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Z YEAR 1 BRS Endocrinology > Sex Hormones During Life > Flashcards

Sex Hormones During Life Flashcards

1
Q

What is then definition of 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

What is Gonadarche?

A

Activation of gonads by HPG axis

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3
Q

What is thelarche?

A

Breast Development

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4
Q

What is menarche?

A

Menstrual Cycles

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5
Q

What is spermarche?

A

Spermatogenesis

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6
Q

What is adrenarche?

A

Adrenal Androgen Production (starts ~2yrs before Gonadarche)

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7
Q

What is pubarche?

A

Pubic hair

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8
Q

What is secondary sexual characteristics with estradiol?

A 
•Breast Development
•Hair Growth - 
-Pubic, Axillary
•Sweat Gland Composition -
-Skin oiliness / Acne
•Changes to external genitalia
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9
Q

What is secondary sexual characteristics with testosterone?

A 
•Deepening of Voice
•Hair Growth - 
-Pubic then Axillary, facial
•Sweat Gland Composition -
-Skin oiliness / Acne
•Changes to external genitalia
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10
Q

What is tanner staging?

A

I-V (breast development )
I-V (testicle volume)
Pubarce

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11
Q

What is stage 1?

A

Breasts: Elevation of papilla only
Genitalia: Testes, penis and scrotum same size as early childhood
Pubic Hair: Velds hair no different form abdominal hair

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12
Q

What is stage 2?

A

Breasts: Breast bud with elevation f breast and papilla and enlargement of aerial
Genitalia: Early enlargement of testes >2cm^3; scrotal skin reddens and changes in texture
Pubic Hair: Slightly pigmented, downy hair

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13
Q

What is stage 3?

A

Breasts: Further enlargement of breast and papilla with no separation of their contours
Genitalia: Penis lengths; testes enlarge 3-6cm^3; growth of scrotum
Pubic Hair: Darker, coarser, more curled hair

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14
Q

What is stage 4?

A

Breasts: Projection of areola and papilla to form a secondary mound
Genitalia: Further penile and scrotal growth 8-12cm^3
Pubic Hair: adult pubic hair that does not reach thighs (axillary hair)

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15
Q

What is stage 5?

A

Breasts: Mature breast, projection of papilla only as areola conforms to breast contour
Genitalia: Genitalia adult in size and shape 15-25cm^3
Pubic Hair: adult hair now on thighs

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16
Q

What is the first sign of puberty for girls?

A

1st sign: Thelarche

Later sign: menarche

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17
Q

What is the boys-testicular size puberty?

A

Prepubabtal <4mls

Adult size >15mls

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18
Q

What is DHEA?

A

An adrenal androgen

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19
Q

What is normal GnRH secretion?

A
  • Pulsatile

- Gonadotrophin relaying hormone

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20
Q

When does menarche occur?

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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21
Q

What is primary amenorrhoea?

A

•Later than 16yrs is regarded as abnormal.

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22
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
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23
Q

How long are menstrual cycles?

A
  • 28-day cycle (24-35 days).

- ±2 days each month.

24
Q

What is A-menorrhoea?

A
  • Absence of Periods
  • No periods for at least 3-6 months.
  • or up to 3 periods per year.
25
Q

What is oligo-menorrhoea?

A
  • Few Periods
  • Irregular or Infrequent periods >35day cycles
  • or 4-9 cycles per year.
26
Q

What is the HPG axis?

A
  • Hypothalamic Pituitary Gonadal axis
    1. Hypothalamus makes pulsatile GnRH
    2. Stimulates pituitary gland and the gonadotroph cells and they make LH and FSH and stimulates testes and ovaries (gonatophins ar e hormones)
27
Q

What is the HPG axis?

A
  1. Mini puberty like a mountain

2. Then sigmoid from childhood through puberty to adult

28
Q

What is precocious puberty?

A

Girls>boys

Pubarche <6

29
Q

What is delayed puberty?

A

Boys>Girls

>14 years

30
Q

What is the first follicular phase?

A
  1. Follicle stimulating hormone (FSH) rises.
  2. 2-3 follicles start to grow.
  3. Produce E2 and Inhibin B.
  4. These reduce FSH (by -ve feedback).
  5. Restrict ‘FSH window’ and non-dominant follicles undergo atresia
31
Q

What is the second follicular phase (pre-ovulatory phase)?

A
  1. A dominant ‘Graafian’ follicle emerges.
  2. E2 continues to increase.
  3. Switch to +ve feedback by E2.
  4. Induces luteinising hormone (LH) Surge
  5. Causes Ovulation (release of egg from follicle)
32
Q

What does corpus lutem secrete? (luteal phase)

A

Form rest of follicle and secrete progesterone and oestradiol

33
Q

What happens with the endometrium in the menstrual cycle?

A
  1. Day 1-5 menstrual bleeding
  2. Day 5-14 proliferative phase to represent oestradiol increase (thickening of oestrogen
  3. Day 14-28 secretory phase full of blood vessels and start to secrete and about implantation
34
Q

What happens if embryo successfully implants in endometrium?

A

Will make B-hCG and can activate receptors e.g. LH for corpus lutem and thenprogesterone

35
Q

What would happen if GnRH was non-pulsatile?

A
  • Inhibition of pituitary gland
  • Decreased LH and FSH
  • Decreased testosteorne and oestrogen e.g. in prostate cancer so want low levels of testosterone
36
Q

How are hormones secreted during menstrual cycle?

A
  1. Follicular phase: pulsatile every 90-120 mins
    - Check LH instead
  2. Ovulation: LH surge
  3. Luteal phase: every 180-240 mins
37
Q

What happens in hypogonadism?

A
  • Decrease test in man and oestro in women
    1. Can occur due to trauma/infection to testes or ovaries e.g. mumps
    2. Or something affecting hypothalamus or pituitary gland and so reduced secretion of LH and FSH so reduced function of testes or ovaries
38
Q

What happens in primary hypogonadism?

A
  • Problem with testes or ovaries
  • Decreased test and oest
  • Therefore reduced negative feedback to both pituitary and hypothalamus
  • So increase in LH and FSH
39
Q

What are signs of primary hypogonadism?

A
  • High LH/FSH
  • Low E2/ Testo
  • Man e.g. infection/trauma/ cancer of testes
  • Women-menopause
40
Q

What is secondary hypogonadism?

A
  • E.G pituitary tumour, high prolactin
  • Secondary or hypogonadotrophic hypogonadism
  • So less LH and FSH
  • Less stimulation for testes and ovaries
41
Q

How is HPG axis affected by menopause?

A
  • Primary hypogonadism
  • Ovaries decreased function
  • less oestrogen
  • Reduced negative feedback to Pituitary gland and hypothalamus
  • Increased LH and FSH
    1. Low E2
    2. High LH/FSH
    3. Low inhibin
  • Reduced gametes: FSH
  • Reduced sex steroids: LH affected
42
Q

What are the symptoms of menopause?

A
  1. Lack of Estradiol
  2. Skin Dryness / Hair Thinning
  3. Hot Flushes / Sweating/ Sleep Disturbance
  4. Mood Disturbance
  5. Osteoporosis - Decr Bone Mineral Density (BMD)
    (E2 stimulates osteoblasts)
  6. Sexual Dysfunction - Vaginal Dryness Decreased Libido
  7. Weight gain
    8.Amenorrhoea - No periods for 1yr / Cessation of fertility
  8. Climacteric - Irregular periods in the years
    Approaching Menopause
43
Q

What is the treatment of menopause?

A
  1. Oestrogen Replacement -
    HRT (Hormone Replacement Therapy)
  2. Oestrogen stimulates the endometrium
    Add Progesterone - if Endometrium is intact to prevent risk of Endometrial Hyperplasia / Cancer
44
Q

What are ovarian reserve markers?

A
  • Anti-Müllerian Hormone (AMH) measure
  • Produced from Sertoli cells
  • Peaks in early adult life
  • Very low at menopause
45
Q

When does menopause occur?

A

51
Range: 45-55
Only 1% menopause <40 yo

46
Q

What is premature ovarian insufficiency (POI)

A
  • Same Symptoms as per Menopause
  • Previously Called ‘Premature Ovarian Failure’ POF
  • Conception can happen in 20%.
  • Diagnosis High FSH >25 iU/L (x2 at least 4wks apart)
47
Q

What are the causes of POI ?

A
  • Autoimmune
  • Genetic eg Fragile X Syndrome / Turner’s Syndrome
  • Cancer therapy Radio- / Chemo-therapy in the past
48
Q

Is there andropause?

A
  • testosterone pretty steady
  • Free testosterone does fall (Late onset hypogonadism)
  • SHBG increase so reduced free testosterone with increasing age and total testosterone doesn’t change so more bound
49
Q

What is free hormone hypothesis?

A

Testosterone levels in blood

  1. 60% SHBG Strongly bonds testosterone (unavailable)
  2. 38% albumin weakly binds testosterone (bioavaliable)
  3. 2% ‘free testosterone’ (active)
50
Q

What rhythm is testosterone?

A
  • Diurnal
  • High in wrong
  • Measure before 11am
  • Sugar can reduce testosterone
51
Q

What re symptoms of testosterone deficiency?

A
  1. Sexual Dysfunction - Reduced Libido (sexual desire)
  2. Erectile Dysfunction&raquo_space; loss of Early Morning erections
  3. Hair Growth - Frequency of Shaving?
  4. Energy levels - General Well-being, Fatigue.
  5. Mood Disturbance
  6. . Body Composition - Increased Fat / reduced Muscle Mass / Gynaecomastia (breast enlargement in man)
  7. Spermatogenesis - High levels of Intratesticular testosterone needed
  8. Bone health - (Via conversion to oestrogen)
52
Q

What is the effect of testosterone in local tissue?

A
  • Testosterone in blood and local tissues
    1. In testes (seminal vesicle, epididymis), prostate gland and scalp, 5 alpha reductase metabolises testosterone to di-hydro testosterone (DHT)
  • DHT potent androgen which is stronger then normal testosterone
  • Important for prostate growth and for male pattern baldness
  • more potent ligand for androgen receptor
    2. Or some tissues will have aromatase
53
Q

Where is aromatase?

A
  • Adipose tissue
  • Adrenal glands
  • Ovaries (granulosa cell)
  • testes (Sertoli cells)
  • Brain
  • Bone
  • Skin
54
Q

What does aromatase do?

A
  • Converts testosterone to oestrogen
    1. Testosterone to 17B-oestradiol
    2. Androstenedione to oestrone
55
Q

What can stimulate aromatase?

A
  • Age
  • Obesity
  • Insulin
  • Gonadotrophins
  • Alcohol
56
Q

How is aromatase important?

A
  • aromatase inhibitor e.g tamoxifen for breast cancer
  • Too much oestrogen can cause breast proliferation and breast cancer sensitive to oestrogen
  • reduce production of oestrodiol
57
Q

When is 5 alpha reductase useful?

A
  • 5 alpha reductase inhibitor e.g. Finasteride prostate cancer
  • Don’t want a lot of DHT

Z YEAR 1 BRS Endocrinology (8 decks)

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