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LCRS Endo > Endocrine infertility > Flashcards

Endocrine infertility Flashcards

(51 cards)

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1
Q

what hormones does GnRH stimulate?

A

LH and FSH

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2
Q

what do Sertoli cells produce?

A

inhibin

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3
Q

what do Leydig cells produce?

A

testosterone

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4
Q

what is the menstrual cycle duration?

A

25-35 days

28 average

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5
Q

what are the phases of menstrual cycle?

A

follicular phase
ovulation
luteal phase

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6
Q

what is the effect of a high levels of oestradiol (E2) on the hypothalamus mid-cycle ? what stage of the menstural cycle does this indicate?

A

positive feedback increases GnRH and therefore LH release for ovulation

ovulation stage

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7
Q

what is the definition of infertility?

A

inability to conceive after 1 year of regular unprotected sex

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8
Q

what are the main two reasons for infertility?

A

1) primary gonadal failure

2) hypothalamic-pituitary disease

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9
Q

what are the hormone levels in primary gonadal failure?

A

due to gonadal failure :
high GnRH
high FSH and LH
low inhibin/testosterone/oestradiol

negative feedback means more gonadotrophin are released

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10
Q

what are the hormone levels in hypo-pit disease?

A

due to hypo-pit failure:

  • low GnRH
  • low FSH and LH
  • low/no inhibin/testosterone/oestradoil

hypothalamus and pituitary don’t react to the negative feedback signal from low production of gonadal hormones

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11
Q

what are the main 5 clinical features of male hypogonadism?

A
  • loss of libido
  • impotence
  • small testes
  • decreased muscle bulk (loss of anabolic effect)
  • osteoporosis (loss of anabolic effect)

these are the effects of low testosterone

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12
Q

what are the 4 causes of male hypogonadism?

A
  • hypo-pit disease
  • primary gonadal disease
  • hyperprolactinaemia
  • androgen receptor deficiency
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13
Q

what comes under hypo-pit disease causing male hypogonadism?

A
  • hypopituitarism
  • Kallmans syndrome (anosmia and low GnRH)
  • illness/underweight (low BMI)
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14
Q

what are 2 types of causes for primary gonadal disease in males?

A
  • congenital: Klinefelters

- acquired: testicular torsion, chemotherapy

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15
Q

what factors are investigated in male hypogonadism?

A 
- LH, FSH and testosterone 
if these are are low--> MRI pituitary 
- prolactin 
- sperm count 
- chromosomal analysis
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16
Q

what are the sperm count disorders?

A

azoospermia- absence of sperm in ejaculation

oligospermia- reduced sperm in ejaculation

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17
Q

what are the 3 treatment options for male hypogonadism?

A

HRT- to replace testosterone (address decreased muscle mass and osteoporosis)

Subcutaneous gonadotrophins- for fertility, as testosterone is not enough

hyperprolactinaemia- dopamine agonist to inhibit prolactin

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18
Q

where are testosterone/androgens produced?

A 
Leydig cells 
adrenal cortex
ovaries
placenta
tumours

prostate
liver
brain
skin

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19
Q

what are the 4 main actions of testosterone?

A
  • development of male genital tract
  • secondary sexual characteristics
  • maintenance of adult fertility
  • anabolic effects (muscle and bone)
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20
Q

how much of circulating testosterone is protein bound?

A

98%

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21
Q

what converts testosterone to DHT?

where does it act?

Study These Flashcards
A

5 alpha reductase

acts on androgen receptor

22
Q

what converts testosterone to 17 beta oestradiol?

where does it act?

Study These Flashcards
A

aromatase

acts on oestrogen receptor

23
Q

what are the clinical uses of testosterone in adulthood?

Study These Flashcards
A
  • increase lean body mass
  • muscle size and strength
  • bone formation and mass
  • libido and potency

does not restore fertility without gonadotrophins

24
Q

what is primary amenorrhoea?

Study These Flashcards
A

failure to begin spontaneous menstruation by age 16

25
secondary amenorrhoea?
absence of menstruation for 3 months but they have had cycles before
26
oligomenorrhoea
irregular, long cycles
27
causes of amenorrhoea
- pregnancy/lactation (high prolactin) - ovarian failure - gonadotrophin failure (same as male) - hyperprolactinaemia - androgen excess
28
ovarian failure constitutes as/ due to
- premature ovarian insufficiency - ovariectomy, chemotherapy - ovarian dysgenesis (Turner syndrome 45 X0)
29
investigations for amenorrhoea
- pregnancy test - LH, FSH, E2 and androgen blood test - Day 21 progesterone (to indicate ovulation has occurred) - prolactin, thyroid function tests - chromosomal analysis - USS of ovaries/uterus
30
treatment for amenorrhoea
- treat cause e.g. low BMI - HRT for infertility due to POI - HRT for oestrogen replacement - gonadotrophins for fertility treatment
31
Polycystic Ovarian Syndrom
1 in 12 women increased CVS risk and insulin resistance risk (however no evidence why)
32
what are the requirements to diagnose PCOS?
2 of the 3: 1) polycystic ovaries on USS 2) oligo-/anovulation - irregular/no ovulation 3) androgen excess e.g. hirsutism
33
3 key clinical features of PCOS
- hirsutism - menstrual cycle disturbance - increased BMI there will be high androgen levels and high LH levels
34
what is the treatment of PCOS?
- metformin due to insulin resistance risk) - clomiphene (stimulate ovulation) - gonadotrophin therapy (part of IVF) - spironolactone (hirsutism)
35
what is clomiphene?
anti-oestrogenic drug i.e oestrogen antagonist binds to receptors in hypothalamus and blocks normal negative feedback therefore increased GnRH and therefore LH/FSH used for anovulation infertility
36
what causes of hyperprolactinaemia
- use of dopamine antagonists (promote prolactin secretion) - prolactinoma - pit stalk compression due to pit adenoma - PCOS - hypopituitarism - oestrogens, pregnancy, lactation - (idiopathic)
37
examples of dopamine antagonists that promote hyperprolactinaemia
anti-emetics like metoclopramide | anti-psychotics like phenothiazines
38
what is the effect of stalk compression
stops dopamine and TRH passing down to the pituitary | compression allowing an autonomous output
39
clinical features of hyperprolactinaemia
- galactorrhea - hypogonadism (reduce LH action) - prolactinoma- headache and visual field defects prolactin associated with child bearing therefore decreases the function of sex hormones that allow reproduction hence the hypogonadism effect
40
treatment of hyperprolactinaemia
- treat cause e.g. drugs - dopamine agonists (inhibit prolactin) - pit surgery (rare) dopamine is the inhibitor of prolactin
41
dopamine agonists
cabergoline and bromocriptine | treat the prolactinoma
42
what effect does dopamine have on prolactin?
dopamine is the main inhibitory hormone of prolactin so reduces its production hence the use of dopamine agonists for prolactinomas (when prolactin levels are high)
43
what is the effect of excess prolactin?
reduce GnRH, LH and FSH (pregnancy state levels) hypogonadism
44
how should Cabergoline be used for women wanting to become pregnant?
Cabergoline is a dopamine agonist that will reduce prolactin - should be stopped when pregnant as it will reduce prolactin levels so GnRH, FSH, LH will increase - GnRH will directly affect the corpus luteum and suppress progesterone production and therefore distrupt the pregnancy - they can go back to using Cabergoline after giving birth but can't breast feed (low prolactin) you want GnRH to be low during pregnancy
45
what is investigated in diagnosing causes of ammenorhoea?
- Check prolactin, FSH and LH levels (gonadotrophin failure) - prolactin (hyperprolactinaemia) - pregnancy test - androgen levels (excess) - family history for premature menopause - chromosomal analysis (Turner 45 XO) - thyroid function test - BMI changes - diet
46
what does high oestrogen, low FSH and LH indicate?
pregnancy
47
what does low LH and FSh and low oestrogen indicate?
hypopituitary disease prolactinoma low leptin
48
what does high LH and FSh and low oestrogen indicate?
premature ovarian failure
49
how much testosterone is protein bound?
98% | therefore inactive
50
what reaction does 5 alpha reductase catalyse?
DHT to testosterone and vice versa
51
what reaction does aromatase catalyse?
testosterone to 17beta oestradiol and vice versa

LCRS Endo (18 decks)

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