
Q

is Kallmann’s Syndrome hypertrophic hypogonadism or hypotrophic hypogonadism?

A

hypotrophic hypogonadism

65
Q

why can hyperprolactinaemia induce hypogonadalism?

A

increased PRL can inhibit kisspeptin neurones, this reduces GnRH levels

66
Q

what is hirsutism?

A

excess hair

if in a women, there is a male pattern hair distribution

67
Q

what is hirsutism caused by?

A

excess circulating androgen

68
Q

what are the 5 main causes of hirsutism?

A 
PCOS
familial
idiopathic
non-classical congenital adrenal hyperplasia
adrenal or ovarian tumour
69
Q

what are the red flag signs for a patient with hirsutism?

A

raipid onset hirsutism

signs of virilisation

70
Q

what is congenital adrenal hyperplasia?

A

an inherited group of disorders characterised by a deficiency in one of the enzymes necessary for cortisol

71
Q

what enzyme is deficient in 90% of cases of congenital adrenal hyperplasia?

A

21alpha-hydroxylase

72
Q

when is classic congenital adrenal hyperplasia typically diagnosed?

A

infancy

73
Q

when is non-classic congenital adrenal hyperplasia typically diagnosed?

A

adolescence/adulthood

74
Q

why do patients with congenital adrenal hyperplasia have virilisation, hirtuism and sometimes infertility?

A

due to increased levels of testosterone

75
Q

is the production of androgens in congenital adrenal hyperplasia ACTH-dependant or independent?

A

ACTH- dependant

76
Q

why are patients with late onset CAH given low dose glucocorticoid?

A

to suppress ACTH drive

reduces androgens

77
Q

what is the unusual karotype of a women with Turner’s syndrome?

A

XO

78
Q

what is gonadal dysgenesis?

A

absent ovaries but no chromosomal abnormality

79
Q

what is testicular feminisation caused by?

A

being insensitive to androgens

80
Q

compare primary and secondary male hypogonadism in terms of hormone levels?

A

both have low testosterone

primary: high LH/FSH
secondary: low LH/FSH

81
Q

what is the unsual karotype of Kleinfelter’s syndrome?

A

XXY

82
Q

does kleinfelter’s syndrome cause primary or secondary hypogonadism?

A

primary hypogonadism

83
Q

at what time of day should you measure testosterone?

A

9am

84
Q

what is Whipple’s triad and what does it indicate?

A
  • presence of symptoms of hypoglycaemia
  • documented low blood sugar
  • relievation of symptoms by glucose adminstration

(all without having taken insulin)
–> insulinoma

85
Q

what cells in the pancreas are insulinomas derived from?

A

pancreatic beta cells

86
Q

what are the 2 types of hypoglycaemic symptoms?

A

autonomic

neuroglycopaenic

87
Q

what are 3 drugs used in the management of insulinomas?

A
  • diazoxide
  • hydrochlorothiazide
  • octreotide
88
Q

compare the frequency of pulses of FSH and LH stimulated by GnRH?

A

low frequency pulses of FSH

high frequency pulses of LH

89
Q

the mid-cycle peak of LH stimulates what process?

A

ovulation

90
Q

what 3 places within the body can oestrogen be physiologically produced from?

A

follicles within ovary
adrenal cortex
placenta

91
Q

what 2 hormones does oestrogen have negative feedback upon?

A

FSH

prolactin

92
Q

what hormone does oestrogen have positive feedback upon?

A

LH

93
Q

what hormone does progesterone have negative feedback upon?

A

LH

94
Q

compare oestrogen and progesterone in terms of what they do to the cervical mucous?

A

oestrogen: makes fertile mucous
progesterone: makes (thick) infertile mucous

95
Q

what hormone has a thermogenic effect within the ovarian cycle?

A

progesterone

96
Q

what does a positive 21 day progesterone confirm?

A

ovulation

97
Q

what are the 3 WHO classifications of causes of anovulation?

A
  1. hypothalamic pituitary failure
  2. hypothalamic pituitary dysfunction
  3. ovarian failure
98
Q

is anovulation due to hypothalmic pituitary failure hypogonadotrophic or hypergonadotrophic hypogonadism?

A

hypogonadotrophic hypogonadism

99
Q

compare the levels of FSH/LH/oestrogen in a patient with hypothalamic pituitary failure causing anovulation?

A

low FSH, LH and oestrogen

100
Q

what is the result of a progesterone challenge test in a patient with hypothalamic pituitary failure causing anovulation?

A

negative

101
Q

does a patient with hypothalamic pituitary failure tend to have amenorrhoea or oligomenorrhoea?

A

amenorrhoea

102
Q

what is the primary defect in hypothalamic pituitary failure?

A

defect in production of GnRH or FSH/LH

103
Q

compare pulsatile GnRH with gonadotrophin (FSH/LH) daily injections for the treatment of hypothalamic anovulation in terms of multiple pregnancy rate?

A

pulsatile GnRH: multple pregnancy rate not increased

LH/FSH daily injections: higher multiple pregnancy rates

104
Q

what is the main problem in hypothalamic pituitary dysfunction causing anovulation?

A

inabiltiy of the ovaries to read the signals coming from the pituitary

105
Q

what WHO classification of anovulation is polycystic ovarian syndrome?

A

type 2:

hypothalamic pituitary dysfunction

106
Q

why is LH elevated in 60% of cases of PCOS?

A

the hyperinsulinaemia (caused by insulin resistance) acts as a co-gonadotrophin to LH causing increased levels

107
Q

why is there hyperandrogenism in PCOS?

A

the hyperinsulinaemia (caused by insulin resistance) lowers SHBG levels, which increases free testosterone

108
Q

compare the recommended dose of folic acid for a pregnant patient with PCOS to a pregnant patient without PCOS?

A

with PCOS: 5mg

without PCOS: 400mcg

109
Q

what are the 3 main methods of ovulation induction in PCOS?

A
  • clomifene citrate (anti-oestrogen) + metformin
  • gonadotrophin therapy
  • laparoscopic ovarian diathermy (drilling)
110
Q

what are the main 3 risks of ovulation induction?

A
  • ovarian hyperstimulation
  • multiple pregnancy
  • ovarian cancer risk
111
Q

compare monozygotic and dizygotic twins in terms of mono/di-amniotic and mono/di-chorionic possibilities?

A

monozygotic:

  • diamniotic dichorionic
  • diamniotic monochorionic
  • monoamniotic monochorionic

dizygotic:
-diamniotic dichorionic

112
Q

what does a lambda sign on ultrasound indicate?

A

dichorionic twins

113
Q

what does a T sign on ultrasound indicate?

A

monochorionic twins

114
Q

is twin-twin transfusion syndrome specific to monochorionic monoamniotic, monochorionic diamniotic or dichorionic diamniotic twin pregnancies?

A

monochorionic diamniotic twins

115
Q

what type of imaging is best for detecting pituitary tumours?

A

MRI

116
Q

do patients with ovarian failure have amenorrhoea or oligomenorrhoea?

A

amenorrhoea

117
Q

what is a progesterone challenge test?

A

-menstural bleed in response to a 5 day course of progesterone

118
Q

a positive progesterone challenge test suggests which hormone levels are normal?

A

oestrogen

119
Q

if the progesterone challenge test is positive which WHO subtype of anovulation should be suspected?

A

type 2: hypothalamic pituitary dysfunction

120
Q

if the progesterone challenge is negative which WHO subtype of anovulation should be suspected?

A

type 1: hypothalamic pituitary failure

type 3: ovarian failure

121
Q

what is the definition of infertility?

A

failure to conceive despite regular unprotected sex over 12 months

122
Q

compare primary and secondary infertility?

A

primary: couple has never conceived
secondary: couple has previously conceived

123
Q

what is the treatment for chlamydia?

A

azithromycin 1g single dose
if allergic to macrolides:
doycycline 100mg BD for 7 days

124
Q

what is the most common cause of anovulatory infertility?

A

polycystic ovarian syndrome

125
Q

compare the risks of multiple pregnancy in use of clomifene citrate to gonadotrophin therapy?

A

risks of multiple pregnancy increases more with gonadotrophin therapy than with clomifene citrate

126
Q

what does a hysterosalipingogram test for?

A

tubal patency

127
Q

what days of the cycle can a hysterosalpingogram be done on?

A

1-10 days of cycle

128
Q

when would you perform a hysteroscopy?

A

in cases with suspected endometrial pathology

129
Q

when would you perform a pelvic ultrasound?

A

when thre is an abnormality on pelvic examination

Endocrine (5 decks)

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