Reproductive Endocrinology Flashcards
1
Q
name the 4 hormones involved in the sex steroid axis
A
GnRH
FSH
LH
oestradiol
2
Q
name the 3 phases of the menstrual cycle
A
follicular
ovulation
luteal
3
Q
mean duration of the menstrual cycle?
A
28 days
4
Q
what range of days is acceptable for a npormal menstrual cycle?
A
21-35 days
5
Q
normal estimated blood loss in a menstrual cycle?
A
30ml
6
Q
what day does ovulation typically occur?
A
day 14
7
Q
the follicular phase begins when levels of what hormone are low?
A
oestrogen
8
Q
what happens when low oestrogen is detected?
A
feeds back to the anterior pituitary to make gonadotrophins
9
Q
what do LH and FSH do to the follicles?
A
- mulate follicles to develop
2. leading follicle develops which makes the egg
10
Q
why is oestrogen high in the follicular phase?
A
granulosa cells around the egg enlarge which releases oestrogen
11
Q
what causes the uterine lining to thicken?
A
oestrogen production by granulosa cells
12
Q
what produces progesterone?
A
corpus luteum
13
Q
what happens to the corpus luteum if the egg is not fertilised?
A
undergoes abration
14
Q
what does progesterone do?
A
supports pregnancy
15
Q
surge in what hormone leads to ovulation?
A
LH
16
Q
what happens to LH and FSH production during ovulation?
A
continue to be released for 3-4 days
17
Q
are LH and oestrogen released in a positive or negative feedback mechanism during ovulation?
A
positive
18
Q
where does fertilisation take place?
A
ampulla of the fallopian tube
19
Q
what happens to the leading follicle in ovulation?
A
it ruptures
20
Q
what causes the degradation of the uterine wall?
A
lack of hCG and progesterone stimulates proteolytic enzymes and
prostaglandins
21
Q
what phase does FSH peak in?
A
follicular
22
Q
what 2 hormones are low in the follicular phase?
A
oestrogen
progesterone
23
Q
what do the granulosa cells become in the luteal phase?
A
corpus luteum
24
Q
when in the menstrual cycle is progesterone production at its highest?
A
1 week after ovulation
25
is the corpus luteum preserved or lost in pregnancy?
preserved
26
what happens to the corpus luteum and progesterone in menstruation?
corpus luteum disintegrates
| progesterone drops
27
average period length?
3-7 days
28
why is a 21 day progesterone test done?
checks progesterone made by the corpus luteum to see if the patient has ovulated
29
what hormone stimulates the pituitary to make gonadotrophins?
GnRH
30
how and where is oestradiol made?
cholesterol -> pregnenolone->progesterone->androstendione->oestradiol
31
name the 3 regions of the hypothalamus
lateral
periventricular
medial
32
what part of the hypothalamus makes GnRH?
arcuate nucleus
33
the ovary is attached to the pelvic side wall by?
the infundibulopelvic ligament
34
name the layers of the ovary from superficial to deep
cortex
| medulla
35
which layer of the ovary contains follicles?
cortex
36
name the layers of the endometrium
basal
| superficial
37
what does FSH do to granulosa cells?
stimulates them to make oestrogen
38
which type of GnRH hormone is responsible for repro function?
GnRH 1
39
how is GnRH release?
in "pulses"
40
why do you only have to take FSH once but GnRH multiple times a day?
FSH has a longer half life
41
what type of cells does LH act on?
theca cells
42
which sex hormone controls cholesterol uptake?
LH
43
what sex hormone induces FSH and LH receptors
oestrogen
44
what sex hormone converts androgens to oestrogens?
LH
45
what hormone releases the egg from the follicle?
LH
46
what 2 hormones are found in the follicular fluid?
inhibin
| activin
47
what effect does inhibin have on FSH secretion?
has negative feedback effect
48
what does activin do?
stimulates FSH induced oestrogen production
49
name the tubular components of the testis=
sertoli cells
| germ cells
50
name the interstitial components o the testis
leydig cells
| capillaries
51
what do sertoli cells do?
support germ cells in development
52
what are the earliest forms of sperm cells?
spermatogonia
53
what 2 hormones stimulate spermatogenesis?
FSH
| testosterone
54
what hormone decreases FSH secretion?
inhibin
55
what hormones do sertoli cells make?
androgen binding globulin
| inhibin
56
what hormone stimulates testosterone secretion?
LH
57
testosterone decreases release of what 2 hormones?
GnRH
| LH
58
in sperm cell formation, what cell structure becomes the acrosome?
Golgi apparatus
59
in sperm cell formation, what cell structure becomes the flagellum?
centriole
60
in general, how many sperm make it to the fallopian tube?
a few hundred
61
why are egg cells so much bigger than sperm cells?
they carry the cytoplasm and organelles necessary for cell division
62
what is the consistency of the cervical mucus in ovulation
thin
63
how does the egg get to the ampulla?
via fimbriae and peristalsis
64
what is capacitation?
maturation of the sperm inside the female genital tract
65
why is capacitation essential?
allows the sperm to penetrate the egg
66
name the 5 stages of fertilisation
```
chemotaxis
release of acrosomal enzymes
binding of sperm
passage through extracellular envelope
fusion of pronuclei
```
67
what triggers the acrosomal reaction (release of acrosomal enzymes) in the sperm?
zone pellucid ZP3
68
what is the acrosome reaction?
change in tail of sperm to make it more motile
69
what effect does fertilisation have on free intracellular Ca in the egg?
increases it
70
how many sperm are deposited in the cervix at ejaculation?
400-600 million
71
how long do sperm last in the female genital tract?
no more than 48hrs
72
what 2 areas can oestrogen come from?
adrenal gland
| ovary
73
why do men get erectile dysfunction?
aromatase converts androgens->oestrogen
-ve feedback stops GnRH production
so testosterone not made
74
name the 3 types of cell that can make oestrogen
granulosa cells
theca cells
corpus luteum
75
how can oestrogen be made outside endocrine glands?
via conversion of androgens to oestrogens by aromatase eg in fat and bone
76
what 3 sources can progesterone be made from?
from pregnenolone in the corpus luteum
placenta during pregnancy
adrenals in androgen synthesis
77
what is oligomenorrhea?
reduction in frequency of periods to less than 9 a year
78
what is primary amenorrhea?
failure to have a period by age 16
79
what is secondary amennorhea?
cessation of periods for >6 months in someone who has previously menstruated
80
what congenital problems can cause primary amenorrhea?
turners
| kallmans
81
what ovarian problems can cause secondary amenorrhea?
PCOS
| premature ovarian failure
82
another word for premature ovarian failure?
early menopause
83
what uterine problem can cause secondary amenorrhea?
uterine adhesions
84
what things can put stress on the hypothalamus and thus cause amenorrhea?
```
weight loss
stress
over-exercise
anabolic steroids
systemic illness
recreational drugs
```
85
what pituitary problems can stop periods?
high prolactin
| hypopituitarism
86
symptoms of oestrogen deficiency?
flushing
poor libido
dyspareunia (pain during sex)
87
clinical presentation of PCOS?
acne
hirsutism
amenorrhea
88
what would you suspect in a patient with primary amenorrhea with reduced sense of smell?
kallman's
89
how is amenorrhea investigated?
```
hormone tests: LH, FSH, oestradiol, TFTs, PFTs prolactin
ovarian USS
testosterone if hirsutism
MRI pituitary if evidence
karyotype if genetic element
```
90
what additional test would you do if hirsutism was present in someone with amenorrhea?
testosterone levels
91
define female hypogonadism
low oestrogen levels
92
where is the problem in primary hypogonadism?
ovaries
93
where is the problem in secondary hypogonadism?
hypothalamus or
| pituitary
94
what do LH and FSH levels look like in primary hypogonadism?
high LH
| high FSH
95
what is hypergonadotrophic hypogonadism?
high LH and FSH but low sex hormones eg oestrogen and testosterone
96
what do LH and FSH look like in secondary hypogonadism?
low LH/FSH
97
what age range do you have to be to qualify as having POF?
<40
98
3 main clinical problems needed to have POF?
amenorrhea
oestrogen deficiency
high gonadotrophins
99
FSH needs to be over what level on tests to qualify as having POF?
>30
100
what genetic conditions can cause POF?
turners
| fragile X
101
autoimmune disease isn't associated with POF: T or F?
F
102
how can POF be cause iatrogenically?
radiotherapy
| chemotherapy
103
does kallman's affect the ovary, pituitary or hypothalamus?
hypothalamus
104
what is kisspeptin?
stimulator of GnRH secretion
105
what happens to GnRH production in hypothalamic amenorrhea?
lose the pulsatile effect
106
what hormone is deficient in kallmans?
loss of GnRH secretion
107
does kallmans mainly affect men or women?
men
108
what would you see on MRI pituitary in someone with kallmans?
nothing
109
puberty is not achieved in kallmans: T or F
T
110
2 main causes of raised prolactin
micro/macroprolactinoma
| drugs
111
what can cause loss of LH/FSH stimulation in the pituitary gland?
non-functioning pituitary macroadenoma
pituitary infarction
empty sella
112
what effect can a non-functioning pituitary macroadenoma have on the pituitary glands?
pressure effects lead to hypopituitarism
113
what thyroid problem can cause a raised prolactin?
hypothyroidism
114
what are the Rotterdam criteria for PCOS
2 of:
menstrual irregularity
hirsutism/elevated testosterone
polycystic ovaries
115
what does hirsutism mean?
excess hair
116
cause of hirsutism?
androgen excess at the hair follicle
117
you can get hirsutism from an ovarian tumour: T or F
T
118
how can CAH present in adolescence?
hirsutism
menstrual disturbance
infertility
119
diagnostic test for CAH?
17- OHP test
120
what will testosterone levels be at if u got an androgen secreting tumour?
>5nmol/l
121
when would you do an MRI of the adrenals/ovaries in a suspected androgen secreting tumour?
if its >1cm
122
treatment of PCOS?
the pill
cyproterone acetate (anti androgen)
metformin
123
genotype for turners?
46 X
124
turners only affects women: T or F
T
125
clinical presentation of turners?
```
short stature
webbed neck
wide nipples
amenorrhea
small fingernails
```
126
pubic hair development is hindered in turners: T or F
F
127
what congenital heart problems can turners patients present with?
coarctation of aorta
| bicuspid aortic walve
128
genetic causes of primary hypogonadism in men?
klinefelters
| y chromosome microdeletion
129
genetic causes of secondary hypogonadism in men?
kallmans
prader willi
CAH
130
what should you ask about in history of hypogonadism?
```
age of puberty
sexual function
fertility
pituitary screen
DURATION (congenital?)
```
131
what testosterone range would indicate hypogonadism?
<9.7
132
clinical features of klinefelters?
```
Reduced testicular volume
Gynaecomastia
Eunuchoidism
(intellectual dysfucntion in 40%)
(azoospermia)
```
133
karyotype for klinefelters?
47 XXY
134
what testosterone, LH and FSH levels would be present in klinefelters?
low testosterone
| high LH/.FSH
135
investigations for secondary hypogonadism?
9am testosterone test
| LH/FSH levels
136
what drugs can cause secondary hypogonadism?
anabolic steroids
| opiates
137
what drugs can cause gynaecomastia?
oestrogens
testosterone
spironolactone
digoxin
138
what kind of tumour can cause gynaecomastia?
hCG secreting tumour
| oestrogen/androgen secreting tumour
139
what endocrine disorders can cause gynaecomastia?
thyrotoxicosis
| cushings
140
investigations for gynaecomastia?
```
Testosterone, LH, FSH
Oestradiol
Prolactin
AFP, HCG
LFTs
SHBG
Breast imaging
Testicular/adrenal imaging
```
141
treatment for gynaecomastia?
remove causative drugs
reassurance
anti-oestrogens
surgery
142
what STI is a common cause of infertility?
chlamydia
143
chance of spontaneous pregnancy at 6 months?
75%
144
chane of spontaneous pregnancy at 12 months?
90%
145
chance of spontaneous pregnancy at 2 years?
95%
146
define infertility
failure to achieve a pregnancy after 12 months of regular unprotected sex in someone who has never had a child
147
how is primary infertility different from secondary?
in primary the couple has never conceived
148
what BMI range would make a woman's chance of conception more likely?
18.5-30
149
what caffeine intake is recommended for maximal fertility?
<2 cups a day
150
are you more likely to get pregnant if you have primary or secondary infertility?
secondary
151
what kind of infertility is anovulatory infertility?
not releasing an egg
152
pituitary causes of anovulatory infertility?
hyperprolactinaemia
tumours
sheehan syndrome
153
ovarian causes of anovulatory infertility?
PCOS
| POF
154
endocrine causes of anovulatory infertility?
testosterone secreting hormones
CAH
thyroid problems
155
what would LH/FSH AND oestrogen look like in anorexia?
all low
156
is PCOS acquired or inherited?
inherited
157
what effect does PCOS have on androgens, LH and glucose?
high androgens
high LH
impaired glucose tolerance
158
clinical features of POF
hot flushes
night sweats
atrophic vaginitis
dyspareunia
159
effect of POF on LH/FSH and oestrogen
LH/FSH high
| oestrogen low
160
infective causes of tubal disease?
PID eg from STIs
transperitoneal spread eg from appendicitis
iatrogenic from procedure
161
non infective causes of tubal disease?
endometriosis
fibroids
polyps
congenital
162
clinical features of PID
```
abdo/pelvic pain
vaginal discharge
dyspareunia
dysmenorrhea
infertility
ectopic pregnancy
```
163
is endometriosis common?
yes, 20% of women
164
what is endometriosis?
presence of endocrine glands outside uterine cavity
165
cause of endometriosis?
retrograde menstruation into the pouch of douglas causing altered immune function
166
what condition results in chocolate cysts on the ovary?
endometriosis
167
clinical presentation of endometriosis?
dysmenorrhea BEFORE menstruation
dyspareunia
painful defaecation
menorrhagia
168
what recreational drugs decrease sperm count
alcohol
tobacco
marijuana
cocaine
169
non obstructive causes of testicular failure?
47 XXY
chemotherapy
radiotherapy
undescended testes
170
clinical features of non obstructive testicular failure?
low testicular volume
| reduced secondary sex characteristics
171
is the vas deferens present in obstructive or non obstructive testicular failure?
non obstructive
172
what do LH/FSH and testosterone in non obstructive testicular failure?
LH/FSH high
| low testosterone
173
which form of testicular failure will have normal testicular volume and secondary sex characteristics?
obstructive
174
causes of obstructve testicular atrophy?
congenital absence of vas deferens
infection
vasectomy
175
what do LH/FSH and testosterone look like in obstructive?
normal
176
how would you investigate a female with infertility?
rubella test
vulval swab for chlamydia
midluteal progesterone
laparoscopy to test tubal patency
177
what 2 tests can be done to check tubal patency?
laparoscopy
| hysterosalpingiogram
178
when would you do a pelvic USS?
when theres an abnormality on pelvic examination
179
1st line test for tubal assessment?
hysterosalpingiogram
180
what hormone profiles would you do in a patient with an aovulatory cycle?
```
urine HCG
prolactn
TSH
tesoterone + SHBG
LH/FS/estrogen
```
181
what additional tests should be done if an anovulatory patient has hirsutism?
testosterone and SHBG
182
what additional test should be doen in a patient with primary amenorrhea with an anovulatory cycle?
karyotype
183
what tests shoudl be done if there is an abnormal semen analysis?
LH/FSH
testosterone
prolactin
TFTs
184
what should be done if there was an abnormality on genital examination of a male?
scrotal USS
185
over what progesterone level is indicative of ovulation?
30nmol/l
186
what would you give someone for chlamydia?
azithromycin 1g
| doxycycline 100mg bd if allergic
187
short term consequences of PID?
tuboovarian abscess
peritonitis
fitz-hugh-curtis syndrome
188
how long after the usrge in LH is ovulation?
36 hous after
189
commonest cause of anovulatory infertility?
PCOS
190
first line treatment for inducing ovulation in PCOS
antioestrogens eg clomifene citrate PLUS metformin
191
why are antioestrogens used in PCOS?
facilitate the conversion of androgen to oestrogen
192
second ine treatment for inducing ovulation in PCOS?
HRT or
| laparoscopic ovarian drilling
193
why is there a risk of giving PCOS patient gonadotrophins?
have an increased sensitivity to them so they can get ovarian hyperstimulation
194
drinking recommendation for a woman wanting to get pregnant?
<4 units per week
195
recommendation for frequency of sexual intercourse in a woman wanting to get pregnant
2-3
