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L05: Endocrine Disorders Affecting Reproduction Flashcards

1
Q

What hormone does the anterior pituitary gland release to the ovaries

A

LH

FSH

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2
Q

Which cells in the ovaries produce androgen

A

Theca cells

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3
Q

What happens to the androgens that are produced by theca cells

A

Enter the follicles where the granulosa cells are and get converted to oestrogen

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4
Q

Which hormone has a negative feedback to the pituitary gland

A

Inhibin

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5
Q

What type of feedback does oestradiol give

A

Negative feedback

Positive feedback

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6
Q

When does oestradiol give negative feedback

A

In the early cycle when there is high moderate levels of it which suppresses LH/FSH

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7
Q

When does oestradiol give a positive feedback

A

In the mid cycle when there is high levels and this causes LH/FSH surge

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8
Q

What hormone from the hypothalamus causes the secretion of LH/FSH

A

GNRH

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9
Q

What type of secretion does GNRH have

A

Pulsatile secretion

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10
Q

If there is continuous secretion of GNRH what happens to the GNRH receptors

A

They become downregulated

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11
Q

So if there is continuous secretion of GNRH what happens to LH/FSH

A

Decreases

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12
Q

What are the 3 areas of problems that can arise in the HPG axis in females

A

1) central damage: lack of LH/FSH
2) gonadal damage: failure of germ cell production or lack of LH and FSH
3) PCOS: gonadal damage but high level of oestrogen

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13
Q

What does hypogonadal mean

A

Decreased gonadal function and decreased sex hormones

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14
Q

What makes you hypergonadal

A

High levels of FSH and LH due to a problem with the gonads so they are not responding to LH/FSH and the pituitary is secreting more to get a response

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15
Q

What does oligomennorhea mean

A

Less than 9 cycles in a year or periods that last more than 42 days

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16
Q

What is ammenorhhea

A

Absence of periods for more than 6 months

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17
Q

What are the 2 types of ammenorhhea

A

Primary

Secondary

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18
Q

What is primary ammenorhhea

A

Patient has never had periods before, indicated failure of menarche after age of 16

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19
Q

What is secondary ammenorhhea

A

Patient had periods but stopped for more than 6 months

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20
Q

What are the consequences of oestrogen deficiency

A

Hot flushes
Poor libido
Painful sex

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21
Q

What are the 3 categorical causes of ammenorhhea

A

Pregnancy
Central
Ovarian

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22
Q

If someone presents with ammenorhhea what do we first need to exclude

A

Pregnancy

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23
Q

What are the central causes of ammenorhhea

A

hypothalamic ammenorhhea
Hyperprolactinemia (lactation)
Pituitary tumours
Hypogonadotrohic hypogonadism (low FSH and LH)

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24
Q

What are the ovarian causes of ammenorhhea

A

Turners syndrome
Premature ovarian failure
PCOS

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25
What are is hypothalamic ammenorhhea due to
Anorexia Exercise Bulimia
26
What is the treatment for hypothalamic ammenorhhea
Weight gain
27
What other hormones does the anterior pituitary gland release
``` ACTH GH TSH LH FSH Prolactin ```
28
What is prolactin involved in
Breast milk production
29
Which cells produce prolactin
Lactotrophs
30
What is prolactin suppressed by
Dopamine
31
What does prolactin inhibit
LH | FSH
32
What other hormone causes the increased release of prolactin
TRH
33
What are the clinical features of high prolactin in pre-menopausal women
``` Oligo/ammenorhhea Oestrogen deficiency- vaginal dryness Spontaneous galactorhhea (milk production) ```
34
What are the pathological causes of high prolactin (hyperprolactinaemia)
- prolactin secreting pituitary tumours (prolactinomas) - loss of dopamine so loss of inhibitory effect by dopamine due to compression of infundibulum by a pituitary tumour - dopamine antagonist drugs - hypothyroidism
35
What are the 2 types of prolactin secreting pituitary tumour that you can get
Microadenoma | Macro adenoma
36
What is the difference between micro and macro adenoma
Microadenoma: less than 1cm in diameter | Macro adenoma: greater than 1cm in diameter
37
Why do you get high levels of prolactin when there is hypothyroidism
1) hypothyroidism means low TH 2) low thyroid hormone mean less negative feedback to the hypothalamus 3) hypothalmus therefore produces more TRH 4) high TRH causes high prolactin
38
What are the clinical features of premature ovarian insuffiency
Ammenorhhea Oestrogen deficiency High levels of FSH/LH- due to lack of negative feedback
39
What are the causes of premature ovarian insuffiency
Turners syndrome Autoimmune such as graves, addition Iatrogenic: Chemotherapy, Radiotherapy and surgery Mutation in FSH receptor in ovary ( FMR1 gene)
40
What are the common features of turners syndrome (44 XO)
``` Short stature Low hairline Shield shaped thorax Widely spaced nipples Elbow deformity Gonadal streaks No menstruation ```
41
What is the autoimmune disease that cause premature ovarian insuffiency
Graves’ disease Addisons Diabetes
42
What is the likely mechanism for autoimmune disease causing premature ovarian insuffiency
Production of anti ovarian antibodies Apoptosis Atrophy
43
What mutations leads to changes in FSH receptor that leads to premature ovarian insufficiency
FMRI gene mutations (fragile X)
44
How do we diagnose for fragile X FRMI mutation
Karyotype and FRMI mutation analysis
45
How do we diagnose for autoimmune premature ovarian insuffiency
Screen for autoimmune disease such as anti ovarian antibodies
46
What is the management of Premature ovarian failure
Oestrogen replacement and progesterone (if there is a uterus)
47
What are the features of PCOS
``` Oligomennorhea Hirtusim Obesity Infertility Polycystic ovaries on ultrasound Hypernadrogenism ```
48
What are the levels of hormones like in PCOS
Increased testosterone, DHEA Increase LH more than FSH No oestrogen deficiency
49
What does PCOS increase the risk of during pregnancy
Gestational diabetes
50
What is the treatment for PCOS for obesity and oligo/amennorhea specifically
Metformin | Lifestyle changes
51
What is the treatment in PCOS for anovulatory infertility
Metformin and clomiphene or letrozole | Metformin and IVF
52
What is the treatment in PCOS for hirtusim
Yasmin or Dianette(contraceptive pill that reduces androgen) Vaniqua cream Cosmetic removal Sprinolactone
53
What are the anti- and organic oral contraceptives
Yasmin | Dianette
54
What does diannete contain
35ug thinly estradiol | Cyproterone acetate
55
What does Yasmin contain
30ug ethinyl estradiol | Drospirenone
56
What does CAH stand for
Congenital adrenal hyperplasia
57
What are the 3 forms of CAH
Classical salt wasting CAH Classical simple virilizing CAH Non classical CAH
58
What is the cause of CAH
21 hydroxylase deficiency (enzyme)
59
Which 2 groups of hormone is 21 hydroxylase enzyme involved in producing
Aldosterone | Cortisol
60
When there is 21 hydroxylase deficiency i.e CAH what are the levels of hormone like
High androgen Low cortisol Low aldosterone
61
What is androgen insensitivity syndrome
A spectrum of disorder due to mutation in the androgen receptors
62
What does complete androgen insensitivity result in
``` poorly virilized infertile mean with complete testicular feminisation Female external genitalia Short blind ending vagina No uterus Absent prostate Breast development ```
63
What is the common presentation of androgen insensitivity
Inguinal hernia which is actually the testis
64
What doe blood test levels of androgen insensitivity show
High levels of testosterone | High LH
65
What is 5 alpha reductase involved in
Converting testosterone to DHT
66
Which is the most androgenic form: DHT or testosterone
DHT
67
If there is 5 alpha reductase deficiency what happens to testosterone
Unable to be converted to DHT
68
What happens to the patients with 5 alpha reductase deficiency
They are genetically male (46xy) but appear female
69
In males when LH is released what cell does it act on in the testis
Leydig cells
70
What does leydig cells produce
Testosterone
71
In males when there is FSH what cell does it act on in the testis
Sertoli cells cells within the seminiferous tubules
72
What does Sertoli cells produce in repsonse to FSH
Inhibin
73
What type of feedback does inhibin have to the pituitary gland
Negative feedback
74
What type of feedback does testosterone have on the pituitary gland and hypothalamus
Negative feedback
75
What happens to the levels of testosterone as you age
Decrease
76
What is the normal adult male testicular volume in ml
15-25ml
77
What are the 2 main categories of male hypogonadism
Primary causes of hypogonadism | Secondary causes of hypogonadism
78
What can cause primary hypogonadism in males
``` Trauma Chemotherapy Undescended testis Infections Klinefelters syndrome (chromosomal abnormality) Systemic disease ```
79
What can cause secondary gonadal failure
``` Pituitary tumour Hypothalamus disorders Hyperprolactinemia Systemic disease Obesity Androgen use and abuse ```
80
What does high levels of LH and FSH indicate
Primary gonadal failure as the testis are not responding to LH and FSH
81
What does low levels of FSH/LH indicate
Secondary gonadal failure as the higher centres are not producing LH/FSH for testosterone to be stimulated for production
82
What is klinefelters syndrome
When you have an extra X chromosome (47xxy)
83
What are the features of klinefelters syndrome
``` small testis No sperm No hair Osteoporosis Tall and slim ```
84
What is the treatment for primary and secondary gonadal failure
Testosterone replacement
85
Why can androgen use and abuse cause hypogonadism
Extra testosterone inhibits LH and FSH (negative feedback) so you do not get sperm production
86
To assess male infertility what do we look at
Seminal fluid LH FSH Testosterone levels
87
If the FSH levels are high what does this indicate
Germ cell failure
88
Why does high FSH indicate germ cell failure
The testis are nor producing spermatocytes and you are not getting a feedback
89
What does a normal FSH indicate
Obstructive disease
90
What does low FSH, LH and testosterone indicate
Endocrine causes of pituitary and hypothalamus
91
What is the treatment for low FSH and low LH
Replacement therapy of LH and FSH

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