Repro 3 Flashcards by Paras Marlowe

What is thelarche?

Development of the breast

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What is puberache?

Development of axillary and pubic hair

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Menarche?

The first mestrual period

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Adrenarche?

The onset of an increase in the secretion of androgens

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Define puberty

A stage of human development during which sexual maturation and growth are completed, resulting in the ability to reproduce

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When are primary sexual characteristics established?

Before birth

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Which hormones are most associated with, and rise at the onset of, puberty?
Hint: 3

GnRH, LH&FSH

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Why are the functioning parts of the reproductive system not active before puberty?

GnRH levels are too low

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Why do men tend to be larger than women?

The male growth spurt is usually longer and faster. It also happens later in boys

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What stops the growth spurt and which hormone is responsible for it in girls?

Closing the epiphyseal growth plates

Osetrogen

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What is happening to the timing of puberty and why?

It is occurring sooner due to better nutrition

The critical weight for puberty to start (47kg in girls) is reached earlier

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What supports the idea of critical weight relating to puberty?

Malnutrition associated with delayed menarche

Primary amenorrhoea common in lean femal athletes

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Which gland can influence puberty timings in humans and why?

The pineal due to its role in regulating circadian rhythym using melatonin

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What, then, can a pineal tumour cause?

Precocious puberty

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Wha does a rise in gonadotrophins lead to?

Secretion of sexual steroids i.e. oestrogens and androgens

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What are the first two substances involved in the hormonal changes of puberty?

Neurokinin B, which promotes production of Kiss 1 neuron arcuate, which in turn increases secretion of GnRH

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Which hormone, secreted from the pituitary, influences the growth spurt and how?

Growth hormone, by increaseing TSH secretion and thereby metabolic rate

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What precedes the phenotypic changes of puberty?

Nocturnal GnRH pulsality causing LH secretion

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What are the first phenotyppic changes of puberty?

Males -testicular enlagrement

Females - breast development?

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What does the increased nocturnal LH lead to?

Nocturnal rise in testosterone in males and oestrogen in femaled leading to early pubertal changes

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When do FSH&LH levels rise in males and what happens at the same time?

~10years

spermatogenesis and growth of sexual characteristics structures e.g. prostate from androgen secretion

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What hormone induces some of the secondary sexual characteristics in females and what are they ?

Oestrogen - growth of pelvis, deposition of subcutaneous fat and growth of internal reproductive organs as well as external genitalia

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What is used to classify the stages of pubertal development?

The Tanner standard - 5 stages

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What are the stages of the Tanner standard for males?

Testicular volume - >4ml 
Penis enlargement - G 1-5
Pubic hair - Pu 1-5 
Axillar yhair - A 1-5
Spermarche

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How many times greater is the velocity of growth during puberty?

2-3

When does puberty start in males and females?

Males - 10-14 | Females - 9-13

What is the first sign of puberty in males and females?

Males - testicular volume 4ml | Females - B2

What are the stages of the Tanner standard for females?

Breast - B 1-5 Pubic hair - Pu 1-5 Axillary hair - A 1-5 Menarche

What initiates the first ovarian cycle?

LH surge

Despite the ovarian cycle begininning, what does not happen during the first and why?

Ovulation - insufficient LH

Define precocious puberty

When puberty occurs younger than 2SD before the average age i.e. girls<8 and boys<9 years old

What are some common causes of precocious puberty?

Gonadotrophin secretinf tumours (trophin dependent) | Pineal tumours or meningitis (early stimulation of neurological maturation)

List some causes of gonadotrophin dependent precocious puberty HInt: 3

Pineal tumours CNS trauma (injury, surgery, infection) Congenital disorders e.g. arachnooid cysts

Describe some causes of gonadotrophin independent precocious puberty Hint: 2

Appearance of secondary sexual characteristics due to; increased production of sex hormones (i.e. gonad matures without GnRH stimulation) LH&FSH suppression

Define delayed puberty

Initial physical changes of puberty not seen by 13 in girls and 14 in boys

When is pubertal development inappropriate?

When the interval between the first signs of puberty and menarche (in girls) or completion of genital growth (in boys) is >5 years

What 2 categories does delayed puberty fit into?

Gonadal failure - hypergonadotrophic hypogonadism | Gonadal deficiency

What are the causes of gonadal failure?

Turner's syndrome Post-malignancy chemo /radiotherapy /surgery Polyglandular autoimmune syndrome

What are the causes of gonadal deficiency?

Congenital hypogonadotrophic hypogondaism e.g. Adrenal hyperfunction or congenital adrenal hyperplasia Hypothalamic/pituitary lesions Gene mutations altering LH&FSH or their receptors (rare)

What is Turner's syndrome?

Karyotype 45,X or 46,XX with structural abnormalities in X chromosome

What are the signs of Turner's syndrome? | Hint: 5

``` Short Gonadal dysgenesis Skeletal abnormalities Cardiac and kidney malformation Dysmorphic face ```

How is Turner's syndrome treated? | Hint: 2 methods

Growth hormone | Sex hormone substitution

What are the "Seven Dwarves" of the menopause?

Itchy, twitchy, sweaty, bloated, moody and forgetful

When is the pre-menopause?

~40yrs

What happens to the menstrual cycle in the pre-menopause?

The follicular phase shortens

What specifically can be absent during the pre-menopause and why?

Ovulation - less oestrogen and more FSH&LH

When does the menopause usually occur?

49-50

Define the menopause in terms of follicles

The time when there are none left to develop

What happens to oestrogen levels during the menopause?

Fall dramatically

What happens to FSH&LH levels during the menopause?

They both rise, FSH more so due to lack of inhibin

What vasuclar changes occur during the manopause and how can they be treated?

Hot flushes - treated with oestrogen

What other changes occur during the menopause? | Hint: 4

Regression of uterine endometrium and shrinkage of the myometrium Thinning of cervix Invlution of some breast tissue Changes in bladder due to loss of pelvic tone (incontinence)

What happens to the bone during the menopause and how can it be limited?

Total mass reduced by 2.5% per year | Increased osteoclast activity as oestrogen drops leading to osteoporosis - oestrogen therapy

In contrast, what happens at the end of the reproductive life of the male?

No obvious event, sperm production continues into 60's & 70's, FSH&LH and oestrogen increase but testosterone levels decrease

What are the phases of the menstrual cycle? | Hint: 4

Proliferative Secretory Ischaemic Mesntruation itself

What occurs during the proliferative phase? | Hint: 3 things

Menses Folliculogenesis Subsequent oestradiol production (responsible for proliferation of endometrium)

Which phase does ovulation occur directly after?

Proliferative

What levels of oestradiol are necessary for ovulation?

200pg/ml for approx. 50 hrs

What is needed to release the oocyte from the follicle?

Proteolytic enzymes and prostaglandins that digest the collagen in its wall

What do the granulosa cells do during the secretory phase?

Enlarge and accquire lutein, becoming the corpus luteum and secreting progesterone

What process occurs first if fertilisation doesn't occur?

Luteolysis - the corpus luteum becomes the corpus albicans

During the ischaemic phase, which arteries are cut off from their blood supply?

The spiral arteries

How long does menstruation last?

24-32 days

How much blood is usually lost during menstruation?

37-43ml

What is menorrhagia and what are some common causes?

``` Heavy periods - Abnormal clotting Fibroids IUCD problems Cancer ```

What are the types of uterine fibroids? | Hint: 3

Subserosal Submucosal Intramural

What is DUB and what are the common causes?

Dysfunctional uterine bleeding - heavy bleeding due to; Pregnancy Idiopathic Bleeding disorders

What commonly casues irregular bleeding?

Hormonal contraceptives

List some common types of amenorrhoea | Hint: 7

``` Prepubertal Pregnancy Menopause Uterine/Endometrial Ovarian Pituitary Hypothalamic ```

List some effects of menstrual disorders | Hint: 7

``` Tiredness Anaemia Depression Iritability Mood swings Anxiety Impact on ability to socialise ```

How are fibroids diagnosed?

Menorrhagia Could be palpable USS

What causes the hormonal changes in the hypothalamus and pituitary during the menopause?

Reduction in gonadal srteroid production

Whate are the main risks of HRT?

Thromboembolism | Breast cancer

Repro 3 Flashcards

(73 cards)