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2.4 BRS Endocrinology > Sex Hormones I > Flashcards

Sex Hormones I Flashcards

1
Q

What is puberty?

A

Process of physical changes making the body capable of sexual reproduction:
1. maturation of reproductive organs
2. sex steroid production (oestradiol and
testosterone)
3. secondary sexual characteristics develop
- females onset 8-13 yo
- males onset 9-14 yo

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2
Q

What is Tanner Staging?

A

Method to track progression of puberty
- 5 stages
- females —> thelarche (1st sign)
—> pubarche
- males —> testicular volume
- measure via prader orchidometer
- prepubertal —> <4ml
adult —> >15ml
—> pubarche

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3
Q

What is gonadarche?

A

Onset of HPG axis activation
- measure via FSH/LH/oestrogen/testosterone
production

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4
Q

What is thelarche?

A

Onset of breast development
- first sign of puberty —> age 11
- stage 2 —> age 11-12
3 —> 12
4 —> 13
5 —> 14-15

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5
Q

What is menarche?

A

Onset of menstrual cycle
- last sign of puberty —> age 14-16 (mean 12.7)
- 2.3 years after thelarche
- soon after PHV (peak height velocity)

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6
Q

What is spermarche?

A

Onset of spermatogenesis
- onset 15-16 yo —> stage 4

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7
Q

What is adrenarche?

A

Onset of adrenal androgen production
- measure via DHEAS/DHEA production
- females - 6-9 yrs
- males - 7-10 yrs
- more important in females ∵ males —> testes
produce testosterone

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8
Q

What is pubarche?

A

Onset of pubic hair
- females:
stage 2 —> age 11-12
3 —> 12-13
4 —> 13
5 —> 14-15

  • males:
    stage 2 —> age 12-13
    3 —> 14
    4 —> 14-15
    5 —> 16
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9
Q

What are the female secondary sexual characteristics? (4)

A
  1. Breast development
  2. Hair growth —> pubic
    —> axillary
  3. Sweat gland compositions —> oily skin
    —> acne
  4. External genitalia changes
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10
Q

What are the male secondary sexual characteristics? (4)

A
  1. Voice deepens
  2. Hair growth —> pubic
    —> axillary
    —> facial
  3. Sweat gland compositions —> oily skin
    —> acne
  4. External genitalia changes
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11
Q

What is the sequence of pubertal events in females?

A
  1. Adrenarche —> 6-9 yo
  2. Growth spurt —> 11-13 (stage 2-3)
  3. Thelarche —> 11-15 (stage 2-5)
  4. Pubarche —> 11-15 (stages 2-5)
  5. Menarche —> 14-16 (stage 5)
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12
Q

What is the sequence of pubertal events in males?

A
  1. Adrenarche —> 7-10 yo
  2. Thelarche —> 12-16 (stage 2-5)
  3. Pubarche —> 12-16 (stages 2-5)
  4. Growth spurt —> 14-16 (stage 3-4)
  5. Spermarche —> 15-16 (stage 4)
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13
Q

What is the mini puberty?

A

HPG-axis first activated in late-foetal life
- not reactivated till puberty
- males —> till 6 months old
females —> till 2 years old
- effects —> testicular descent
—> penile length
—> sertoli cell maturation
—> behaviour

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14
Q

What is precocious vs delayed puberty?

A

Precocious —> early puberty
- females - onset <8 yo - more common than males

Delayed —> late puberty
- males - onset >14 yo - more common than females

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15
Q

What is amenorrhea vs oligomenorrhea?

A

Amenorrhea = no period
- primary —> don’t start after age 16
- secondary —> start then stop
- stop for 3-6 months
- <3/year

Oligomenorrhea = few periods (frequent/irregular)
- >35 day cycles
- 4-9 cycles/year

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16
Q

What occurs during the follicular phase of the menstrual cycle?

A
  1. FSH rises —> 2-3 follicles start to grow
  2. Follicles produce E2 (oestradiol) + inhibin B —> dec
    FSH via -ve feedback
  3. Restricted ‘FSH window’ —> atresia of non-
    dominant follicles —> only 1 egg/month
  4. High E2 —> switch to +ve feedback —> LH inc
    (causes ovulation on day 14)
17
Q

What occurs during the uterine cycle?

A

Menstrual phase —> endometrium sheds
Proliferative phase —> endometrial lining grows
(oestradiol) - new epithelial cells
- gland proliferation
- inc stroma and arterioles
Secretory phase —> receptive for implantation
(progesterone) - inc stomal cells —> thick/spongy
- cork-screw glycogen glands
- spiral arteries coil + lengthen

18
Q

What happens in to the corpus luteum at the end of the menstrual cycle?

A

Fertilised - B-hCG maintains corpus luteum —>
secretes more progesterone and oestrogen
Not fertilsied —> degrades to corpus albicans

19
Q

How does GnRH secretion change throughout the menstrual cycle?

A

Follicular phase —> pulsatile every 90-120 mins
Luteal phase —> pulsatile every 180-240 mins

(continuous non-pulsatile GnRH would result in dec LH/FSH)

20
Q

What is hypogonadism?

A

Female —> low oestrogen
Male —> low testosterone
- HPG axis inhibited

21
Q

What is primary hypogonadism?

A

Hypogonadism due to gonad issue
- males —> infection
—> testicular trauma
—> testicular cancer
females —> menopause
- dec oestrogen/testosterone
inc LH/FSH levels ∵ pituitary —> dec -ve feedback

22
Q

What is secondary hypogondaism?

A

Hypogonadism due to pituitary issue
- male/female —> pituitary tumour
—> high prolactin
- dec oestrogen/testosterone
dec LH/FSH levels ∵ pituitary —> dec -ve feedback

23
Q

What is menopause?

A

When a female has naturally lost all of their eggs
- physiological primary hypogonadism —> dec E2
- peri-menopausal —> before menopause
post-menopausal — >1 year after
- onset —> 45-55 yo
- <45 —> premenopause
- <40 —> premature —> POI

Symptoms:
- skin dryness/hair thinning
- hot flushes/sweating —> disturb sleep
- mood changes
- osteoporosis + joint pain (dec BMD)
- sexual dysfunction (vaginal dryness, low libido)
- frequent UTIs (genitourinary disturbance)
- weight gain
- amenorrhoea
- infertile

24
Q

How are menopausal symptoms treated?

A

MHT = Menopausal Hormone Therapy
- give oestrogen —> endometrium proliferation
and progesterone —> prevent endometrial
hyperplasia/cancer

25
Q

What are ovarian reserve markers?

A

Measures used to predict oocyte yield
- AMH = Anti-Müllerian Hormone
- produced by granulosa cells
- v. low at birth —> peak in 20s —> v.low at
menopause

26
Q

What is POI?

A

Premature Ovarian Insufficiency
- symptoms of menopause before age 40
- 20% can still conceive
- diagnosis —> FSH>25 iU/L (x2, 4 weeks apart)
- causes —> autoimmune
—> genetic - Fragile X, Turner’s syndrome
—> cancer therapies

27
Q

What is late onset hypogonadism?

A

Testosterone deficiency in elderly
- 2% testosterone free —> active
38% —> weakly bound to albumin —> bioactive
60% —> strongly bound to SHBG —> unavailable
- with age, SHBG inc —> less testosterone free (still
same total testosterone)

28
Q

When are serum testosterone levels measured?

A

Morning —> highest level (morning erections)
Fasted —> glucose intake can dec testosterone

29
Q

What are the symptoms of testosterone deficiency?

A
  1. Sexual dysfunction - dec libido, erectile dysfunction,
    lose morning erection
  2. Dec hair growth —> dec frequency shaving
  3. Low energy —> fatigue
  4. Mood changes
  5. Body changes - inc fat, dec muscle, gynaecomastia
  6. Dec bone health (oestrogen dec)
30
Q

Which 2 other hormones can testosterone be converted to?

A
  1. DHT (dihydrotestosterone)
    • via 5 α-reductase
    • in prostate and scalp (—> male pattern baldness)
    • more potent ligand for AR (androgen receptor)
      —> 5 α-reductase inhibitor for prostate cancer
  2. Oestrogen
    • via aromatase
    • testosterone —> 17B-oestradiol
      androstenedione —> oestrone
    • in adipose tissue
      —> aromatase inhibitor for breast cancer

2.4 BRS Endocrinology (9 decks)

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