Endocrine Control Female Reproduction 7 Flashcards

Summarize the hormonal changes characteristics of different categories of reproductive disorders.

1
Q

List the types of gonadotropin profiles in reproductive disorders.

A
  • Hypogonadotropic hypogonadism
  • Hypergonadostropic hypogonadism
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2
Q

Describe the common features of hypogonadotropic hypogonadism.

A
  • Findings:
    • anovulation
    • oligomenorrhea or amenorrhea
    • low or “inappropriately” normal circulating LH and FSH levels
  • A single blood level does not reflect LH secretion
    • circulating levels must be asses because of pulsatile nature
    • done in context of reproductive function
    • ex. if LH levels are normal but there is anovulation, then LH secretion is inadequate
    • circulating E2 levels may be normal or low depending ont he diagnosis and duration of the condition
    • common organs affected:
      • hypothalamus
      • pituitary
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3
Q

Describe the common features of hypergonadotropic hypogonadism.

A
  • Findings:
    • anovulation
    • oligomenorrhea or amenorrhea
    • high circulating FSH and variably elevated LH levels
  • Elevated FSH levels are a reliable indicator of ovarian follicular damage
  • Circulating E2 levels are usually low
  • Damage or loss of ovarian follicles results in this
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4
Q

List the common hypothalamus disorders that affect reproduction.

A
  • Absence/destruction of GnRH secretory neurons
  • GnRH deficiency - Functional Hypothalamic Amenorrhea (FHA)
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5
Q

What are the common causes of absence/destruction of GnRH secretory neurons?

A
  • Idiopathic hypogonadotropic hypogonadism (IHH)
    • more common in men than women
    • usually presents with delayed puberty
    • can be caused by several genetic defects
    • can be acquired and result in secondary amenorrhea
  • Structural lesions
    • ex. craniopharyngiomas
  • Infiltrative disorders
    • ex. sarcoidosis
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6
Q

What is functional hypothalamic amenorrhea (FHA) and what are the common causes? What is the treatment?

A
  • GnRH deficiency
    • due to disruption of GnRH release in the absence of structural lesions (hence “functional”)
    • ovulation depends on the precisely coordinated pulsatile secretion of GnRH
      • disruption can result in failure of ovulation and irregular or absent menses
    • GnRH secretion is often present but disrupted
    • LH and FSH are usually within the normal range but inappropriately low due to anovulation
  • Treatment
    • opiate antagonists or leptin
      • restores ovulator cycles
  • Causes
    • weight loss
      • anorexia nervosa
      • simple weight loss
    • exercise
      • elite runners
      • gymnasts
      • ballet dancers
    • stress
      • change in environment
      • systemic disease
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7
Q

What are the common disorders of the pituitary that lead to reproductive problems in females?

A
  • Prolactinomas
    • hyperprolactinemia
    • results in alterations in dopaminergic thone
    • disrupts GnRH release
    • ovulatory cycles can be restored by lowering prolactin levels
    • macroadenomas can cause mass effect as well
  • Other secretory pituitary tumors
    • elevated cortisol levels of Cushing’s syndrome can suppress GnRH release
  • Gonadotrope destruction
    • non-functional tumors
    • postpartum necrosis (Sheehan’s)
    • primary and secondary hemachromatosis
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8
Q

What happens in dysfunction of the ovary? How is this detected?

A
  • Primary gonadal failure with loss of gonadal steroid and inhibin feedback
    • results in increased LH and FSH levels
  • FSH most sensitive marker of gonadal failure
    • inhibin secretion can be diminished before steroid secretion
    • loss of inhibin results in a selective increase in circulating FSH levels
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9
Q

What is premature ovarian insufficiency (POI)?

A
  • Defined as the onset of menopause or evidence of follicular loss
    • ex. increased FSH levels before 40
  • Common causes:
    • idiopathic
    • 45 XO mosaics
      • presenting as secondary amenorrhea
    • cytotoxic drugs
      • ex. cytoxan
    • radiation
    • autoimmune polyendocrine syndromes (APSs)
  • Some causes can wax and wane so there may onl be intermittent elevations of FSH
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10
Q

Aside from PCOS, what is the other cause of androgen excess?

A
  • Hyperandrogenic chronic anovulation differential
    • ​PCOS
    • Classic congenital adrenal hyperplasia
      • presents in infancy
    • Non-classic congenital adrenal hyperplasia
      • 21-hydroxylase deficiency
      • presents after menarche with hyperandrogenism and chronic anovulation
    • Extreme insulin resistance syndromes
      • Type A syndrome
      • Familial partial lipodystrophy syndromes
    • Hyperprolactinemia
    • Androgen secreting tumors
    • Cushing’s
    • Iatrogenic - anabolic steroids
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