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Y2 Endocrine > Week 5 > Flashcards

Week 5 Flashcards

1
Q

What are the hormones involved in the menstrual cycle

A

GnRH
FSH
LH
Oestrogen
Progesterone

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2
Q

What are the 2 phases of the menstrual cycle

A

Follicular Phase
Luteal Phase

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3
Q

If a woman’s menstrual cycle is not 28 days, the length of which phase out of the 2 would change

A

Follicular phase can vary in length whereas luteal phase is always 14 days

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4
Q

Describe how GnRH is released from the hypothalamus in females and males

A

Released in a pulsatile manner at different frequencies in females
Released in a pusaltile manner at constant frequency in males

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5
Q

Why is GnRH released in a pulsatile manner in females

A

Because females have the menstrual cycle. Releasing GnRH at different frequencies induces secretion of different hormone

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6
Q

GnRH secreted in pulses at high frequency induces the secretion of

A

LH

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7
Q

GnRH secreted in pulses at low frequency induces the secretion of

A

FSH

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8
Q

FSH and LH are secreted by

A

Anterior pituitary gland

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9
Q

Which phase occurs first in the menstrual cycle

A

Follicular phase

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10
Q

What occurs in the follicular phase

A

Follicle develops

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11
Q

What occurs in the luteal phase

A

Ovulation - egg released from ovary
Corpus luteum forms

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12
Q

In which phase is oestrogen released

A

Follicular phase

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13
Q

In which phase is progesterone released

A

Luteal phase

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14
Q

What controls the pulsatility of GnRH

A

Oestrogen and Progesterone through activating receptors on Kisspeptin neutrons

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15
Q

Why are kisspeptin neurons needed to regulate the pulsatility GnRH

A

Because the GnRH neurons do not have oestrogen or progesterone receptors.

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16
Q

Which hormone is predominant in follicular phase

A

FSH

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17
Q

Which hormone is predominant in luteal phase

A

LH

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18
Q

Describe the follicular phase

A
  1. FSH stimulates follicular growth
  2. This causes an increase in oestrogen
  3. The initial increase in oestrogen exerts a negative feedback to lower FSH temporarily
  4. As oestrogen reaches the threshold, it exerts positive feedback on both FSH and LH
  5. This causes the surge in LH and an increase in FSH
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19
Q

FSH causes the growth of multiple follicles but in the end, only 1 follicle matures completely. Why is that

A

Due to the fall in FSH as oestrogen level increases initially.
Only the follicle that can withstand the fall in FSH will develop completely as FSH rises again but the others will be lost

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20
Q

Describe the Luteal phase

A
  1. Surge in LH causes ovulation
  2. Egg leaves follicle = follicle becomes corpus luteum
  3. Corpus luteum produces and releases progesterone
  4. Progesterone causes the drop in LH by decreasing pulsatility of GnRH
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21
Q

What happens to the endometrium under the influence of oestrogen

A

Oestrogen causes the thickening of endometrium

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22
Q

What happens to the endometrium under the influence of progesterone

A

Progesterone also causes the thickening of endometrium and turns it into a secretory tissue

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23
Q

Thickening of endometrium allows

A

Implantation of fertilised egg -> pregnancy

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24
Q

What happens to the hormones if there is pregnancy

A

LH will be substituted by HCG which maintains the corpus luteum hence progesterone will still be released

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25
Q

Why should the corpus luteum be maintained during pregnancy

A

So that progesterone will still be released and maintain the thickness of endometrium to prevent miscarriage

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26
Q

What happens to the hormones if there is no pregnancy

A

LH level drops hence corpus luteum cannot be maintained
So progesterone is not released -> endometrium thickness not maintained so it breaks down -> causing menstrual period

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27
Q

What is the threshold of oestrogen needed to cause LH surge

A

200 pg/ml

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28
Q

What is the precursor of progesterone and oestrogen

A

Cholesterol

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29
Q

What happens to the viscosity of cervical mucus under the influence of oestrogen and why

A

Viscosity decreases
To allow better sperm penetration to form fertilised egg

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30
Q

hat happens to the viscosity of cervical mucus under the influence of progesterone and why

A

Viscosity increases
To prevent more sperm penetration
To prevent infection

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31
Q

What structures in the cervix can make sperm penetration harder

A

Grooves and folds

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32
Q

Types of grooves in the cervix

A

Primary groove
Secondary groove

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33
Q

What structures in the cervix can make sperm penetration harder

A

Thicker mucus in cervical canal
Concentrated immune cells in cervical canal

34
Q

What is the optimal route for a sperm to pass through the cervix and fertilise the egg

A

Through primary and secondary grooves and avoid cervical canal

35
Q

Where are sperm made in the testes

A

seminiferous tubules

36
Q

Where are sperm stored in the testes

A

epididymis

37
Q

What is considered as infertility

A

Failure to achieve pregnancy after 12 months of regular intercourse without contraception

38
Q

What is primary infertility

A

In women that have never had a child

39
Q

What is secondary infertility

A

In women who had conceived before but unsuccessful (miscarriage / ectopic pregnancy)

40
Q

Risk factors for infertility

A

Age over 30
Obesity
Male infertility
Smoking
Drug usage
Diseases

41
Q

Common causes of secondary infertility

A

Endometriosis
Pelvic inflammatory diseases
Fibroids
Obesity

42
Q

Conditions that can cause infertility

A

Anovulatory infertility
PCOS
Endometriosis
Premature Ovarian failure
Pelvic inflammatory diseases
Fibroids

43
Q

What is anovulatory infertility

A

Infertility due to absence of ovulation

44
Q

Causes of anovulatory infertility

A

Eating disorders - anorexia / bulimia
Hyperprolactinaemia
Abnormal TSH level
PCOS
Premature ovarian failure
Drugs

45
Q

How does hyperprolactinaemia cause infertility

A

High prolactin levels causes low oestrogen level -> follicles do not mature -> egg not released

46
Q

Endocrine features of PCOS

A

High androgen level
High LH
Insulin resistance - High insulin

47
Q

Clinical features of PCOS

A

Obesity
Hirsutism
Acne
Abnormal menstrual cycles
Infertility
Anovulation
Acanthosis nigricans

48
Q

What is acanthosis nigricans

A

Dry, dark discoloration in body folds and creases esp in groin, axilla and neck

49
Q

Risk factors for PCOS

A

Genetics
Weight gain

50
Q

PCOS increases risk of

A

Diabetes
Infertility
NAFLD

51
Q

Which criteria is used to diagnose PCOS

A

Rotterdam criteria

52
Q

What is considered as premature ovarian failure

A

Menopause before the age of 40

53
Q

Endocrine feature of premature ovarian failure

A

Hypergonadotrophic hypogonadism

54
Q

What is hypergonadotrophic hypogonadism

A

Under activity of the ovaries (gonad) causing lack of negative feedback on the pituitary gland leading to excess FSH and LH

55
Q

Causes of premature ovarian failure

A

Turner syndrome
Chemotherapy / Radiotherapy
Infections

56
Q

What infections may cause premature ovarian failure

A

Mumps
CMV
TB

57
Q

Symptoms of premature ovarian failure

A

Amenorrhea
Irregular menstrual periods
Hot flushes
Night sweats
Vaginal dryness
Infertility

58
Q

Which symptoms of premature ovarian failure is due to lack of oestrogen

A

Hot flushes
Night sweats
Vaginal dryness

59
Q

What would the FSH and LH levels be in premature ovarian failure

A

High

60
Q

Premature ovarian failure increases the risk of

A

Osteoporosis
Dementia
Parkinson

61
Q

Investigations for premature ovarian failure

A

FSH/LH level
Oestrogen level

62
Q

What would the oestrogen level be in premature ovarian failure

A

Low because ovaries produce oestrogen hence abnormal ovaries cannot produce oestrogen even if there is high FSH

63
Q

Management for premature ovarian failure

A

Oestrogen therapy

64
Q

What is endometriosis

A

Ectopic endometrial tissue outside the uterus

65
Q

What are endometrioma in ovaries often called

A

Chocolate cysts

66
Q

What are the potential causes of endometriosis

A
  1. Retrograde menstruation
  2. Spread of endometrial cells via lymphatics
  3. metaplasia of cells outside uterus
67
Q

What is retrograde menstruation and how may it cause endometriosis

A

When the endometrial lining flows backwards during menstrual period and flows out of the fallopian tubes into peritoneum and pelvis

68
Q

Why do patients with endometriosis experience cyclical pelviv / abdominal pain

A

Because the endometrial cells outside the uterus responds to the hormones the same way.
This means that the ectopic endometrial tissue will shed and bleed too during menstrual cycle, causing inflammation of surrounding tissues

69
Q

Why may patients with endometriosis experience chronic non-cyclical pain

A

Adhesion may occur.
Inflammation of surrounding tissues induces formation of scar tissue which can cause organs to stick together and become irritated

70
Q

Symptoms of endometriosis

A

Cyclical abdominal / pelvic pain
Non-cyclical pain
Dysmenorrhea (painful periods)
Pain on deep sexual intercourse
Infertility
Cyclical bleeding from other sites causing haematuria and bloody stool

71
Q

How may endometriosis cause haematuria and bloody stool

A

If the endometrial cells deposit in the intestines / bladder

72
Q

Investigations for endometriosis

A

Ultrasound
Biopsy of the lesions via laparoscopy

73
Q

Management of endometriosis

A

Laparoscopic surgery

74
Q

What are causative pathogens of pelvic inflammatory diseases

A

Gonorrhea
Chlamydia
Syphilis
TB

75
Q

What are fibroids

A

Benign smooth muscle tumour that grows in the uterus from its muscle layers

76
Q

Cause of fibroids

A

Oestrogen and progesterone

77
Q

Non-obstructive causes of male infertility

A

Klinefelter syndrome
Hypogonadism
Hyperprolactinaemia
Chemotherapy / radiotherapy
Varicocele
Ejaculatory failure
Erectile dysfunction
Undescended testicles

78
Q

What is varicocele

A

Varicose veins (enlarged veins) within the skin that holds the testicles = ineffective blood circulation, deoxygenated blood pooling in the veins

79
Q

What are undescended testicles

A

Testicles that have not descended into the scrotum. This increases risk of trauma due to pubic bone putting pressure on the testicles

80
Q

Obstructive causes of male infertility

A

Cystic fibrosis
Ejaculatory duct obstruction
Post vasectomy

Y2 Endocrine (6 decks)

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