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Repro 2 F > Puberty & Disorders Of Dev And Menstrual Disorders (9) > Flashcards

Puberty & Disorders Of Dev And Menstrual Disorders (9) Flashcards

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1
Q

What’s stored in the Post Pituitary?

A

Oxytocin

Vasopressin (ADH)

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2
Q

What are the phases of the ovarian cycle?

A

Follicular (estrogen dep)

Luteal (progesterone release)

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3
Q

Decreasing levels of estradiol and progesterone from regressing corpus luteum of preceding cycle does what?

A

Initiates inc in FSH

- FSH stimulates follicular growth and estradiol secretion

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4
Q

What are the 5 peptides that affect the reproductive cycle?

A 
GnRH -> FSH and LH
TRH -> TSH
SRIF (somatostatin) inh GH
CRF/H -> ACTH
PIF (dopamine) inh prolactin release
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5
Q

Where is GnRH synthesized? What does it stimulate? Estradiol usually inh FSH and LH, when doesn’t it?

A

Arcuate nucleus
Gonadotrophs and FSH/LH synthesis

When high enough levels of estradiol -> LH surge

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6
Q

Where does lots of progesterone present/occur in the menstrual cycle?

A

Prior to ovulation d/t unreuptured luteinizing graafian follicle, Corpus luteum (max 5-7 days after ovulation)

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7
Q

Describe follicular development:

A

Primordial follicles dev, differentiate, and mature > graafian follicle > graafian follicle ruptures releasing ovum > ruptured follicle produces corpus luteum

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8
Q

Preovulatory surge of LH causes what?

A

Biochemical and structural changes resulting in ovulation

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9
Q

What undergoes luteinization after ovulation?

A

Granulosa cells of ruptured follicle -> corpus luteum (produces lots of progesterone and some estradiol)

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10
Q

Normal functioning life span of corpus luteum is what? What’s it replaced by?

A

9-10 days

Corpus albicans

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11
Q

What zones is the endometrium divided into? What are some features of these zones?

A

Outer portion: functionalis

  • undergoes cyclic changes during menstrual cycle
  • sloughed off at menstruation
  • contains spiral aa

Inner portion: basalis

  • remains relatively unchanged during each cycle
  • houses stem cells to renew functionalis
  • basal aa
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12
Q

What are the stages of the histo-phys changes of the endometrium?

A
  1. Menstrual phase
  2. Proliferative/estrogenic phase
  3. Secretory/progestational phase
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13
Q

Describe the menstrual phase:

A

Only portion of cycle visualized externally

First day of menstruation is known as cycle day 1

During this phase: disintegration of endometrial glands and stroma, sloughing of functionalis layer, compression of basalis layer

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14
Q

What does one see histologically in the proliferative/estrogenic stage of the endometrium cycle?

A

Inc length o spiral aa + numerous mitoses

Endometrial growth

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15
Q

What does one see histologically in the secretory/progestational stage of the endometrium cycle?

A

Progesterone -> Mucous/glycogen secretion
Stroma is edematous
Mitoses are rare
Endometrial lining reaches max thickness

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16
Q

What day does the corpus luteum begin to regress?

A

Day 23 if conception doesn’t occur

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17
Q

What is imperative in regulating menstruation?

A

Intact coagulation pathway

Allows inured vessels to be repaired rapidly after menstruation

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18
Q

What’s the median age of menarche? Occurs how many years after thelarche/breast budding? How many females should have menarche by 15?

A

12.43

3 years

98%

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19
Q

Define primary amenorrhea:

A

No menstruation by 13 w/o secondary sex dev

No menstruation by 15 with secondary sexual dev

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20
Q

Can cycles be irregular during their first year or so?

A

Yes, often are, 21-45 days

By third year they’re normalized (21-35 days), 28+/- 7 days

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21
Q

What’s the average mean blood loss per menstrual period? How often are pads changed? What amount is associated w/ anemia?

A

30cc

3-6 times

80cc, pad change every 1-2h

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22
Q

Do obese kids have earlier onsets of puberty? Malnourished?

A

Yes

No, later onset

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23
Q

What hormone may stimulate puberty in females?

A

Leptin around 106 lbs

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24
Q

What’s the peak number of oocytes and when is it reached?

A

6-7 million

16-20w during gestation

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25
What's the hypothalamic-pituitary system regulating gonadotropin release called?
Gonadostat
26
What changes from 8-11 are associated w/ puberty from a biochemical standpoint? 11 onward?
Inc serum DHEA and androsenedione - zona reticularis begins producing andregens (adrenarch) - axillary and pubic hair (pubarche) Gonadostat loses sensitivity - sleep induces GnRH secretions - GnRH -> sex steroid production
27
What does thelarche mean? Why is it significant? What are some features?
Breast dev First physical sign of puberty Requires estrogen Unilateral dev in first 6 months not uncommon
28
What does axially and pubic hair growth require?
Androgens
29
What does menarche require?
Pulsatile GnRH > FSH and LH > estrogen and progesterone
30
What's the order of things in puberty? (TAPMM)
``` Thelarche Adrenarche Peak height velocity Menarche Mature sexual hair and breasts ```
31
What's Tanner staging used for?
Staging normal female pubertal dev
32
What is precocious puberty?
Early dev of sex characteristics - 8yo for girls - 9yo for boys More likely in girls 75% of cases idiopathyic Leads to premature fusion of long bones of the epephyses
33
What are the 2 subgroups of precocious puberty?
Heterosexual and isosexual Heterosexual is the dev of secondary sex characteristics opposite expected - virulizing neoplasms, congenital adrenal hyperplasia, expsure to exogenous androgens Isosexual: sex characteristic dev that's appropriate for individuals phenotype - 10% organic brain dx, dg w/ MRI of head, pt p/w neurologic sxs - 75% idiopathic or constitutional, dg w/ administration of exogenous GnRH looking from LH rise
34
What's the common androgen secreting neoplasm of childhood?
Sertoli-Leydig cell tumor
35
What's the most common defect in Congenital adrenal hyperplasia? What's the most severe form of CAH? What's a late onset form?
21-hydroxylase causing excessive androgen production Classical: females born w/ ambiguous genitalia Non-classical: premature pubarche, PCOS-like disorder
36
What's the tx for isosexual precocious puberty?
``` GnRH agonist (leuprolide acetate) - suppresses FSH and LH release ```
37
What is psuedoisosexul precocity?
Inc estrogen levels w/ sexual characteristic maturation w/o activation of the HPO axis (d/t an estrogen-excreting tumor) - McCune-Albright syndrome (polyostotic fibrous dysplasia): cafe au lait spots, adrenal hypercortisolism, bone defects - Peutz-Jeghers: sx cord tumor that secretes estrogen, GI polyposis and pigmentation
38
What causes hypergonadotropic hypogonadism?
Gonadal dysgenesis (Turner syndrome)
39
Difference between primary and secondary amenorrhea?
Primary: no menstruation by 15 w/ dev sexual characteristics or 13 w/ no dev of sec sex characteristics Secondary: pt w/ prior menses as absent menses for > 6 months
40
What's the most common cause of primary amenorrhea?
Extreme exercise, constitutional (physiologic delay) is the most common
41
Kallman syndrome is?
KAL gene mutation prevents migration of GnRH neurons into hypothalamus
42
Turner's syndrome is what? What are some signs?
Most common form of female gonadal dysgenesis, majority will show no signs of sec sex char Webbing o the neck (pterygium colli), broad flat chest, short stature, streaked ovaries (functionless tissue), coarctation of the atorta
43
Mullerian dysgenesis/agenesis is also associated w/ what anatomical findings? What's the karyotype? What the abnormally high hormone?
Renal abnormalities/urinary system No sexual hair Absent uterus and upper vagina (mullerian dysgenesis/agenesis) 46XY, testosterone
44
Whats Maryer-RKH syndrome?
Absent uterus and upper vagina Normal external features Normal testosterone Karyotype, 46XX
45
What's a normal prolactin level? What causes hyperprolactinoma < 100 ng/mL? Hyperprolactinoma > 100 ng/mL?
< 20 ng/mL Ectopic production (renal cell carcinoma), breast feeding or stimulation, excessive exercise, hypothyroidism, meds (OCs) Pituitary adenoma, Empty sella syndrome
46
What's the size of a macroadenoma vs microadenoma? Tx?
Micro < 10mm Macro > 10mm Bromocriptine/Parlodel
47
Amenorrhea w/ normal TSH and prolactin, what's done next? How are results determined? What's done after?
Progesterone challenge test ``` Positive = positive bleeding, PCOS most common etiology Negative = no bleeding, inadequate estrogenization or outflow abnormality ``` Estrogen/progesterone challenge test (neg = outflow tract obstruction, postive = estrogen prob)
48
Asherman syndrome causes? Due to?
Amenorrhea d/t scar tissue in the uterus from ablation procedures or a spontaneous abortion
49
What are the positive PCT: normogonadotropic amenorrhea w/ hyperandrogenism issues associated w/?
Adrenal disorders: non-classic congenital adrenal hyperplasia, Cushings, Adrenal androgen secreting tumor (DHEA > 7000 ng) Ovarian disorders: PCOS, androgen-secreting tumor (sertoli-leydig tumor) Exogenous
50
What's the leading cause of female anovulatory infertility? What 3 criteria are involved in its diagnosis? What're other common findings associated w/ this?
PCOS Oligomenorrhea (less) or amenorrhea, biochemical or clinical signs of hyperandrogenism (LH to FSH is 2:1), ultrasound positive or small cysts on cortex of ovary Insulin sensitivity is decreased -> insulin hypersecretion, reduced hepatic production of sex hormone binding globulins (SHBG) -> inc circulating testosterone
51
What's secreted in excess in PCOS? What's not?
Estrogen Progesterone
52
What are some features of PCOS?
Anovulation, hyperandrognism, hirsuitism, acne, menstrual dysfunction, hyperinsulinemia, LH hypersecretion, elevated testosterone, obesity, sleep disorders, acanthosis nigricans, chronic anovulation (inc risk for endometrial CA)
53
"Ring of pearls" on US associated w/?
PCOS
54
Tx for PCOS?
``` Wt loss (10% wt loss can re-stimulate cycles) OCs Clomiphene citrate Spironolactone Metformin ```
55
What do you test for to confirm CAH?
17-hydroxyprogesterone levels (which builds up d/t lack of 21-hydroxylase enzyme)
56
Define primary amenorrhea.
No menstruation by 13 yo w/o sec sexual characteristics OR no menstruation by 15 WITH sec sexual characteristics
57
Define secondary amenorrhea.
Absence of menses for 6 months or more
58
Define polymenorrhea.
Abnormally freq menses at intervals < 21 days
59
Define monorrhagia (hypermenorrhea).
Excessive and/or prolonged bleeding (> 80mL and > 7 days) occurring at normal intervals
60
Define metrorrhagia.
Irregular episodes of uterine bleeding
61
Define menometrorrhagia.
Heavy and irregular uterine bleeding
62
Deine Intermenstrual bleeding.
Scant bleeding at ovulation or 1 or 2 days
63
Define Oligomenorrhea.
Menstrual cycles occurring > 35 days but less then 6 months
64
DUB (dysfunctional uterine bleeding) is caused by what? When does it occur?
Aberrations in the HPO axis causing anovulation Around years of menarche (11-1) or perimenopause (45-50)
65
What's the PALM (structural causes)-COEIN (non-structural causes) classification system for abnormal bleeding in reproductive-aged women?
P: polyp (AUB-P) A: adenomyosis (AUB-A), boggy uterus L: leiomyoma (AUB-L), subserosal, interstitial, submucosal M: malignancy and hyperplasia (AUB-M) C: coagulopathy (AUB-C), vWD O: ovulatory dysfunction (AUB-O), unpredictable menses E: endometrial (AUB-E), inection I: iatrogenic (AUB-I), IUD/S, exogenous hormones N: not yet classified (AUB-N)

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