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2 Endocrine > Reproductive Endocrinology > Flashcards

Reproductive Endocrinology Flashcards

1
Q

name the 4 hormones involved in the sex steroid axis

A

GnRH
FSH
LH
oestradiol

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2
Q

name the 3 phases of the menstrual cycle

A

follicular
ovulation
luteal

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3
Q

mean duration of the menstrual cycle?

A

28 days

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4
Q

what range of days is acceptable for a npormal menstrual cycle?

A

21-35 days

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5
Q

normal estimated blood loss in a menstrual cycle?

A

30ml

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6
Q

what day does ovulation typically occur?

A

day 14

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7
Q

the follicular phase begins when levels of what hormone are low?

A

oestrogen

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8
Q

what happens when low oestrogen is detected?

A

feeds back to the anterior pituitary to make gonadotrophins

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9
Q

what do LH and FSH do to the follicles?

A
  1. mulate follicles to develop

2. leading follicle develops which makes the egg

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10
Q

why is oestrogen high in the follicular phase?

A

granulosa cells around the egg enlarge which releases oestrogen

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11
Q

what causes the uterine lining to thicken?

A

oestrogen production by granulosa cells

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12
Q

what produces progesterone?

A

corpus luteum

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13
Q

what happens to the corpus luteum if the egg is not fertilised?

A

undergoes abration

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14
Q

what does progesterone do?

A

supports pregnancy

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15
Q

surge in what hormone leads to ovulation?

A

LH

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16
Q

what happens to LH and FSH production during ovulation?

A

continue to be released for 3-4 days

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17
Q

are LH and oestrogen released in a positive or negative feedback mechanism during ovulation?

A

positive

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18
Q

where does fertilisation take place?

A

ampulla of the fallopian tube

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19
Q

what happens to the leading follicle in ovulation?

A

it ruptures

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20
Q

what causes the degradation of the uterine wall?

A

lack of hCG and progesterone stimulates proteolytic enzymes and
prostaglandins

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21
Q

what phase does FSH peak in?

A

follicular

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22
Q

what 2 hormones are low in the follicular phase?

A

oestrogen

progesterone

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23
Q

what do the granulosa cells become in the luteal phase?

A

corpus luteum

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24
Q

when in the menstrual cycle is progesterone production at its highest?

A

1 week after ovulation

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25
Q

is the corpus luteum preserved or lost in pregnancy?

A

preserved

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26
Q

what happens to the corpus luteum and progesterone in menstruation?

A

corpus luteum disintegrates

progesterone drops

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27
Q

average period length?

A

3-7 days

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28
Q

why is a 21 day progesterone test done?

A

checks progesterone made by the corpus luteum to see if the patient has ovulated

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29
Q

what hormone stimulates the pituitary to make gonadotrophins?

A

GnRH

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30
Q

how and where is oestradiol made?

A

cholesterol -> pregnenolone->progesterone->androstendione->oestradiol

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31
Q

name the 3 regions of the hypothalamus

A

lateral
periventricular
medial

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32
Q

what part of the hypothalamus makes GnRH?

A

arcuate nucleus

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33
Q

the ovary is attached to the pelvic side wall by?

A

the infundibulopelvic ligament

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34
Q

name the layers of the ovary from superficial to deep

A

cortex

medulla

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35
Q

which layer of the ovary contains follicles?

A

cortex

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36
Q

name the layers of the endometrium

A

basal

superficial

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37
Q

what does FSH do to granulosa cells?

A

stimulates them to make oestrogen

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38
Q

which type of GnRH hormone is responsible for repro function?

A

GnRH 1

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39
Q

how is GnRH release?

A

in “pulses”

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40
Q

why do you only have to take FSH once but GnRH multiple times a day?

A

FSH has a longer half life

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41
Q

what type of cells does LH act on?

A

theca cells

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42
Q

which sex hormone controls cholesterol uptake?

A

LH

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43
Q

what sex hormone induces FSH and LH receptors

A

oestrogen

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44
Q

what sex hormone converts androgens to oestrogens?

A

LH

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45
Q

what hormone releases the egg from the follicle?

A

LH

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46
Q

what 2 hormones are found in the follicular fluid?

A

inhibin

activin

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47
Q

what effect does inhibin have on FSH secretion?

A

has negative feedback effect

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48
Q

what does activin do?

A

stimulates FSH induced oestrogen production

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49
Q

name the tubular components of the testis=

A

sertoli cells

germ cells

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50
Q

name the interstitial components o the testis

A

leydig cells

capillaries

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51
Q

what do sertoli cells do?

A

support germ cells in development

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52
Q

what are the earliest forms of sperm cells?

A

spermatogonia

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53
Q

what 2 hormones stimulate spermatogenesis?

A

FSH

testosterone

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54
Q

what hormone decreases FSH secretion?

A

inhibin

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55
Q

what hormones do sertoli cells make?

A

androgen binding globulin

inhibin

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56
Q

what hormone stimulates testosterone secretion?

A

LH

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57
Q

testosterone decreases release of what 2 hormones?

A

GnRH

LH

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58
Q

in sperm cell formation, what cell structure becomes the acrosome?

A

Golgi apparatus

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59
Q

in sperm cell formation, what cell structure becomes the flagellum?

A

centriole

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60
Q

in general, how many sperm make it to the fallopian tube?

A

a few hundred

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61
Q

why are egg cells so much bigger than sperm cells?

A

they carry the cytoplasm and organelles necessary for cell division

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62
Q

what is the consistency of the cervical mucus in ovulation

A

thin

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63
Q

how does the egg get to the ampulla?

A

via fimbriae and peristalsis

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64
Q

what is capacitation?

A

maturation of the sperm inside the female genital tract

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65
Q

why is capacitation essential?

A

allows the sperm to penetrate the egg

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66
Q

name the 5 stages of fertilisation

A 
chemotaxis
release of acrosomal enzymes
binding of sperm
passage through extracellular envelope
fusion of pronuclei
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67
Q

what triggers the acrosomal reaction (release of acrosomal enzymes) in the sperm?

A

zone pellucid ZP3

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68
Q

what is the acrosome reaction?

A

change in tail of sperm to make it more motile

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69
Q

what effect does fertilisation have on free intracellular Ca in the egg?

A

increases it

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70
Q

how many sperm are deposited in the cervix at ejaculation?

A

400-600 million

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71
Q

how long do sperm last in the female genital tract?

A

no more than 48hrs

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72
Q

what 2 areas can oestrogen come from?

A

adrenal gland

ovary

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73
Q

why do men get erectile dysfunction?

A

aromatase converts androgens->oestrogen
-ve feedback stops GnRH production
so testosterone not made

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74
Q

name the 3 types of cell that can make oestrogen

A

granulosa cells
theca cells
corpus luteum

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75
Q

how can oestrogen be made outside endocrine glands?

A

via conversion of androgens to oestrogens by aromatase eg in fat and bone

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76
Q

what 3 sources can progesterone be made from?

A

from pregnenolone in the corpus luteum
placenta during pregnancy
adrenals in androgen synthesis

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77
Q

what is oligomenorrhea?

A

reduction in frequency of periods to less than 9 a year

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78
Q

what is primary amenorrhea?

A

failure to have a period by age 16

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79
Q

what is secondary amennorhea?

A

cessation of periods for >6 months in someone who has previously menstruated

80
Q

what congenital problems can cause primary amenorrhea?

A

turners

kallmans

81
Q

what ovarian problems can cause secondary amenorrhea?

A

PCOS

premature ovarian failure

82
Q

another word for premature ovarian failure?

A

early menopause

83
Q

what uterine problem can cause secondary amenorrhea?

A

uterine adhesions

84
Q

what things can put stress on the hypothalamus and thus cause amenorrhea?

A 
weight loss
stress
over-exercise
anabolic steroids
systemic illness
recreational drugs
85
Q

what pituitary problems can stop periods?

A

high prolactin

hypopituitarism

86
Q

symptoms of oestrogen deficiency?

A

flushing
poor libido
dyspareunia (pain during sex)

87
Q

clinical presentation of PCOS?

A

acne
hirsutism
amenorrhea

88
Q

what would you suspect in a patient with primary amenorrhea with reduced sense of smell?

A

kallman’s

89
Q

how is amenorrhea investigated?

A 
hormone tests: LH, FSH, oestradiol, TFTs, PFTs prolactin
ovarian USS
testosterone if hirsutism
MRI pituitary if evidence
karyotype if genetic element
90
Q

what additional test would you do if hirsutism was present in someone with amenorrhea?

A

testosterone levels

91
Q

define female hypogonadism

A

low oestrogen levels

92
Q

where is the problem in primary hypogonadism?

A

ovaries

93
Q

where is the problem in secondary hypogonadism?

A

hypothalamus or

pituitary

94
Q

what do LH and FSH levels look like in primary hypogonadism?

A

high LH

high FSH

95
Q

what is hypergonadotrophic hypogonadism?

A

high LH and FSH but low sex hormones eg oestrogen and testosterone

96
Q

what do LH and FSH look like in secondary hypogonadism?

A

low LH/FSH

97
Q

what age range do you have to be to qualify as having POF?

A

<40

98
Q

3 main clinical problems needed to have POF?

A

amenorrhea
oestrogen deficiency
high gonadotrophins

99
Q

FSH needs to be over what level on tests to qualify as having POF?

A

> 30

100
Q

what genetic conditions can cause POF?

A

turners

fragile X

101
Q

autoimmune disease isn’t associated with POF: T or F?

A

F

102
Q

how can POF be cause iatrogenically?

A

radiotherapy

chemotherapy

103
Q

does kallman’s affect the ovary, pituitary or hypothalamus?

A

hypothalamus

104
Q

what is kisspeptin?

A

stimulator of GnRH secretion

105
Q

what happens to GnRH production in hypothalamic amenorrhea?

A

lose the pulsatile effect

106
Q

what hormone is deficient in kallmans?

A

loss of GnRH secretion

107
Q

does kallmans mainly affect men or women?

A

men

108
Q

what would you see on MRI pituitary in someone with kallmans?

A

nothing

109
Q

puberty is not achieved in kallmans: T or F

A

T

110
Q

2 main causes of raised prolactin

A

micro/macroprolactinoma

drugs

111
Q

what can cause loss of LH/FSH stimulation in the pituitary gland?

A

non-functioning pituitary macroadenoma
pituitary infarction
empty sella

112
Q

what effect can a non-functioning pituitary macroadenoma have on the pituitary glands?

A

pressure effects lead to hypopituitarism

113
Q

what thyroid problem can cause a raised prolactin?

A

hypothyroidism

114
Q

what are the Rotterdam criteria for PCOS

A

2 of:
menstrual irregularity
hirsutism/elevated testosterone
polycystic ovaries

115
Q

what does hirsutism mean?

A

excess hair

116
Q

cause of hirsutism?

A

androgen excess at the hair follicle

117
Q

you can get hirsutism from an ovarian tumour: T or F

A

T

118
Q

how can CAH present in adolescence?

A

hirsutism
menstrual disturbance
infertility

119
Q

diagnostic test for CAH?

A

17- OHP test

120
Q

what will testosterone levels be at if u got an androgen secreting tumour?

A

> 5nmol/l

121
Q

when would you do an MRI of the adrenals/ovaries in a suspected androgen secreting tumour?

A

if its >1cm

122
Q

treatment of PCOS?

A

the pill
cyproterone acetate (anti androgen)
metformin

123
Q

genotype for turners?

A

46 X

124
Q

turners only affects women: T or F

A

T

125
Q

clinical presentation of turners?

A 
short stature
webbed neck
wide nipples
amenorrhea
small fingernails
126
Q

pubic hair development is hindered in turners: T or F

A

F

127
Q

what congenital heart problems can turners patients present with?

A

coarctation of aorta

bicuspid aortic walve

128
Q

genetic causes of primary hypogonadism in men?

A

klinefelters

y chromosome microdeletion

129
Q

genetic causes of secondary hypogonadism in men?

A

kallmans
prader willi
CAH

130
Q

what should you ask about in history of hypogonadism?

A 
age of puberty
sexual function
fertility
pituitary screen
DURATION (congenital?)
131
Q

what testosterone range would indicate hypogonadism?

A

<9.7

132
Q

clinical features of klinefelters?

A 
Reduced testicular volume
Gynaecomastia
Eunuchoidism
(intellectual dysfucntion in 40%)
(azoospermia)
133
Q

karyotype for klinefelters?

A

47 XXY

134
Q

what testosterone, LH and FSH levels would be present in klinefelters?

A

low testosterone

high LH/.FSH

135
Q

investigations for secondary hypogonadism?

A

9am testosterone test

LH/FSH levels

136
Q

what drugs can cause secondary hypogonadism?

A

anabolic steroids

opiates

137
Q

what drugs can cause gynaecomastia?

A

oestrogens
testosterone
spironolactone
digoxin

138
Q

what kind of tumour can cause gynaecomastia?

A

hCG secreting tumour

oestrogen/androgen secreting tumour

139
Q

what endocrine disorders can cause gynaecomastia?

A

thyrotoxicosis

cushings

140
Q

investigations for gynaecomastia?

A 
Testosterone, LH, FSH
Oestradiol
Prolactin
AFP, HCG
LFTs
SHBG
Breast imaging
Testicular/adrenal imaging
141
Q

treatment for gynaecomastia?

A

remove causative drugs
reassurance
anti-oestrogens
surgery

142
Q

what STI is a common cause of infertility?

A

chlamydia

143
Q

chance of spontaneous pregnancy at 6 months?

A

75%

144
Q

chane of spontaneous pregnancy at 12 months?

A

90%

145
Q

chance of spontaneous pregnancy at 2 years?

A

95%

146
Q

define infertility

A

failure to achieve a pregnancy after 12 months of regular unprotected sex in someone who has never had a child

147
Q

how is primary infertility different from secondary?

A

in primary the couple has never conceived

148
Q

what BMI range would make a woman’s chance of conception more likely?

A

18.5-30

149
Q

what caffeine intake is recommended for maximal fertility?

A

<2 cups a day

150
Q

are you more likely to get pregnant if you have primary or secondary infertility?

A

secondary

151
Q

what kind of infertility is anovulatory infertility?

A

not releasing an egg

152
Q

pituitary causes of anovulatory infertility?

A

hyperprolactinaemia
tumours
sheehan syndrome

153
Q

ovarian causes of anovulatory infertility?

A

PCOS

POF

154
Q

endocrine causes of anovulatory infertility?

A

testosterone secreting hormones
CAH
thyroid problems

155
Q

what would LH/FSH AND oestrogen look like in anorexia?

A

all low

156
Q

is PCOS acquired or inherited?

A

inherited

157
Q

what effect does PCOS have on androgens, LH and glucose?

A

high androgens
high LH
impaired glucose tolerance

158
Q

clinical features of POF

A

hot flushes
night sweats
atrophic vaginitis
dyspareunia

159
Q

effect of POF on LH/FSH and oestrogen

A

LH/FSH high

oestrogen low

160
Q

infective causes of tubal disease?

A

PID eg from STIs
transperitoneal spread eg from appendicitis
iatrogenic from procedure

161
Q

non infective causes of tubal disease?

A

endometriosis
fibroids
polyps
congenital

162
Q

clinical features of PID

A 
abdo/pelvic pain
vaginal discharge
dyspareunia
dysmenorrhea
infertility
ectopic pregnancy
163
Q

is endometriosis common?

A

yes, 20% of women

164
Q

what is endometriosis?

A

presence of endocrine glands outside uterine cavity

165
Q

cause of endometriosis?

A

retrograde menstruation into the pouch of douglas causing altered immune function

166
Q

what condition results in chocolate cysts on the ovary?

A

endometriosis

167
Q

clinical presentation of endometriosis?

A

dysmenorrhea BEFORE menstruation
dyspareunia
painful defaecation
menorrhagia

168
Q

what recreational drugs decrease sperm count

A

alcohol
tobacco
marijuana
cocaine

169
Q

non obstructive causes of testicular failure?

A

47 XXY
chemotherapy
radiotherapy
undescended testes

170
Q

clinical features of non obstructive testicular failure?

A

low testicular volume

reduced secondary sex characteristics

171
Q

is the vas deferens present in obstructive or non obstructive testicular failure?

A

non obstructive

172
Q

what do LH/FSH and testosterone in non obstructive testicular failure?

A

LH/FSH high

low testosterone

173
Q

which form of testicular failure will have normal testicular volume and secondary sex characteristics?

A

obstructive

174
Q

causes of obstructve testicular atrophy?

A

congenital absence of vas deferens
infection
vasectomy

175
Q

what do LH/FSH and testosterone look like in obstructive?

A

normal

176
Q

how would you investigate a female with infertility?

A

rubella test
vulval swab for chlamydia
midluteal progesterone
laparoscopy to test tubal patency

177
Q

what 2 tests can be done to check tubal patency?

A

laparoscopy

hysterosalpingiogram

178
Q

when would you do a pelvic USS?

A

when theres an abnormality on pelvic examination

179
Q

1st line test for tubal assessment?

A

hysterosalpingiogram

180
Q

what hormone profiles would you do in a patient with an aovulatory cycle?

A 
urine HCG
prolactn
TSH
tesoterone + SHBG
LH/FS/estrogen
181
Q

what additional tests should be done if an anovulatory patient has hirsutism?

A

testosterone and SHBG

182
Q

what additional test should be doen in a patient with primary amenorrhea with an anovulatory cycle?

A

karyotype

183
Q

what tests shoudl be done if there is an abnormal semen analysis?

A

LH/FSH
testosterone
prolactin
TFTs

184
Q

what should be done if there was an abnormality on genital examination of a male?

A

scrotal USS

185
Q

over what progesterone level is indicative of ovulation?

A

30nmol/l

186
Q

what would you give someone for chlamydia?

A

azithromycin 1g

doxycycline 100mg bd if allergic

187
Q

short term consequences of PID?

A

tuboovarian abscess
peritonitis
fitz-hugh-curtis syndrome

188
Q

how long after the usrge in LH is ovulation?

A

36 hous after

189
Q

commonest cause of anovulatory infertility?

A

PCOS

190
Q

first line treatment for inducing ovulation in PCOS

A

antioestrogens eg clomifene citrate PLUS metformin

191
Q

why are antioestrogens used in PCOS?

A

facilitate the conversion of androgen to oestrogen

192
Q

second ine treatment for inducing ovulation in PCOS?

A

HRT or

laparoscopic ovarian drilling

193
Q

why is there a risk of giving PCOS patient gonadotrophins?

A

have an increased sensitivity to them so they can get ovarian hyperstimulation

194
Q

drinking recommendation for a woman wanting to get pregnant?

A

<4 units per week

195
Q

recommendation for frequency of sexual intercourse in a woman wanting to get pregnant

A

2-3

2 Endocrine (35 decks)

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