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2.2 T2: Reproductive system, foetal development > T2 L6: Disorders of ovulation > Flashcards

T2 L6: Disorders of ovulation Flashcards

1
Q

What is the role of kisspeptin in ovulation?

A

It stimulates the secretion of GnRH. It’s found at the apex of the reproductive axis in the hypothalamus

Kisspeptin neurones are very responsive to oestrogen

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2
Q

What is Amenorrhoea?

A

Lack of period for more than 6 months

Primary amenorrhoea- has never had a period (never went through menarche)

Secondary amenorrhoea- has menstruated before

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3
Q

What is Oligomenorrhoea?

A

Irregular periods

Usually occurring 6 weeks apart

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4
Q

What is Polymenorrhoea?

A

Period occurring less than 3 weeks apart

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5
Q

What causes ovulation problems?

A

Hypothalamus (lack of GnRH)
Pituitary (lack of FSH and LH)
Ovary
Hyperandrogenism

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6
Q

What is anosmia?

A

Inability to smell

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7
Q

What are some Hypothalamic ovulation problems?

A

Hypothalamus (lack of GnRH)

  • Kallmann’s syndrome (GnRH deficiency)
  • Functional hypothalamic amenorrhoea caused by weight loss, stress, excessive exercise, anorexia
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8
Q

What are some Pituitary ovulation problems?

A

Pituitary (lack of FSH and LH)

  • pituitary tumours Eg. Prolactinoma
  • Post pituitary surgery/radiotherapy
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9
Q

What are some ovary associated ovulation problems?

A

Ovary

-Premature ovarian insufficiency caused by chromosomal abnormalities like Turner syndrome, autoimmune, or iatrogenic

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10
Q

What are some hyperandrogenism ovulation problems?

A

Hyperandrogenism

  • Polycystic ovarian syndrome (commonest cause)
  • Congenital adrenal hyperplasia
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11
Q

What is Hirsutism?

A

Excessive hair in a male distribution

Not androgen-independent hair growth (Hypertrichosis) or familial/racial hair growth

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12
Q

What is Hypertrichosis?

A

Excessive hair growth over and above the normal for the age, sex and race of an individual

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13
Q

What can cause Hirsutism?

A

PCOS (95%)
Non-classical congenital adrenal hyperplasia (CAH)
Cushing’s syndrome
Adrenal/ovarian tumour

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14
Q

How prevalent is PCOS?

A

5-10% of women

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15
Q

What are some clinical features of PCOS?

A
  • Hyperandrogenism (Hirsutism and acne)
  • Chronic oligomenorrhoea/ amenorrhoea
  • Obesity
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16
Q

What is a USS appearance of polycystic ovaries?

A

> 10 subcapsular follicles 2-8mm in diameter arranged around a thickened ovarian stroma

17
Q

What are some hormonal abnormalities in PCOS?

A
  • Raised baseline LH levels and normal FSH
  • Raised androgens and free testosterone
  • Reduced sex hormone binding globin (SHBG)
  • Oestrogen is usually normal
18
Q

What is sex hormone binding globin (SHBG)?

A

It binds to testosterone and oestradiol

It’s produced by the liver

If testosterone is found, it’s inactive. Levels of SHBG are increased by oestrogens and decreased by testosterone

19
Q

How does PCOS affect metabolic syndrome?

A
  • Insulin resistance
  • Impaired glucose tolerance
  • Dyslipidaemia
  • Vascular dysfunction
20
Q

What are the reproductive effects of PCOS?

A
  • 80% lack ovulation
  • Increased risk of miscarriage
  • Increased risk of gestational diabetes
21
Q

How does PCOS increase the risk of endometrial cancer?

A

Because the patients are not ovulating but the levels of oestrogen are high causing endometrial hyperplasia and cancer

Endometrial cancer is also associated with T2 diabetes and obesity

22
Q

What are the effects of lifestyle changes like diet, exercise and stopping smoking in PCOS?

A
  • Decreased insulin resistance
  • Increased SHBG
  • Decreased free testosterone
  • Improved fertility
  • Improved metabolic syndrome risk factors
23
Q

What effect does a combined oral contraceptive have on PCOS?

A
  • Increases SHBG and thus decreases free testosterone
  • Decreases LH and FSH which decreases ovarian stimulation
  • Regulates cycle and decreases endometrial hyperplasia

May cause weight gain, venous thrombosis, adverse effects on metabolic risk factors

24
Q

Why is Cyproterone Acetate used to treat PCOS symptoms?

A

It’s an oral pill that inhibits binding of testosterone and 5 alpha dihydrotestosterone to androgen receptors

It acts on the androgen imbalance

25
Q

Why is Spironolactone used to treat PCOS symptoms?

A

It has anti-mineralocorticoid and anti-androgen properties

26
Q

How is Insulin resistance treated in PCOS and why?

A

With Metformin

  • It decreases insulin resistance, insulin levels, and ovarian androgen production
  • It may help with weight loss/diabetes prevention
  • May increase ovulation
27
Q

What is the presentation of primary ovarian insufficiency?

A

Primary or secondary amenorrhoea

Secondary is associated with hot flushes and sweats

28
Q

What is primary ovarian insufficiency also known as?

A

Premature ovarian failure

Premature menopause

29
Q

What is the cause of primary ovarian insufficiency?

A
  • Autoimmune associates with other endocrine conditions
  • X chromosome abnormalities like Turner syndrome of Fragile X
  • Genetic predisposition
  • Iatrogenic causes like surgery, radiotherapy or chemotherapy
30
Q

How is premature ovarian failure managed?

A
  • Psychological support
  • Hormone replacement therapy
  • Monitor bone density
  • Fertility - IVF with donor egg
31
Q

What investigations are done to see if someone has premature ovarian failure?

A
  • History/examination
  • Increased LH and FSH
  • Pelvic ultrasound
  • Screen for autoimmune endocrine diseases
32
Q

What are the presentations of Turner syndrome?

A
  • May be diagnosed as a neonate
  • Short stature in childhood
  • Primary or secondary amenorrhoea
33
Q

What are some medical problems associated with Turner syndrome?

A
  • Short stature so consider GH treatment
  • CV system (coarctation of aorta, bicuspid aortic deviation, aortic dissection, hypertension)
  • Renal congenital abnormalities
  • Metabolic syndrome
  • Hypothyroidism
  • Hearing problems
  • Osteoporosis
34
Q

What is congenital adrenal hyperplasia (CAH)?

A

A disorder of cortical biosynthesis in the adrenal glands. It causes the release of little cortisol and a lot of male hormones

95% of cases are caused by 21-hydroxylase deficiency

35
Q

What are the presentations of CAH in childhood?

A
  • Salt wasting (salt wasting and shock)
  • Virilisation (ambiguous genitalia in girls and early virilisation in boys)
  • Precocious puberty
  • Abnormal growth
36
Q

What is Virilisation?

A

A development of male physical characteristics in a female or precociously in a boy

37
Q

What are the presentations of CAH in adulthood?

A
  • Hirsutism
  • Oligo/Amenorrhoea
  • Acne
  • Subfertility

Similar to PCOS presentation

38
Q

What is the treatment for CAH?

A
  • Glucocorticoid and mineralocorticoid replacement
  • Additional salt in infancy
  • Surgical management of ambiguous genitalia

2.2 T2: Reproductive system, foetal development (16 decks)

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