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BRS Y1 > Week 5- Sex Hormones > Flashcards

Week 5- Sex Hormones Flashcards

1
Q

Define puberty

A

The maturation of reproductive organs causing production of sex steroids, development of secondary sexual characteristics and attainment of capability to reproduce

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2
Q

How are the stages of puberty classed?

A

The Tanner staging scale

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3
Q

What is breast development known as?

A

Thelarche

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4
Q

What is growth of pubic hair known as?

A

Pubarche

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5
Q

What is gonadarche?

A

Activation of gonads by HPG axis

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6
Q

What is adrenarche?

A

Adrenal androgen production

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7
Q

What are main 2ndary sexual characteristics for girls?

A

Breast development
Hair growth (pubic and axiallary)
Sweat gland composition
Changes to external genitalia

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8
Q

What are main 2ndary sexual characteristics for boys?

A

Deepening of voice
Hair growth (pubic then axillary/facial)
Sweat gland composition
Changes to external genitalia

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9
Q

What is the first sign of puberty for girls and the late sign?

A

First sign: Thelarche

Late sign: Menarche

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10
Q

What is the testicular size for boys when they are prepubertal vs when they are adults?

A

Prepubertal: < 4mls
Adult: > 15mls

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11
Q

During puberty how is GnRH released?

A

Nocturnally in pulses

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12
Q

During adulthood how is GnRH released?

A

In pulses throughout the day

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13
Q

When is the normal onset of puberty for girls?

A

8-13 yrs

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14
Q

When is the normal onset of puberty for boys?

A

9-14 yrs

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15
Q

What is early puberty known as and is it more common in girls or boys?

A

Precocious puberty, more common in girls

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16
Q

What is late puberty known as and is it more common in girls or boys?

A

Delayed puberty, more common in boys

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17
Q

How many years approx after thelarche does menarche occour?

A

2.3 yrs

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18
Q

After what age is amenorrhea regarded abnormal?

A

16 yrs

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19
Q

What happens during the follicular phase?

A 
FSH rises
2/3 follicles start to grow
Follicles produce E2 and inhibin
This reduces FSH via -ve feedback
Non dominant follicles undergo atresia
A dominant Graafian follicle emerges
Theres a switch to positive feedback by E2
Induces a LH surge
Ovulation
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20
Q

What 2 hormones does the corpus luteum produce?

A

Progesterone

Oestradiol

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21
Q

What is the name of the phase after ovulation?

A

Luteal phase

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22
Q

What chemical is tested for to see if someone has ovulated?

A

Midluteal D21 progesterone

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23
Q

What phase is the endometrium in during ovulation?

A

Proliferative phase

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24
Q

What phase is the endometrium in during the luteal pahse?phase?

A

Secretory phase

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25
Q

What effect does hCG have on the corpus luteum?

A

Causes continual production of progesterone and oestradiol, maintaining the uterine lining allowing pregnancy to continue

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26
Q

What time elapses between GnRH pulses during the follicular phase?

A

Every 90-120 mins

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27
Q

What time elapses between GnRH pulses during the luteal phase?

A

Every 180- 240 mins

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28
Q

What is hypogandism in males vs females?

A

Males: decreased testosterone
Females: decreased oestrogen

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29
Q

What does the ‘primary’ in primary hypogonadism signify?

A

Direct damage to the gland eg testes/ovaries

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30
Q

What happens in hypogonadism?

A

Decreased testosterone/oestrogen causes reduced negative feedback to GnRH or the pituitary gland causing increased levels of FSH/LH

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31
Q

What happens in menopause?

A

Low oestrogen causing eventual increase in FSH/LH as well as low E2 and low inhinbin

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32
Q

What are some symptoms of menopause?

A 
Skin dryness
Hair thinning
Hot flushes/sweating
Sleep distrubance
Osteoporosis
Sexual dysfunction
Weight gain
Amenorrhea
Climateric (irregular periods in the years approaching menopause)
33
Q

What is the treatment for menopause?

A

Oestrogen replacement (HRT)

This stimulates the endometrium, if progesterone is added the endometrium is intact to prevent risk of endometrial hyperplasia/cancer

34
Q

At what age does menopause occur?

A

45-55 years (51 is median)

35
Q

Menopause before what age qualifies as premature menopause?

A

Less than 40 years old

36
Q

What else is premature menopause known as?

A

Premature ovarian insufficiency

37
Q

What are some causes of premature ovarian insufficiency?

A

Autoimmune
Genetic (fragile X syndrome/turners syndrome)
Cancer therapy

38
Q

What time of day is testosterone measured and why?

A

Before 11 am as it has a diurnal rythm

39
Q

What are some symptoms of testosterone deficiency?

A

Sexual dysfunction
Hair growth (ask about frequency of shaving)
Lower energy levels
Mood disturbance
Body composition (increased fat/reduced muscle mass/ gynaecomastia ie breast enlargement)

40
Q

How many stages are there in the Tanner staging scale?

A

5 (I-V)

41
Q

What hormone causes 2ndary sexual characteristics on females?

A

Oestradiol

42
Q

What hormone causes 2ndary sexual characteristics on males?

A

Testosterone

43
Q

When does adrenarche occur in females?

A

6-9 yrs

44
Q

When does adrenarche occur in males?

A

7-10 yrs

45
Q

When do females normally have a growth spurt?

A

11-13 years

46
Q

When do males normally have a growth spurt?

A

13-15 yrs

47
Q

What hormone markedly increases during adrenarche?

A

DHEA

48
Q

What 2 hormones markedly increase during gonardarche? Which of the 2 is higher?

A

LH and FSH, with FSH always being higher

49
Q

What is mini puberty?

A

When there is activation of the HPG axis in the first 6 months of life leading to oestrodiol/testosterone production depending on wether you are male or female

50
Q

What is the condition that arises when mini puberty doesnt occour? How does it manifest in males?

A

Cowman’s syndrome, causes males testes not to drop properly and they have a micropenis

51
Q

How many follicles start to grow in the follicular phase of the menstrual cycle?

A

2-3

52
Q

What do developing follicles produce in the follicular phase of the menstrual cycle?

A

E2 and inhibin B

53
Q

What negative feedback response do E2 and inhibin B cause during the follicular phase of the menstrual cycle?

A

Reduce FSH production

54
Q

What is the name of the process undergone by non dominant follicles in the follicular phase of the menstrual cycle?

A

Atresia

55
Q

What is the dominant follicle called in the follicular phase of the menstrual cycle?

A

Graafian follicle

56
Q

What chemical rises in level after the emergence of the Graafian follicle in the follicular phase of the menstrual cycle? What effect does it have?

A

E2, it causes positive feedback inducing an LH surge

57
Q

Which chemical in the follicular phase causes a surge in LH?

A

E2

58
Q

What hormone provides evidence of ovulation?

A

Midluteal D21 progesterone

59
Q

What type of release is GnRH released by?

A

Pulsatile

60
Q

What happens when GnRH is released constantly instead of in pulses?

A

Decreased LH/FSH is secreted

61
Q

What happens to LH/FSH/E2 and testosterone levels in hypogonadism?

A

LH/FSH levels rise

E2/testosterone levels fall

62
Q

What is secondary hypogonadism?

A

Due to a problem with the pituitary gland eg pituitary tumor/high prolactin

63
Q

What happens to levels of LH/FSH/E2/testosterone in secondary hypogonadism?

A

Low or normal LH/FSH

Low E2/testosterone

64
Q

What is the main marker of ovarian reserves? How does it indicate ovarian reserves?

A

Anti Mullerian hormone, it peaks in early adult life and is very low at menopause

65
Q

Where is anti mullerian hormone synthesised?

A

In sertoli cells in the ovary

66
Q

How does testosterone circulate?

A

38% bound to albumin
60% bound to SHBG
2% free/unbound

67
Q

What is the difference between albumin and SHBG in relation to testosterone binding?

A

Albumin binds weakly so testosterone is bioavailable

SHBG binds strongly so the testosterone is unavailable

68
Q

What happens to the way testosterone circulates as men get older?

A

Less testosterone circulates freely, more is bound to SHBG so free testosterone is reduced

69
Q

When is it ideal to measure testosterone and why?

A

Measure it fasting as levels can fall as much as 20% with sugar

70
Q

What enzyme converts testosterone to oestrogen?

A

Aromatase

71
Q

What enzyme converts testosterone to dihydrotestosterone?

A

5 alpha reductase

72
Q

How is dihydrotestosterone different to testosterone?

A

DHT is a more potent ligand for androgen receptors

73
Q

Where is aromatase found?

A 
Adipose tissue 
Adrenal glands 
Ovaries (granulosa cells)
Testes (sertoli cells)
Brain
Bone 
Skin
74
Q

Where is 5 alpha reductase found?

A

Testes (seminal vesicle, epididymis)
Prostate
Skin
Liver

75
Q

Why may there be low levels of testosterone?

A

Primary causes: damage to the testes due to trauma, mumps etc

Secondary causes: damage to the pituitary due to head trauma, pituitary adenoma (hyperprolactinemia)

Interference with pulsatile secretion: due to drugs (depressent ones eg citalopram, alcohol, heroine, cannabis)

76
Q

When a patient presents with low testosterone, why should you examine 2ndary sexual characteristics?

A

If they are absent, the low testosterone is likely due to genetic conditions

77
Q

What questions would help when diagnosing someone with low testosterone?

A

Have you noticed any changes in your vision?

Are you a drug user?

Do you drink frequently? If so how much

Have you had any infections recently?

Have you experienced a lot of stress recently?

Have you had any milk expression?

78
Q

What happens if someone is deficient in 5 alpha reductase?

A

2ndary male sexual characteristics are not driven, baby is born looking completely female but has male reproductive organs internally. Voice may deepen etc in early teens, they wont get a period, may start to feel as if they are a boy and present with symptoms

BRS Y1 (52 decks)

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