L23: Repro - Shortened Flashcards
A patient comes in with elevated androstenidone levels, LH, and hyperinsulinemia. Which of the following conditions do they likely have?
PCOS
True or False: In PCOS, there is a FSH>LH ratio
False - LH>FSH
In PCOS, there is an elevated GnRH, which increases LH. How does this affect kisspeptin secretion and plasma progresterone?
Elevated GnRH….
- Elevated Kisspeptin
- Low plasma progesterone
In PCOS, insulin increases the transcription of which gene, leading to elevated LH?
A. 17-B-HSD gene
B. FSH-B gene
C. LH-B gene
C. LH-B gene
How does PCOS affect the adrenal gland?
A. Increases insulin
B. Decreases DHEAS synthesis
C. Increases testosterone synthesis
D. Increases DHEAS synthesis
D. Increases DHEAS synthesis
Which enzyme converts testosterone to DHT?
A. 17-B-HSD
B. 5a-reductase
C. Aromatase
B. 5a-reductase
In PCOS, there is high androstenidone. How does this affect testosterone, DHT, and E2 levels?
Testosterone: Excess
DHT: Excess
E2: Normal
Excess of ___ in hair follicles play a key role in hirsuitism
A. Testosterone
B. DHT
C. 5-a-reductase
B. DHT
Which four factors cause insulin resistance in PCOS?
- Ovary
- Adrenal
- AP
- Hepatic
- Ovary: ↑ androstenidone
- Adrenal: ↑ DHEAS
- AP: ↑LH
- Hepatic: ↓ SHBG
A patient comes in with irregular menses and hirsuitism. Upon testing, there is elevated androgens and serum 17-OHprogesterone.
What condition do they likely have?
A. PCOS
B. Non-classical congenital adrenal hyperplasia
C. Athlete Triad
B. Non-classical congenital adrenal hyperplasia
Non-classical congenital adrenal hyperplasia is due to partial deficiency in which gene?
21-hydroxylase (CYP21A2)
Where is androstenidone converted to testosterone? By which enzyme?
Peripheral Tissues
- 17B-HSD
True or False: The majority of testosterone is made in peripheral tissues, not the ovary
True
DHEA is converted to ___ and ___ in the ovary
Androstenidone, then Testosterone
All of the following are made in the adrenal zona reticularis except:
A. Androstenedione
B. DHEAS
C. DHEA
D. Testosterone
D. Testosterone
What are two ways that stress inhibit GnRH secretion?
- Beta endorphins activate opioid receptor
- Stressors increase CRH
How does estrogen affect GnRH and LH?
How does progesterone affect GnRH and FSH?
Estrogen = ↑ GnRH = ↑ LH
Progesterone = ↓GnRH = ↑ FSH
How are the following affected if one has the Athlete Triad?
- GnRH pulse generator
- LH pulse freq
- Estrogen
- Ovulation
- Leptin/Ghrelin
- GnRH pulse generator: Inhibited
- LH pulse freq: too slow
- Estrogen: ↓
- Ovulation: None
- Leptin(↓)/Ghrelin (↑)
Which condition is an example of Functional Hypothalamic Amenorrhea (Secondary Amenorrhea)?
Female Athlete Triad
True or False: 1/2 amenorrhea, as well as osteoporosis, and disordered eating are features of the Female Athlete Triad
True
Three features of Functional Hypothalamic Amenorrhea?
- Estrogen?
- LH/FSH?
- Secondary Sexual Features?
- Estrogen: ↓
- LH/FSH: ↓
- Secondary Sexual Features: Normal
How do you restore normal LH/FSH levels in Functional Hypothalamic Amenorrhea?
Exogenous GnRH
Four major causes of secondary amenorrhea?
- Functional Hypothalamic Amenorrhea
- Androgen Excess
- PCOS - 1 Ovarian Insufficiency
- Endocrine Pathology
Which two conditions would you expect to be associated with Tanner Staging 1?
-Mullerian agenesis (no uterus)
-Delayed puberty
