Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 203 Reproduction & endocrinology > T2 L6 Disorders of ovulation > Flashcards

T2 L6 Disorders of ovulation Flashcards

1
Q

Describe the supra-chiasmic nuclei

A

Master circadian clock which interacts with kisspeptin neurons and KNDy neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are kisspeptin neurons located?

A

In arcuate nucleus and ateroventral peri ventricular area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does LH trigger?

A

Ovulation
Resumption of oocyte meiosis
Changes granulosa cells into luteal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Why do some women get mid cycle pain during ovulation?

A

Due to leakage of follicle fluid at the time of ovulation irritating the peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What shouldn’t be used to diagnose ovulation?

A

Basal body temperature
Cervical mucus change
Vaginal epithelium changes
Endometrial biopsies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some hypothalamic causes of ovulation problems?

A

Kiss1 gene deficiency
GnRH gene deficiency
Weight loss / stress related / excessive exercise
Anorexia / bulimia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some pituitary causes of ovulation problems?

A

Pituitary tumours - prolactinoma / other tumours

Post pituitary surgery / radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some ovarian causes of ovulation problems?

A

Premature ovarian syndrome

  • developmental or genetic causes e.g. Turner’s syndrome
  • autoimmune damage and destruction of ovaries
  • cytotoxic and radiotherapy
  • surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the commonest cause of ovulation problems?

A

PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is amenorrhoea?

A

Lack of a period for > 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is primary amenorrhoea?

A

Never had a period (never went through menarche)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is secondary amenorrhoea?

A

Has menstruated before but hasn’t had a period for 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is polymenorrhea?

A

Periods occurring less than 3 weeks apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is androgen-dependent hirsutism?

A

Excess body hair in a male distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is hypertrichosis?

A

Excess hair growth that doesn’t follow the male pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 3 clinical features of PCOS?

A

Hyperandrogenism

  • hirsutism
  • acne

Chronic oligomenorrhoea / amenorrhoea

  • ≤9 periods a year
  • subfertility

Obesity
-25% are lean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is PCOS diagnosed?

A

When 2 of these 3 symptoms are met:

  • polycystic ovaries
  • androgen excess
  • oligo/anovulation
18
Q

Describe the link between metabolic syndrome and PCOS

A

Insulin resistance with increasing insulin
- increase in androgen production by ovarian theca cells
- decrease in SHBG production by liver
Impaired glucose tolerance
Dyslipidaemia
Vascular dysfunction
Increased risk of cardiovascular disease

19
Q

Describe the ultrasound appearance of PCOS

A

≥ 10 subcapsular follicles, 2-8mm diameter
Arranged around thickened ovarian storm
Not all women with PCOS will have ultrasound appearance

20
Q

Describe the hormone levels in PCOS

A

Raised baseline LH and normal FSH levels
Raised androgens and free testosterone
Reduced sex hormone binding globulin
Oestrogen is usually low but it can be normal

21
Q

What are the reproductive effects of PCOS?

A

Associated with varying degrees of infertility
Associated with increased miscarriages
Increased risk of gestational diabetes

22
Q

What is the link between PCOS and endometrial cancer?

A

Increased endometrial hyperplasia and cancer
Lack of progesterone on the endometrium
Endometrial cancer is associated with type 2 diabetes and obesity

23
Q

What are the treatment options for PCOS?

A 
Lifestyle modifications
Combined oral contraceptives
Anti-androgens
Metformin
Hair removal
24
Q

What lifestyle modifications are advised in PCOS?

A

Diet and exercise
Stop smoking
High frequency eating disorders

25
Q

What are the effects of making lifestyle modifications?

A

Decreases insulin resistance
Increases SHBG concentration
Improved fertility / pregnancy outcomes
Improved metabolic syndrome risk factors

26
Q

Describe how COCP can help with PCOS?

A

Increase SHBG to decrease free testosterone
Decrease FSH and LH to stimulate ovaries
Regulates cycle to decrease endometrial hyperplasia

27
Q

Describe the use of anti-androgens for PCOS

A

Taken with COCP / other form of secure contraception
Cyproterone acetate inhibits binding of testosterone and 5 alpha dihydrotestosterone to androgen receptors
Spironolactone has anti-mineralocorticoid and anti-androgen properties

28
Q

How does metformin help with PCOS?

A

Decrease insulin resistance and insulin levels
Decrease ovarian androgen production
May help with weight loss / diabetes prevention
Increase ovulation
Less helpful for hirsutism and oligomenorrhoea

29
Q

What are the options for hair removal?

A

Photoepilation / electrolysis

Eflomithine cream

30
Q

What are the differential diagnoses for hirsutism?

A

95% is PCOS or idiopathic hirsutism
1% of non-classical congenital adrenal hyperplasia
<1% Cushing’s syndrome
<1% adrenal / ovarian tumour

31
Q

What is primary ovarian insufficiency?

A

Premature ovarian failure / premature menopause

Loss of normal function of ovaries

32
Q

What is the aetiology of primary ovarian insufficiency?

A

Autoimmunity
X chromosomal abnormalities - Turner syndrome, fragile X
Genetic predisposition - premature menopause
Iatrogenic - surgery, radiation, chemo

33
Q

What investigations should be done when considering primary ovarian insufficiency?

A 
History / examination
Increased LH and FSH
Possible karyotype
Consider pelvic ultrasound
Consider screening for other autoimmune endocrine disease
34
Q

What is the management for primary ovarian insufficiency?

A

Psychological support
HRT
Monitor bone density
Fertility - IVF with donor egg

35
Q

What is Turner’s syndrome?

A

Complete / partial X monosomy in some / all cells

36
Q

What are some problems associated with Turner’s syndrome?

A 
Short stature
CV system
- coarctation of aorta
- bicuspid aortic valve
- aortic dissection
- hypertension
Renal
Metabolic syndrome
Hypothyroidism
Ears / hearing problems
Osteoporosis
37
Q

What is congenital adrenal hyperplasia?

A

Disorders of cortisol biosynthesis

Defect in cortisol biosynthesis –> raised CRH / ACTH –> excess adrenal androgen production

38
Q

How is congenital adrenal hyperplasia diagnosed?

A

High concentration of 17-hydroxyprogesterone

Can confirm with synacthen test

39
Q

What is the presentation of congenital adrenal hyperplasia in adulthood?

A

Hirsutism
Oligo/amenorrhoea
Acne
Subfertility

40
Q

What is the treatment for congenital adrenal hyperplasia?

A

Glucocorticoid and mineralocorticoid replacement
Supraphysioloical glucocorticoid doses may be needed to suppress adrenal androgen production
Surgical management for ambiguous genitalia
Can treat in the same was as PCOS

Module 203 Reproduction & endocrinology (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions