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Endocrinology > Sex Hormones > Flashcards

Sex Hormones Flashcards

1
Q

Define Puberty

A

Maturation of Reproductive Organs
Production of Sex-Steroids E.g. Oestradiol / Testosterone
Develop Secondary Sexual Characteristics
Attain capability to Reproduce

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2
Q

How to we stage puberty?

A

I-V

Tanner Staging

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3
Q

What is the key feature of puberty in girls?

A

Breast development

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4
Q

What is the key feature of puberty in boys?

A

Testicular volume

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5
Q

What is breast development know as?

A

Thelarche

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6
Q

What is the growth of pubic hair known as?

A

Pubarche

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7
Q

What does -arche mean?

A

Onset of

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8
Q

What is gonadarche?

A

Activation of gonads by HPG axis

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9
Q

What is menarche?

A

Menstrual Cycles

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10
Q

What is spermarche?

A
  • Spermatogenesis
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11
Q

What is adrenarche?

A
  • Adrenal Androgen Production

starts ~2yrs before Gonadarche

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12
Q

What are the secondary sexual characteristic is females?

A 
Breast Development
Hair Growth - 
      Pubic, Axillary
Sweat Gland Composition -
      Skin oiliness / Acne
Changes to external genitalia
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13
Q

What are the secondary sexual characteristics in males?

A 
Deepening of Voice
Hair Growth - 
      Pubic then Axillary, facial
Sweat Gland Composition -
      Skin oiliness / Acne
Changes to external genitalia
Increase in muscle mass
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14
Q

In what tanner stage does the growth spurt occur?

A

Girls 2-3

Boys 3-4

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15
Q

When does puberty onset?

A

Girls: 8-13 years
Boys: 9-14 years

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16
Q

In what tanner stage does the menarche occur?

A

5

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17
Q

In what tanner stage does the spermarche occur?

A

4

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18
Q

When does adrenarche occur?

A

Girls: 6-9 years
Boys: 7-10 years

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19
Q

What is prepubertal testicular size?

A

< 4mls

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20
Q

What is adult testicular size?

A

> 15mls

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21
Q

What is the HPG axis?

A

Hypothalmuic
Pituitary
Gonadal axis

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22
Q

What happens as you approach puberty?

A

Increased pulsatility of GnRh

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23
Q

What is mini puberty?

A

Development that occurs early in life

During infancy

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24
Q

What is early puberty know as?

A

Precocious more common in girls

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25
Q

What is late puberty know as?

A

Delayed more common in boys

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26
Q

When does menarche occur?

What is the mean age?

A

Occurs 2.3yrs after Thelarche / soon after Peak Height Velocity (PHV).
Mean Age 12.7 years (Range 10.7-16.1 years)

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27
Q

What are periods starting later that 16 years known as?

A

Primary amenorrhoea

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28
Q

What is secondary amenorrhoea?

A

Common for Periods to be irregular/ anovulatory for first 18months.
Periods start but then stop for at at least 3-6 months

29
Q

What is the duration of the menstrual cycle?

A
  • 28-day cycle (24-35 days).

- ±2 days each month.

30
Q

What is amenorrhoea?

A

No periods for at least 3-6 months.

or up to 3 periods per year.

31
Q

What is oligomenorrhoea?

A

Irregular or Infrequent periods >35day cycles

or 4-9 cycles per year.

32
Q

What occurs in the follicular phase of the menstrual cycle?

A

Follicle stimulating hormone (FSH) rises.
2-3 follicles start to grow.
Produce E2 and Inhibin B.
These reduce FSH (by -ve feedback).
Restrict ‘FSH window’ and non-dominant follicles undergo atresia.

33
Q

What occurs in the follicular phase of the menstrual cycle? (Pre-ovulatory phase)

A

A dominant ‘Graafian’ follicle emerges.
E2 continues to increase.
Switch to +ve feedback by E2.

Induces luteinising hormone (LH) Surge.
Causes ‘Ovulation’

34
Q

What makes up the corpus luteum?

A

remnants of the follicle that was ovulated

35
Q

What does the corpus lute secrete?

A

Progesterone

Oestradiol

36
Q

What is the part of the menstrual cycle after ovulation known as?

A

Luteal phase

37
Q

What are the phases of the endometrium?

A

Menstrual phase
Proliferative phase
Secretory phase (receptive to implantation)

38
Q

What happens if implantation is successful?

A

Secretes B-hCG

“pregnancy hormone”

39
Q

What hormone maintains pregnancy?

A

Corpus luteum secreting progesterone

40
Q

Why is pulsatile secretion of GnRH so important?

A

Continuous activation of the pituitary gland

41
Q

What would continuous administration of GnRH result in?

A

Decreased LH/FSH secretion

42
Q

How often are pulses of GnRH?

A

Every 90-120 mins increases are ovulation is approaches

Slows in luteal phase ever 180-240 mins

43
Q

What is hypogonadism?

A

Decreased Oestrogen in a Woman /

Decreased Testosterone in a Man

44
Q

How can hypogonadism arise?

A

Affect testes/ovaries directly
Affect on hypothalamus/pituitary

Trauma to the gonads
Congenital- Kleifelters
Infection- Mumps
Chryptochidism- when the testes don't descend into the scrotum at birth 
Pituitary tumours (secrete prolactin)
High Prolactin 
Kallman's syndrome 
Drugs
Chronic Alcohol levels
Cystic Fibrosis
Depression
45
Q

What is primary hypogonadism?

A

Testes/Ovaries issues
Reduced negative feedback
High LH / FSH
Low E2 / Testo

Man - Eg Infection/
Trauma / Cancer of Testes
Woman - Menopause

46
Q

What can cause secondary hypogonadism?

A

Pituitary Tumour

High Prolactin

47
Q

What results from hypogonadism?

A

Low (or normal) LH / FSH

Low E2 / Testosterone

48
Q

What causes menopause?

A

Lack of estradiol
High LH/FSH
Low inhibin
(Primary hypogonadism|)

49
Q

What are the symptoms of menopause?

A

Skin Dryness / Hair Thinning

Hot Flushes / Sweating/ Sleep Disturbance

Mood Disturbance

Osteoporosis - Decreased Bone Mineral Density (BMD)
(E2 stimulates osteoblasts)

Sexual Dysfunction - Vaginal Dryness, Decreased Libido

Weight gain

Amenorrhoea - No periods for 1yr / Cessation of fertility

Climacteric - Irregular periods in the years
Approaching Menopause

50
Q

How is menopause treated?

A

Oestrogen Replacement -

HRT (Hormone Replacement Therapy)

51
Q

How does oestrogen prevent menopause?

A

Oestrogen stimulates the endometrium

Add Progesterone - if Endometrium is intact to prevent risk of Endometrial Hyperplasia / Cancer

52
Q

When do the number of gametes peak in females?

A

Birth

53
Q

What is AMH?

A

Anti-Müllerian Hormone

54
Q

Why do we measure AMH?

A

Assess ovarian reserve
Peaks in middle adult life
Declines as menopause approaches

55
Q

What is the median range for menopause?

A

51 years

Range: (45-55 years)

56
Q

What is early menopause know as?

A

Premature Ovarian Insufficiency (POI)

Can happen in 20%

57
Q

What are the possible causes for POI?

A

Autoimmune
Genetic eg Fragile X Syndrome / Turner’s Syndrome
Cancer therapy Radio- / Chemo-therapy in the past

58
Q

How is POI diagnosed?

A

High FSH >25 iU/L (x2 at least 4wks apart)

59
Q

How do the number of gametes vary in men?

A

Relatively stable

60
Q

What is the testosterone-‘free hormone’ hypothesis?

A

Late onset hypogondaism
Total Testosterone is unchanged
But SHBG is increased
‘Free’ Testosterone reduced

61
Q

How does testosterone vary during the day?

A

Higher in the morning

62
Q

What are the symptom of testosterone deficiency?

A

Sexual Dysfunction - Reduced Libido (sexual desire)
Erectile Dysfunction&raquo_space; loss of Early Morning erections
Hair Growth - Frequency of Shaving?
Energy levels - General Well-being, Fatigue.
Mood Disturbance
Body Composition - Increased Fat / reduced Muscle Mass / Gynaecomastia (breast enlargement in man)
Spermatogenesis - High levels of Intratesticular testosterone needed
Bone health - (Via conversion to oestrogen)

63
Q

How does testosterone effect local tissues?

A

Via 5alpha-reductase:
Seminal vesicle, epididymis, prostate, scalp, liver

Via aromatase (conversion to oestrogen):
Adipose tissue 
Adrenal glands Ovaries (Granulosa Cell) 
Testes 
(Sertoli Cells)
Brain
Bone
Skin
64
Q

What are the 5 stages of thelarche?

A

Elevation of papilla only

Breast bud with elevation of breast and papilla and enlargement of areola

Further enlargement of breast and papilla with no separation of their contours

Projection of areola and papilla to
form a secondary mound

Mature breast, projection of papilla only as areola conforms to breast contour

65
Q

What are the 5 stages of genitalia?

A

Testes, penis, and scrotum
same size as early childhood

Early enlargement of testes >2 cm3; scrotal skin reddens
and changes in texture

Penis lengthens;
testes enlarge 3–6 cm3;
growth of scrotum

Further penile and scrotal growth;
testes 8–12 cm3

Genitalia adult in size and shape,
Testes 15–25 cm3

66
Q

What are the 5 stages of pubarche?

A

Vellus hair no different from abdominal hair

Slightly pigmented,
downy hair

Darker, coarser,
more curled

Adult pubic hair that does not reach thighs (axillary hair)

Adult hair now on thighs

67
Q

What questions would you ask when assessing possible low testosterone?

A

How often are you shaving? Is this abnormal?

Do you have erectile dysfunction?

Any changes in mood?

Any changes to his energy levels?

Changes to his body composition? (Muscle/Fat)

What medication are you taking?

Are you taking any drugs? Steroids?

Over-exercising? Excess acts as a stress on the axis

What is his alcohol intake?

Any trauma? To the testes? Or bones?- osteoporosis

Any headaches?

Any changes in his vision?-Bitemporal hemianopia

68
Q

What is the difference between testosterone and dihydrotestosterone?

A

dihydro- more potent, stronger ligand
lower conc. to produce the same effect
dihydro formed by 5-alpha reductase

Endocrinology (9 decks)

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