Sex Hormones and Disease

Question 1

When is tamoxifen indicated?

Answer 1

Palliative treatment of metastatic breast cancer

Adjuvant after lumpectomy

Question 2

When is oestrogen indicated in children?

Answer 2

Hypogonadism > development of secondary sex characteristics and accelerated growth

Question 2

What accounts of oestrogen’s rapid effects?

Answer 2

Binding and acting through membrane bound oestrogen receptor and G-coupled protein receptor 30 (GPR30)

Question 2

What is the predominant physiological effect of oestrogen acting on its receptor?

Answer 2

Growth

Question 3

Which is more important for negative feedback, oestrogen or progesterone?

Answer 3

Oestrogen

Question 4

What the mechanism of action of oestrogen?

Answer 4

Cross cell membrane

Bind to its receptor

Dimerise with another ligand-receptor complex or another transcription factor

Active gene transcription

Question 4

Which tissues is tamoxifen a partial agonist to and which tissues is it an antagonist?

Answer 4

Partial agonist: Uterus, Bone and CVS

Antagonist: Breast and CNS

Question 5

Why is testosterone is used for surgical recovery?

Answer 5

But it promotes growth

Question 5

What are the adverse effects of finasteride?

Answer 5

Impotence, decreased libido and ejaculation disorder

Breast enlargement and tenderness

Breast cancer has been reported

Question 6

Why does breast enlargement occur in response to 5alpha-reductase treatment?

Answer 6

Because excess testosterone is converted to oestrogen

Question 7

What are the risks associated with postmenopausal hormone therapy?

Answer 7

Breast tenderness, nausea and fluid retention

Increased risk of breast/uterine cancer

Increased risk of thromboembolism/stroke

Question 9

What converts testosterone to dihydrotestosterone?

Answer 9

5alpha-reductase

Question 10

Where does testosterone act in its target cells?

Answer 10

Can be converted to dihydrotestosterone and act on cytoplasmic receptors

Or can act directly on nuclear receptors

Question 12

What are the main benefits of postmenopausal hormone therapy?

Answer 12

Improved bone density

Relief from flushes, fatigue and vaginal dryness

Reverses atrophy of vulva, vagina, urethra

Improved sleep

Question 13

What is the pattern of gonadotrophin release?

Answer 13

Pulsatile

Question 14

In general, why are aromatase inhibitors used?

Answer 14

To reduce the production of oestrogen by blocking the conversion of its precursors to it.

Question 16

How do androgens effect the development of CHD?

Answer 16

They increase the risk of it by increasing LDL and decreasing HDL

Question 17

Which diseases does aromatase inhibitors reduce the incidence of?

Answer 17

Contralateral breast cancer

Endometrial cancer

Thromboembolic events

Question 18

Which hormones does testosterone negatively feedback onto?

Answer 18

LH

GnRH

Question 19

Why is testosterone used it endometriosis?

Answer 19

To promote local oestrogen production

To help with pain

Question 20

What is flutamide?

Answer 20

A non-steroidal antagonist - that may selectively block androgen receptors in the prostate only

Question 22

What are some adverse effects of tamoxifen?

Answer 22

Endometrial hyperplasia, polyps and cancer

Thromboembolic events

Menopausal symptoms

Question 23

When is oestrogen indicated in adults?

Answer 23

Primary amenorrhoea and contraceptive (with progestin)

Menopause

Question 24

What is the name of a androgen receptor antagonist? When is it indicated?

Answer 24

Cyproterone

Prostate cancer

Androgenisation in females

Question 25

What is the name of a 5alpha reductase inhibitor and when is it indicated?

Answer 25

Finasteride

Benign prostatic hypertrophy