Y2 ENDOCRINE REPRODUCTION Flashcards
1
Q
mean duration of menstrual cycle
A
28 days
2
Q
average duration of menses
A
3-8 days
3
Q
normal estimated blood loss during menstruation
A
=30ml
4
Q
when during the menstrual cycle does ovulation usually occur?
A
day 14
5
Q
low oestrogen levels signal the anterior pituitary to produce?
A
FSH
6
Q
what stimulates follicle maturation?
A
FSH
7
Q
what triggers ovulation?
A
surge in LH at peak of follicular growth
8
Q
what secretory phase begins following ovulation?
A
luteal phase
9
Q
what are the granulosa cells called in the luteal phase?
A
corpus luteum
10
Q
peak progesterone production occurs?
A
one week after ovulation
11
Q
if pregnant, embryo releases hormones to preserve?
A
corpus luteum
12
Q
what hormone drops if there is no embryo to initiate menstruation?
A
progesterone
13
Q
what structure of the hypothalamus produces GnRH?
A
arcuate nucleus
14
Q
the ovary attaches to the pelvic side wall by?
A
infundibulopelvic ligament
15
Q
where are the follicles within the ovary?
A
cortex
16
Q
endometrium is which layers of the uterus?
A
basal and superficial.
17
Q
what thickens in the uterus in response to oestrogen?
A
endometrium
18
Q
endometrium sloughs off in response to?
A
drop/absence of hCG and progesterone
19
Q
GnRH is what type of hormone?
A
deca-peptide
20
Q
GnRH is released in which manner?
A
pulsatile
21
Q
half life of GnRH?
A
2-4 minutes
22
Q
what is FSH?
A
a glycoprotein of 2 subunites
23
Q
half life of FSH?
A
several hours
24
Q
- acts on theca cells to cause uptake of cholesterol, androgen production and conversion to oestrogen.
A
LH
25
acts synergistically with FSH and induces FSH and LH?
oestrogen
26
Local peptide in follicular fluid that acts by negative feedback on pituitary FSH secretion. Locally enhances LH-induced androstenedione production.
inhibin
27
Found in follicular fluid it stimulates FSH induced oestrogen production.
activin
28
tubular components of the testis?
sertoli cells and germ cells
29
interstitial components of the testis?
leydig cells and capillaries
30
what happens to the cervical mucous pre-fertilisation?
it becomes thin
31
sperm cannot fertilise an egg without?
capacitation
32
where does capacitation occur?
female genital tract
33
what follows capacitation?
acrosome reaction
34
what allows sperm to penetrate the egg?
acrosome reaction
35
what triggers the acrosomal reaction?
zona pellucida ZP3
36
what prevents polyspermy?
zona reaction
37
how many sperm are deposited at the cervical opening during ejaculation?
400-600 million
38
how many sperm reach the fertilisation site?
=200
39
what controls the development and maintenance of female sexual characteristics?
oestrogens
40
granulosa cells are stimulated by LH to produce?
pregnenolone
41
expression of aromatase and 17B-HSD is controlled by?
FSH stimulation
42
aromatase is expressed where?
non-gonadal sites
43
aromatase facilitates?
peripheral aromatisation of androgens to estrone e.g. fat and bone
44
progesterone is synthesised from and where?
pregnenolone in the
- corpus luteum
- placenta during pregnancy
- adrenal glands
45
main product during follicular maturation?
oestradiol
46
main product in luteal phase following ovulation?
progesterone.
47
reduction in frequency of periods to less than 9/year.
oligomenorrhoea
48
failure of menarche by the age of 16 years.
primary amenorrhoea
49
cessation of periods for >6 months in an individual who has previously menstruated
secondary amenorrhoea
50
what may cause physiological amenorrhoea?
- pregnancy
| - post-menopause
51
what may cause primary amenorrhoea?
- congenital problems e.g. Turner's, Kallman's.
52
what may cause secondary amenorrhoea?
- ovarian problems: PCOS, premature ovarian failure.
- uterine problem: uterine adhesions.
- hypothalamic dysfunction: weight loss, over exercise, stress, infiltrative.
- pituitary: high PRL, hypopituitarism.
53
female hypogonadism is identified by?
low oestrogen levels.
54
what is primary hypogonadism in females?
- ovary problems.
| e. g. premature ovarian failure.
55
what form of hypogonadism in females is ass. with high LH and FSH?
primary
56
what form of hypogonadism in females is ass. with low LH and FSH?
secondary
57
what is secondary hypogonadism in females?
- hypothalamus or pituitary problems e.g. high PRL, hypopituitarism.
58
what causes premature ovarian failure?
- chromosome abnormalities e.g. Turner's, Fragile X.
- gene mutations (FSH or LH receptor).
- autoimmune disease e.g. Addison's thyroid, anti-phospholipid.
- iatrogenic e.g. chemo or radiotherapy.
59
amenorrhoea, oestrogen deficiency and elevated gonadotrophins occurring at <40 years of age due to loss of ovarian function.
premature ovarian failure
60
how do you diagnose premature ovarian failure?
FSH >30 on 2 separate occasions >1 month apart
61
genetic disorder causing loss of GnRH secretion + anosmia or hyposmia.
Kallman's syndrome
62
Kallman's syndrome more commonly affects?
males 4x
63
Kallman's syndrome shows a normal MRI pituitary but absence of?
olfactory bulbs
64
Rotterdam criteria used to diagnose?
PCOS
65
what are the Rotterdam criteria?
2 of:
- menstrual irregularity
- hyperandrogenism (hirsutism or elevated free testosterone).
- polycystic ovaries
66
in PCOS, oestrogen levels are?
normal
67
what causes hirsutism?
excess androgen at hair follicle
68
management of PCOS?
- oral contraceptive pill.
- anti-androgens e.g. cyproterone acetate.
can give dianette = OCP + cyproterone acetate.
- local anti-androgens e.g. efflornithine cream (vaniqa).
- cosmesis: electrolysis and laser phototherapy.
69
clinical features of Turner's syndrome?
- short
- webbed neck
- shield chest with wide spaced nipples
- cubitus valgus
70
Turner's syndrome manifests in the CVS as?
- coarctation of the aorta
- bicuspid aortic valve
- hypoplastic left heart
71
Turner's syndrome manifests in the GI system as?
- crohn's or UC.
| - bleed
72
what conditions (not CVS or GI) are ass. with Turner's syndrome?
- lymphoedema
- hypothyroidism
- osteoporosis
- scoliosis
- otitis media
- renal abnormalities
73
most common congenital form of primary hypogonadism in males?
Klinefelter's
74
Klinefelter's karyotype
XXY
75
Turner's karyotype
XO
76
Klinefelter's biochemical results?
- low testosterone
- high LH/FSH
- elevated SHBG/oestradiol
77
secondary male hypogonadism biochemical results?
- low/normal FSH and LH.
| - low 9am testosterone
78
what causes secondary hypogonadism?
hypothalamic or pituitary dysfunction
- Kallman's, CAH.
- exercise, weight change, stress, systemic illness etc.
79
management of male hypogonadism?
if <50 - testosterone therapy.
will not restore fertility and may actually act as contraception
80
benefits of testosterone replacement therapy?
- improved sexual function
- bone health
- body composition/muscle strength
- improved QoL and cognition
- insulin sensitivity and diabetes
81
what causes gynaecomastia?
- increased oestrogen action on breast tissue
82
investigation of gynaecomastia?
- testosterone, LH and FSH
- oestradiol, prolactin.
- AFP, SHBG and hCG.
- LFTs
breast, testicular and adrenal imaging.
83
GnRH released by?
neurons in the hypothalamus in pulsatile release
84
GnRH stimulates?
FSH and LH synthesis/release from anterior pituitary
85
FSH in females?
stimulates follicular development and endometrium thickening
86
FSH in males?
stimulates sertoli cells and spermatogenesis
87
LH in females?
peak stimulates ovulation, corpus luteum development and endometrium thickening.
88
LH in males?
stimulates leydig cells, testosterone secretion and spermatogenesis
89
oestradiol peaks when in regards to ovulation?
before
90
progesterone peaks when in regards to ovulation?
after
91
which hormone is responsible for infertile thick cervical mucous?
progesterone
92
what hormone increases basal body temperature?
progesterone
93
management of PCOS?
weight loss.
stop smoking/alcohol.
- folic acid 400mcg/5mg a day.
- metformin (insulin resistance)
94
symptoms of pelvic inflammatory disease?
- abdo/pelvic pain
- fever
- vaginal discharge
- dyspareunia (difficult/painful intercourse).
- cervical exctiation
- menorrhagia
- dysmenorrhoea
- infertility
- ectopic pregnancy
95
"chocolate cysts" on ovary.
endometriosis
96
presence of endometrial glands outside uterine cavity
endometriosis
97
how can you test tubal patency?
- laparoscopy
| - hysterosalpingiogram
98
when is laparoscopy contra-indicated?
- obesity, previous pelvic surgery, Crohn's disease.
99
when should hysteroscopy be performed?
only where suspected or known endometrial pathology e.g. septum, polyps, adhesion
100
how do you manage hyperprolactinaemia?
- dopamine antigonists.
e. g. Cabergoline (long-acting) 2x a week.
stop when pregnancy occurs
