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Unit 1 ID+LC > Reproductive disorders Female > Flashcards

Reproductive disorders Female Flashcards

1
Q

LH and FSH levels in the early follicular phase is characterized by what?

A

Equal LH and FSH levels for the first 1-5 days after the beginning of menses

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2
Q

LH and FSH levels in the middle of the cycle is characterized by what?

A

higher LH and FSH levels

- follicular recruitment –> speeds up pulse generator

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3
Q

LH and FSH levels in the luteal phase is characterized by what?

A

High LH pulses

Lower FSH levels

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4
Q

Granulosa cells make ____ and the luteal cells make ____

A

estradiol

DHEA (androgens)

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5
Q

Fxn of Gonadal peptides made by the ovary:

  1. Inhibin
  2. Activin
  3. Follistatin
A
  1. Inhibin:
    - inhibits FSH
  2. Activin
    - Activates FSH
  3. Follistatin:
    - activin binding protein that controls its activity
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6
Q

Inhibin A is important in the _____ phase. Inhibin B is active in the ____ phase of the menstrual cycle.

A

A: luteal

B: follicular

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7
Q

Usually we must exclude pregnancy and elevated prolactin levels (prolactinomas) in women with disturbances in her menstrual cycle. When do we evaluate a woman with disturbances in her menstrual cycle using:

  1. Androgen levels
  2. GnRH stimulation test
  3. Drawing LH + FSH levels 5 days after menses starts
A
  1. Androgen levels:
    only indicated in presence of hirsutism and/or acne
  2. GnRH stimulation test
    - children with precocious puberty
    (hypothalamic amenorrhea)
  3. Drawing LH + FSH levels
    - nlly LH=FSH at that time
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8
Q

Hypothalamic amenorrhea

A

An acquired deficit of Hypogonadotropic hypogonadism

disorder of the GnRH secretory program is one of the most common endocrine disorders (3-5% of amenorrheic women)

  • due to stress
  • poor nutrition

*abnl GnRH secretion –> low to low nl FSH + LH + E

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9
Q

Hypergonadotropic hypogonadism levels

A

high FSH and/or LH
Low Estradiol

Amenorrhea

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10
Q

Congenital hypergonadotropic hypogonadism

A

Turner’s syndrome

Gonadal dysgenesis (XO, XX/XO)

*these people ahve menopause b4 menarche

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11
Q

Premature ovarian insufficiency (POI)

A

Acquired Hypergopnadotropic hypogonadism

  • ovarian failure b4 age 40
  • usually do to an autoimmune process
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12
Q

Signs and symptoms of early gonadal failure in premature ovarian syndrome (POI)

A
  1. irregular menses w/o molimal symptoms that are signs of an ovulatory cycle
    - breast tenderness
    - bloating
    - cramping
  2. FSH lvls rise before LH lvls
    - due to loss of inhibin
  3. waxing and waning course
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13
Q

PCOS most common begins in _______ with irregular menses, anovulation, hirsutism and acne.

60% of pts are overweight, but all are ________

A

adolescence

insulin resistant

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14
Q

Lab evals of PCOS

A

timed gonadotropin levels

High LH:FSH >2.5/1
- LH stimulates Theca cells in the ovaries

Increased androgens (DHEAS + T)

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15
Q

Etiology of PCOS

A

controversial:

GnRH pulse generator that is turned up too high -->
High LH -->
High androgens (theca stim) -->
low SHBG -->
increase in free hormone levels
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16
Q

PCOS is a polygenic disorder with increased risk for many problems, list some

A
  1. endometrial cancer
    - unopposed Estrogen
  2. Diabetes
  3. HTN
  4. Premature cardiac disease
17
Q

Goals of care for PCOS

A
  1. block effects of hyperandrogenization

2. ensure endometrial shedding to prevent endometrial cancer

18
Q

Testosterone and DHEAS levels that suggest Tumor in females

A

T lvls >200 ng/dl

DHEAS lvls > 800 ng/dl

19
Q

Difference between obesity induced anovulation and PCOS

A

Obesity induced anovulation:
- nl puberty and cycles until weight set point is exceeded

  1. Early follicular blood sample reveals nl equal LH and FSH,
  2. MILD elevation in androgens
    - problem due to excessive activity of aromatase and 5a-reductase activity in fat tissue
20
Q

Clomiphene citrate (Clomid)

A

An mixed estrogen agonist/antagonist used if fertility is desired in female pts with hypogonadism

  • augments folliculogenesis –> ovulation
  • fools repro axis into thinking that there is E deficiency
  • given on days 5-9 of the menstrual cycle
21
Q

Pergonal

Menotropin

Profasi

A

Pergonal
- hu menopausal gonadotropins

Menotropin
- recombinant FSH

Profasi
- pharmacologically stimulate folliculogenesis and ovulation

*all have risk for hyperstimulation and multiple gestations

22
Q

Tx for PCOS

A

Lupron - GnRH agonist given continuously for 1 month
- down reg GnRH receptors

Then
Pergonal - pulsatile GnRH

*can also give metformin for insulin sensitization and Thiazoladinediones to suppress androgens can improve ovulation rates

23
Q

Definition of menopause

A

cessation of ovarian fxn

~ 51 is ave age

Unit 1 ID+LC (32 decks)

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