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JL Endocrinology > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What is the same about oogenesis and spermatogenesis?

A

Identical meiotic and mitotic divisions

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2
Q

When does oogenesis begin?

A

In utero but is suspended for many years

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3
Q

What happens to complete oogenesis?

A

Fertilisation

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4
Q

What is the earliest female germ cell?

A

Primordial

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5
Q

The primordial germ cell is capable of mitosis - where does it migrate to by week 6 of embryo development?

A

Genital ridge

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6
Q

What do the female germ cells oogonia give rise to?

A

Oocytes (completion of last pre-meiotic division)

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7
Q

What cells in the female germ line enter meiosis?

A

Oocytes

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8
Q

What is one of the first two products in the first stage of meiosis?

A

first polar body

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9
Q

What signifies sperm entry and the completion of 2nd meiotic division?

A

Presence of two polar bodies

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10
Q

How long does the ovarian cycle last for?

A

28 days

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11
Q

What phase in the ovarian cycle involves maturation of egg, ready for ovulation at midcycle-ovulation signals end of this phase?

A

Follicular phase

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12
Q

What phase of the ovarian cycle involves development of corpus luteum and induces preperation of reproductive tract for pregnancy (if fertilisation occurs)?

A

luteal phase

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13
Q

Before birth, what is the primary oocyte surrounded by?

A

Single layer of granulosa cells

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14
Q

What is each primary follicle capable of producing?

A

Single ovum

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15
Q

Until puberty - what happens to primary follicles?

A

Degenerate to scar tissue before ovulation

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16
Q

After puberty around how many eggs will be ovulated?

A

400 - rest undergo atresia

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17
Q

What ends the follicular phase?

A

Ovulation

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18
Q

What do follicular cells left behind ovulation undergo?

A

Luteinisation - transformation to hte corpus luteum

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19
Q

What does the corpus luteum secrete?

A

Progesterone

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20
Q

What secreted in follicular phase and what secreted in luteal phase are essential for preperation of uterine lining for implantation?

A

Follicular - oestrogen

Luteal - Progesterone

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21
Q

What does degeneration of corpus luteum signal the start of?

A

New follicular phase

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22
Q

The hypothalamus secretes GnRH which acts on what?

A

anterior pituitary

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23
Q

What does FSH from anterior pituitary stimulate?

A

Development of follicles

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24
Q

What does LH stimulate?

A

Follicle maturation, ovulation and development of the corpus luteum

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25
Q

FSH + LH stimulate what?

A

Secretion of oestradiol and ovulation

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26
Q

When LH and FSH are secreted in the follicular phase how do the 15 follicles mature?

A

Granulosa and theca cells develop

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27
Q

What do the theca cells produce which is converted by the granulosa (aromatase) to oestradiol?

A

Androgen

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28
Q

What does oestrogen suppress?

A

FSH production (selection of dominant follicle)

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29
Q

What do granulosa in the dominant follicle express?

A

LH receptors

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30
Q

What do high levels of oestrogen at mid cycle cause the hypothalamus to release?

A

GnRH which causes FSH and LH surge from anterior pituitary

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31
Q

Before ovulation what happens to the cumulus oophorus after increase in follicular fluid and number of granulosa?

A

Loosens and follicle wall weakens

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32
Q

After ovulation what happens to FSH and LH?

A

They fall

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33
Q

How can you detect ovulation?

A

Day 21 progesterone check

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34
Q

At 12 days - if there is no hCG production from an embryo, the corpus luteum degenerates forming the what?

A

Corpus albicans - progesterone and estrogen levels fall, removing negative feedback and cycle begins again

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35
Q

If pregnancy occurs, what does the developing embryo produce and what does it maintain?

A

hCG - maintains corpus luteum

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36
Q

What is the name of the class of steroid hormones which control the development and maintanence of female sexual characteristics?

A

Oestrogens

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37
Q

Where does glandular oestrogen synthesis occur?

A

In the granulosa and theca cells of the ovaries as well as corpus luteum

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38
Q

What are granulosa cells stimulated by to produce pregnenolone?

A

LH

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39
Q

What is the expression of aromatase and 17beta-HSD controlled by?

A

FSH stimulation

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40
Q

During extraglandular synthesis - what is expressed in non-gonadal sites and facilitates peripheral aronmitasation of androgens to estrone?

A

Aromatase

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41
Q

what is oligomenorrhea?

A

Reduction in frequency of periods to less than 9/year

42
Q

What is primary amenorrhea?

A

Failure of menarche by age 16

43
Q

What is secondary amenorrhea?

A

Cessation of periods for >6months in an individual who has previously menstruated

44
Q

What two congenital problems can cause primary amenorrhea?

A

Turners and Kallmans

45
Q

What two pituitary causes can result in secondary amenorrhea?

A

High PRL

Hypopiutuitarism

46
Q

Give three symptoms of oestrogen deficiency?

A

Flushing
Libido
Dyspareunia

47
Q

Give two clinical features of PCOS and androgen excess?

A

Hirtuism/acne

48
Q

Name the 5 substances that are tested when investigating amenorrhea?

A

LH
FSH
Thyroid function
Prolactin

49
Q

What investigation would you do if primary amenorrhea was present?

A

Karyotype

50
Q

What type of hypogonadism involves problems with the ovaries, high LH/FSH (hypergonadotrophic hypogonadism) and an example is premature ovarian failure?

A

Primary hypogonadism

51
Q

What type of hypogonadism involves problem with hypothalamus or pituitary, low LH/FSH (hypogonadotrophic hypogonadism) and an example is high PRL, hypopituitarism?

A

Secondary hypogonadism

52
Q

What condition has amenorrhea, oestrogen deficiency and elevated gonadotrophins occuring

A

Premature Ovarian Failure (POF)

53
Q

How is the diagnosis of POF made?

A

FSH more than 30 on 2 seperate occasions more than 1 month apart

54
Q

Can radiotherapy/chemo cause POF?

A

Yes

55
Q

What is the major defect in idiopathic hypogonadotrophic hypogonadism?

A

Inability to activate pulsatile GnRH secretion during puberty

56
Q

Name the genetic disorder characterised by loss of GnRH secretion + anosmia or hyposmia?

A

Secondary hypogonadism: Kallmans syndrome

57
Q

What seperates Kallmans and idiopathic hypogonadotropic hypogonadism?

A

Lack of smell in kallmans - MRI absence of olfactory bulbs

58
Q

For the diagnosis of PCOS you need normal oestrogen levels and 2 of what three things?

A
  1. Menstrual irregularity
  2. Hyperandrogenism
  3. Polycystic ovaries
59
Q

What does a polycystic ovary increase?

A

Testosteone

60
Q

In PCOS what does increased testosterone do?

A

Increases LH and insulin resistance and hyperinsulinaemia

61
Q

What sign does excess androgen cause in women?>

A

Hirtuism

62
Q

What is an inherited group of disorders characterised by a deficiency in one of the enzymes needed for cortisol synthesis?

A

Congenital Adrenal Hyperplasia - autosomal recessive

63
Q

What are 90% of CAH cases due to?

A

21alphahydroxylase deficiency

64
Q

What are androgen secreting tumours frequently associated with signs of?

A

Virulisation and high testosterone above 5

65
Q

Name three medications used to treat PCOS?

A
  1. contraceptive pill (regulates cucle, drecrease ovarian androgens)
  2. Anti-androgens - cyproterone acetate
  3. Local anti-androgens (efflornithine cream)
66
Q

How do you treat late onset CAH?

A

Low dose glucocorticoid to suppress ACTH drive

67
Q

What is the genetic defect in Turners syndrome?

A

46X0 instead of 46XX

68
Q

Give four clinical features of Turners syndrome?

A
  1. Short stature
  2. Webbed neck
  3. Shielf chest with wide space nipples
  4. Cubitus Valgus
69
Q

What congenital condition are these CVS problems found in: coarctation of aorta, bicuspid aortic valve and hypoplastic left heart?

A

Turnesr

70
Q

What male hypogonadism involves low testosterone with high LH/FSH?

A

Primary hypogonadism

71
Q

What is the most common congenital form of primary hypogonadism?

A

Klinefelters syndrpme 47XXY

72
Q

Give five clinical features of Klinefelters sybdrome?

A
  1. Reduce testicular volume
  2. Gynaecomastia
  3. Eunochoidism
  4. Intellectual dysfunction
  5. Azoospermia
73
Q

LH and FSH from pituitary react on ovaries to release what?

A

Estradiol

Progesterone

74
Q

What type of pulses foes GnRH have to do to stimulate FSH?

A

Low frequency pulses (LH is high frequency)

75
Q

In relation to hormone levels in menstrual cycle - when does estradiol peak?

A

Before ovulation

76
Q

In relation to hormone levels in mesntrual cycle - when does progesterone peak?

A

Following ovulation

77
Q

What does high oestrogen concentration inhibit and stimulate?

A

Inhibits FSH and prolactin

Stimulates LH

78
Q

What does progesterone inhibit?

A

LH

79
Q

How do you confirm regular cycles?

A

Midluteal day 21 serum progesterone more than 30

80
Q

How do you manage hypothalamic anovulation?

A

Stabilise weight, pulsatile GnRH or FSH+LH daily injections. both need ultrasound monitoring of response

81
Q

What acts as a co-gonadotrophin to LH?

A

Insulin

82
Q

What dose of folic acid should be given pre treatment of PCOS?

A

400mcg

83
Q

What are the three methods of ovulation induction in PCOS?

A
  1. Clomifene citrate, tamoxifen
  2. Gonadrotrophin therapy: daily injections
  3. Laparoscopic ovarian diathermy
84
Q

When inducing ovulation in PCOS if a patient doesnt ovulate on Clomifene what is the other option?

A

Metformin

85
Q

In a patient who has induced ovulation what does a lambda sign on ultrasound suggest?

A

Dichorionic twins - risk

86
Q

In a patient who has induced ovulation what does a T sign suggest on ultrasound?

A

Monochorionic twins

87
Q

What is the pathophysiology of twin-twin transfusion syndrome (risk when inducing ovulation in PCOS)?

A

Unbalanced vascular communications within placental bed

88
Q

What levels are FSH/LH, oestrogen, serum prolactin and TFT in hyperprolactinaemia?

A

FSH/LH - normal
Oestrogen - low
Prolactin - raised > 1000
TFT - normal

89
Q

Name a dopamine agonist used to treat hyperprolactinaemia#/

A

Cabergoline

90
Q

Name three endocrine features anorexia nervosa gives?

A
  1. Low FSH
  2. Low LH
  3. Low oestradiol
91
Q

What exacerbates PCOS?

A

Weight gain

92
Q

Give three endocrine features of PCOS?

A
  1. High free androgens
  2. High LH
  3. Impaired glucose tolerance
93
Q

Give three endocrine features of premature ovarian failure?

A
  1. High FSH
  2. High LH
  3. Low oestradiol
94
Q

What could cause abdo/pelvic pain, vaginal discharge, dyspareunia, cervical excitation menorrhagia, dysmenorrhoea, infertility and ectopic pregnancy?

A

Hydrosalpinx due to pelvic inflammatory disease

95
Q

What is endometriosis>?

A

Presence of endometrial glands outside uterine cavity

96
Q

With endometriosis - what might a scan show?

A

Characteristic chocolate cysts on ovary

97
Q

Name a congenital absence that can cause male infertility?

A

Cystic fibrosis

98
Q

In obstructive causes of male infertility what happens to LH, FSH and testosterone?

A
  1. Normal Lh
  2. Normal FSH
  3. Normal testosterone
99
Q

Give two clincal features of non-obstructive male infertility such as klinefelters?

A
  1. Low testicular volume

2. Reduced secondary sexual characteristics

100
Q

What happens to LH, FSH and testosterone in non-obstructive male infertility such as klinefelters?

A
  1. High LH
  2. High FSH
  3. Low testosterone
101
Q

What test is used to test tubal patency in women with infertility?

A

Hysterosalpingiogram

JL Endocrinology (12 decks)

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