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Endocrinology > Reproductive endocrinology > Flashcards

Reproductive endocrinology Flashcards

1
Q

What are the key reproductive hormones?

A
  • GnRH
  • LH
  • FSH
  • Oestrogen
  • Progesterone
  • Testosterone
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2
Q

What are the 2 main reproductive hormones realised by the anterior pituitary?

A
  • FSH

- LH

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3
Q

Explain the effect of FSH in males?

A
  • causes testes to produce sperm
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4
Q

Explain the effect of FSH in females?

A
  • causes growth of ovarian follicles and causes the secretion of oestrogen
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5
Q

What is the effect of LH in males?

A
  • causes the testes to secret testosterone
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6
Q

What is the effect of LH in females?

A
  • causes ovulation

- progesterone production by corps luteum

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7
Q

GnRH is released in what manner?

A

-pulsatile manner

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8
Q

Explain the release of GnRH in males and females?

A
  • males: constant frequency

- females: varies during menstrual cycle

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9
Q

High frequency GnRH secretes?

A
  • LH
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10
Q

Low frequency GnRH secretes?

A
  • FSH
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11
Q

Follicle growth affect on GnRH

A
  • oestrogen secreted
  • increases pulsatile nature
  • LH secreted
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12
Q

LH causes an increase in progesterone which causes what?

A
  • decrease in pulsatile nature

- FSH increases

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13
Q

GnRH is regulated by what receptor?

A
  • kisspeptin
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14
Q

How many days on average is the menstrual cycle?

A
  • 28 days
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15
Q

What is the first phase of the menstrual cycle known as?

A
  • follicular phase

- follicular growth = oestrogen

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16
Q

What is the second phase of the menstrual cycle known as?

A
  • luteal phase
  • LH surge = ovulation
  • increases progesterone
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17
Q

Explain a follicle?

A
  • an oocyte surrounded by follicular cells
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18
Q

Explain follicular growth?

A
  • the oocyte does not grow

- it is the follicular cells around that increase in number

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19
Q

What occurs to the endometrium under the influence of oestrogen?

A
  • thickens
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20
Q

What is the progestational hormone?

A
  • progesterone

- without = no pregnancy

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21
Q

Thea cells are sensitive to what?

A
  • LH
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22
Q

What do Thea cells produce?

A
  • androgens
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23
Q

Granulosa cells are sensitive to??

A
  • FSH
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24
Q

What is the role of granulosa cells?

A
  • convert androgens to oestrogen.
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25
Q

There is both a FSH independent and FSH dependant stage during folliculognesis?

True or false?

A
  • true
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26
Q

When does the LH surge occur?

A
  • 34-36hours before ovulation
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27
Q

With increasing LH levels what else increases?

A
  • progesterone
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28
Q

What does LH do to the corpus luteum?

A
  • LH stimulates angiogenesis

- LH stimulates enzymes involved in conversion of cholesterol to progesterone

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29
Q

What is the role of oestrogens?

A
  • thickens vaginal wall
  • regulates LH surge
  • decreases viscosity of cervial mucus
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30
Q

What is the role of progesterone

A
  • maintains thickness of endometrium

- responsible for infertile thick mucus

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31
Q

What 2 cells are in close contact for spermatogenesis development?

A
  • Sertoli cells and germ cells
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32
Q

What is the role of the blood testes barrier?

A
  • prevents immune system interference and prevents immune suppression
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33
Q

What is the role of testosterone?

A
  • maintains integrity of blood testes barrier

- releases mature spermatozoa

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34
Q

Infertility is defined as?

A
  • failure to achieve a clinical pregnancy after 12 months of trying
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35
Q

What are hormonal levels of anorexia?

A

-low FSH, LH and oestradiol

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36
Q

What are the symptoms of PCOS?

A
  • weight gain
  • acne
  • hirsutism
  • abnormal menstrual cycle
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37
Q

What is the 2/3 diagnostic criteria for PCOS?

A
  • Chronic anovulation
  • polycystic ovaries
  • hyperandrogenism
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38
Q

Symptoms of premature ovarian failure?

A
  • hot flushes
  • night sweats
  • amenorrhoea
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39
Q

Hormonal levels of premature ovarian failure?

A
  • high FSH
  • High LH
  • low oestrogen
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40
Q

What is endometriosis?

A
  • presence of endometrial glands outside uterine cavity
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41
Q

A chocolate cyst may be seen in what?

A
  • endometriosis
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42
Q

If a patient presents with hirsute what should be examined?

A
  • testosterone
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43
Q

What stimulates the hypothalamus to produce GnRH?

A
  • Kisspeptin
44
Q

FSH in males is responsible for what?

A
  • spermatogenesis
45
Q

What cells in males are responsible for spermatogenesis and what hormone regulates?

A
  • Sertoli cells

- FSH

46
Q

What cells in males are responsible for testosterone production and what hormone regulates?

A
  • Leydig cells

- LH

47
Q

The majority of testosterone in males is bound to what?

A
  • SHBG

- Sex hormone binding globulin

48
Q

What is the form of highly active testosterone?

A
  • dihydrotestosterone
49
Q

Male hypogonadism is what deficiency?

A
  • testosterone deficiency
50
Q

What blood results would be expected in primary male hypogonadism?

A
  • Testosterone low
  • LH/FSH, GnRH high
  • Hypergonadotropic hypogonadism
51
Q

What is mainly affected in hypergonadotropic hypogonadism?

A
  • spermatogenesis

- primary male hypogonadism

52
Q

What is mainly affected in hypogonadotropic hypogonadism?

A
  • spermatogenesis and testosterone production
53
Q

What blood results would be expected in secondary male hypogonadism?

A
  • low testosterone
  • low FHS/LH
  • Low GnRH
54
Q

What are some congenital causes of male primary hypogonadism?

A
  • Klinefelters

- cryptorchidism

55
Q

What are some causes of acquired primary male hypogonadism?

A
  • testicular trauma
  • chemotherapy
  • varicocele
  • mumps
56
Q

Klinefelter’s syndrome is caused by what?

A
  • nondysjunction
57
Q

What is the karyotype of Klinefelter’s syndrome?

A
  • 47 XXY
58
Q

What are some congenital causes of male secondary hypogonadism?

A
  • Kallmann’s syndrome

- prader-willi syndrome

59
Q

What are some acquired causes of secondary male hypogonadism

A
  • pituitary disease

- hyperprolactinaemia

60
Q

Explain Kallmann’s syndrome

A
  • isolated genetic deficiency of GnRH

- Causes secondary male hypogonadism

61
Q

Symptoms associated with Kallmann’s syndrome?

A
  • loss of smell (anosmia)
  • colour blindness
  • unilateral renal agenesis
62
Q

Symptoms of male hypogonadism?

A
  • small male sexual organs
  • gynaecomastia (breast development)
  • decreased body/pubic hair
63
Q

Diagnosis of male hypogonadism?

A
  • semen sample if infertile
  • 2xtestosterone AM samples
  • FSH/LH
  • Prolactin and pituitary hormones
  • MRI?
64
Q

What time should testosterone be measures?

A
  • between 8-11am
65
Q

What is the management of male hypogonadism?

A
  • testosterone replacement therapy
66
Q

Name 2 different types of testosterone replacement therapies?

A
  • Nebido

- sustanon

67
Q

What is testosterone replacement therapy contraindicated in?

A
  • hormone responsive cancer (breast or prostate)
  • haematocrit
  • sleep apnoea
  • heart failure
68
Q

What folic acid dosage should be recommended to women trying to conceive with low risk neural tubal risk?

A
  • 400micrograms

- before conceiving to 12 weeks into pregnancy

69
Q

What dosage of folic acid should be given to patients with high risk neural tubal defects or diabetes?

A
  • 5mg
70
Q

What supplements should be given before conception/pregnancy?

A
  • folic acid (400micromg or 5mg)

- vitamin D

71
Q

What is the affect on rubella on a child?

A
  • microcephaly
  • PDA
  • cataracts
  • rashes
72
Q

What is the advice regarding the MMR vaccine and pregnancy?

A
  • not to get pregnant within a month of vaccine as it is a live attenuated vaccine
73
Q

Treatment of chlamydia?

A
  • doxyxycline
74
Q

At what day of a cycle should you check progesterone levels?

A
  • day 21
75
Q

Irregular periods may be suggestive of ___

A

-anovulation

76
Q

Explain group 1 ovulation disorders?

A
  • hypothalamic
  • anorexia
  • excessive exercise
77
Q

Explain group 2 ovulation disorders?

A
  • hypothalamic pituitary dysfunction

- PCOS

78
Q

PCOS is what group of ovulation disorders?

A
  • group 2
79
Q

Explain group 3 of ovulation disorders?

A
  • ovarian failure
80
Q

Management of hypothalamic anovulation?

A
  • stabilise weight
  • pulsatile GnRH
  • daily gonadotrophin FSH and LH injections
81
Q

Treatment of PCOS?

A
  • lifestyle changes
  • clomifene citrate
  • gonadotrophin therapy
  • laparoscopic surgery
82
Q

Letrozole and tamoxifen are drugs used to treat?

A
  • PCOS
83
Q

What is the role of pelvic adhesions divisions?

A
  • maintains patency
84
Q

Explain hydrosalpinx?

A
  • water cyst in tube

- reduces pregnancy rate

85
Q

Treatment of hydrosalpinx?

A
  • laparoscopic salpingectomy
86
Q

When is a hysteroscopy recommend in IVF?

A
  • after 2 failed attempts
87
Q

What is a uterine fibroid?

A
  • benign lump on the womb
88
Q

Treatment of a submucosal fibroid?

A
  • hysteroscopically
89
Q

Treatment of a subserosal fibroid

A
  • little affect on fertility

- leave

90
Q

Explain the outlines of IVF treatment?

A
  • hormonal injection to produce many eggs
  • USS guided collection of follicles from ovary
  • culture media of egg and sperm
  • embryo transfer
91
Q

At what day is an embryo regarded as a blastocyst?

A
  • day 5
92
Q

On what day of the menstrual cycle does ovulation occur?

A
  • day 14
93
Q

Define oligomenorrhoea?

A
  • cycles >42 days

- less than 8 periods per year

94
Q

Define amenorrhea?

A
  • absent menstruation
95
Q

When does LH peak?

A
  • peak levels stimulate ovulation
96
Q

Ovulation predictor kit measures what hormone?

A
  • Measures LH levels

- LH surge prior to ovulation

97
Q

What is oestrogen secreted by?

A
  • ovarian follicles
  • adrenal cortex
  • placenta
98
Q

Oestrogen __increased/decreases__ viscosity of cervical mucus?

A
  • oestrogen decreases viscosity
99
Q

Progesterone __increases/decreases__ viscosity of cervical mucus?

A
  • progesterone increases viscosity
100
Q

Explain the spinnbarkeit criteria for ovulation?

A
  • cervical mucus becomes thinner during ovulation (oestrogen)
  • basal body temp increases (progesterone)
  • progesterone >30nmol/l
101
Q

Explain the progesterone challenge test?

A
  • to distinguish between group 1 ovulation disorders and other causes
  • progesterone given to stimulate a period
  • if bleeding = normal oestrogen
102
Q

What are the symptoms of ovarian hyperstimulation?

A
  • ovaries swell and become painful
103
Q

Premature menopause is before what age?

A
  • before the age of 40
104
Q

What treatment is given to premature menopause?

A
  • HRT (Bone density)

- assisted conception

105
Q

What is another pituitary cause of amenorrhea?

A
  • hyperprolactinaemia
106
Q

What are the investigations of hyperprolactinaemia?

A
  • high prolactin
  • normal or low FSH/LH
  • low oestrogen
107
Q

Treatment of prolactinaemia?

A
  • dopamine agonist

- cabergoline

Endocrinology (16 decks)

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