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J Endocrine > Reproduciton and sex steroids > Flashcards

Reproduciton and sex steroids Flashcards

1
Q

which hormone does ‘ovulation tests’ measure

A

LH

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2
Q

which layer of the uterus sheds during menstruation

A

endometrium

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3
Q

where does fertilisation occur

A

ampulla

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4
Q

first step of fertilisation, when receptors on egg undergo exocytosis

A

chemotaxis

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5
Q

what is it called when 1 sperm binds and polyspermy is prevented

what does it involve

A

zona reaction

increased Ca and enzymes

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6
Q

in males and females;
hypothalamus secrete GnRH which stimulates the production of … (2)

where

A

LH and FSH

anterior pituitary

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7
Q

in males

LH stimulates which cells

A

leydig cells

Lh = Leydig

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8
Q

in males

what do leydig cells secrete in response to LH

what is it used for
where

A

testosterone

spermatogenesis in the setoli cells

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9
Q

in males

FSH stimulates which cells

A

setoli cells

fSh = Setoli

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10
Q

in males

what happens in setoli cells in response to FSH

which hormone is needed for this to happen

where does it come from

A

spermatogenesis

testosterone

leydig cells (stimulated by LH)

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11
Q

dihydrotestosterone definition

presentation

A

too much testosterone production

enlargement of male sex organs, anabolism

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12
Q

oligomenorrhoea definition

A

<9 periods in a year (either irregular or infrequent >35 day cycles)

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13
Q

primary amenorrhoea definition

A

female >16 thats never had a period

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14
Q

secondary amenorrhoea definition

A

no period for >6months but has previously had a period

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15
Q

what must you always do for a female presenting with amenorrhoea

A

pregnancy test! (hCG)

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16
Q

aetiology of primary amenorrhea (3)

A

turners syndrome (XO)
congenital adrenal hyperplasia (CAH)
kallmans syndrome

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17
Q

genetics of turners syndrome

A

XO (one X chromosome only)

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18
Q

aetiology of secondary amenorrhoea (7)

A

menopause
pregnancy
polycystic ovarian syndrome (PCOS)
premature ovarian failure
hyperprolactinaemia
hypopituitarism (non functioning pituitary tumour)
hypothalamic dysfunction (over exercise, weight loss, low BMI, stress, illness)

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19
Q

most common aetiology of secondary amenorrhea (if pregnancy and menopause ruled out)

A

polycystic ovarian syndrome (PCOS)

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20
Q

how does hypothalamic dysfunction (from over exercise, weight loss, low BMI, stress, illness) cause amenorrhoea

A

loss of pulsatile production of GnRH from hypothalamus = no FSH/LH production

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21
Q

which aetiology of primary amenorrhoea presents with lack of sense of smell (anosmia)

A

kallmans syndrome (lack of GnRH)

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22
Q

presentation of primary amenorrhoea

A

absence of puberty (no breast development)

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23
Q

presentation of secondary amenorrhoea

A

loss of libido
painful intercourse
hirsutism (male facial hair pattern in females)

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24
Q

what is oestrogen levels in amenorrhoea

A

low

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25
Q

what hormones (other than oestrogen) do you want to measure in amenorrhoea (2)

why

A

LH and FSH

to figure out if hypogonadism is primary or secondary

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26
Q

LH and FSH in primary hypogonadism causing amenorrhoea (eg premature ovarian failure, polycystic ovarian syndrome

A

high

the problem is at the gonads

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27
Q

LH and FSH in secondary hypogonadism causing amenorrhoea eg pituitary tumour, hyperprolactinaemia

A

low

the problem is that no LH and FSH are made in the first place

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28
Q

apart form LH and FSH levels, what test can you do to see if amenorrhoea is caused by primary or secondary hypogonadism

explain the test

what are the results for primary and secondary hypogonadism in this test

A

progesterone challenge test

give progesterone for 5 days and see if you can cause a menstrual bleed

primary hypogonadism = positive (no bleeding occurs, problem is the ovaries)
secondary hypogonadism = negative (bleeding occurs, problem is further up)

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29
Q

what MSK condition is low oestrogen associated with

A

osteoporosis

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30
Q

is premature ovarian failure the same as early menopause

A

no

they may still have eggs in premature ovarian failure its the ovary thats stopped working

in menopause there are no eggs left

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31
Q

aetiology of premature ovarian failure (4)

A

idiopathic
autoimmune (addisons)
genetic
chemo/radiotherapy

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32
Q

hormone levels in premature ovarian failure (LH, FSH, oestrogen)

A

high LH
high FSH
low oestradiol

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33
Q

treatment for premature ovarian failure

A

hormone replacement therapy (oral contraceptive)

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34
Q

treatment of someone with osteoporosis (from premature ovarian failure)

A

vit D supplements
Ca
bisphosphonates (alendronic acid)

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35
Q

treatment of premature ovarian failure that has caused infertility (and they want kids)

A

egg donation, IVF

adoption

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36
Q

does turners syndrome present in males or females

A

females (only one X chromosome)

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37
Q

kidney defect in turners syndrome (XO)

A

horseshoe kidney

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38
Q

nipples in turners syndrome (XO)

A

wide spaced

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39
Q

‘pearl necklace’ on ovaries

A

polycystic ovarian syndrome (PCOS)

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40
Q

risk factor for PCOS

A

diabetes (hyperinsulinaemia)

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41
Q

if you aren’t a diabetic, why else can you get polycystic ovarian syndrome (PCOS)

A

genetics

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42
Q

in PCOS the things on the ovary surface aren’t actually cysts, what are they

A

immature follicles

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43
Q

what does immature follicles in PCOS mean about progesterone

what normally happens

A

no progesterone is released = low progesterone in blood

mature follicles release progesterone

44
Q

in PCOS decreased progesterone release from follicles (bc they are immature not mature) results in what clinical presentation (3)

A

amenorrhoea
hirsutism (male facial hair pattern in females)
infertility

45
Q

initial pathophysiology of PCOS (high something affects something cells)

A

high LH or high insulin = affects theca and granulosa cells

46
Q

Rotterdam criteria for PCOS, need 2/3 of;

A 
oligomenorrhoea 
clinical hyperandrogenism (hirsutism, acne) 
polycystic ovaries on US
47
Q

oestrogen in PCOS

A

normal (should be low but high insulin + androgens = oestrogen secretion = brings it back to normal)

48
Q

progesterone in PCOS

A

low

49
Q

androgens/testosterone in PCOS

A

high

50
Q

PCOS lifestyle change

A

loose weight, diet

51
Q

PCOS first line treatment

why

A

antioestrogens (clomifene citrate) to improve fertility

52
Q

PCOS second line treatment after weight loss and antioestrogens (3 - one a step up from weight loss, the other 2 is a step up from antioestrogens (one drug, one not))

A

metformin
gonadotrophins (LH and FSH injections)
surgery (drill holes) to induce ovulation

53
Q

side effect of gonadotrophin therapy (LH and FSH injections used in PCOS)

A

multiple pregnancy with complications

54
Q

male primary hypogonadism aetiology (1)

A

klinefelters (XXY)

55
Q

male secondary hypogonadism aetiology (3)

A

pituitary disease
kallmans
prdaer willi syndrome

56
Q

male hypogonadism with no sense of smell aetiology

A

kallmans

57
Q

presentation of genetic male hypogonadism in teenager

A

no puberty (ask about shaving)

58
Q

presentation of pituitary male hypogonadism in adult (2)

A

loss of libido (ejaculations, erections)

infertility

59
Q

testosterone, LF, FSH in primary hypogonadism

is it hyper or hypogonadotrophic hypogonadism

A

low testosterone
high LF
high FSH

hypergonadotrophic hypogonadism

60
Q

testosterone, LF, FSH in secondary hypogonadism

is it hyper or hypogonadotrophic hypogonadism

A

low testosterone
low LF
low FSH

hypogonadotrophic hypogonadism

61
Q

treatment of hypogonadism in men >50

A

nothing

62
Q

treatment of hypogonadism in men <50

A

testosterone replacement

63
Q

when wouldnt you give testosterone in men with hypogonadism (2)

A

if >50

if prostatic cancer (can make it worse)

64
Q

gynaecomastia definition

A

enlarged breasts in men (different from fat!)

65
Q

oestrogen in gynaecomastia

A

high

66
Q

treatment of gynaecomastia (3)

A

treat underlying cause
reassurance!
anti-oestrogens

67
Q

definition of infertility

A

failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child

68
Q

primary infertility definition

A

infertility in a couple who have never conceived

69
Q

secondary infertility definition

A

infertility in a couple who have previously conceived by pregnancy unsuccessful (miscarriage or ectopic pregnancy)

70
Q

aetiology of infertility in females (8)

A 
menopause 
anorexia
kallmans 
hypogonadotrophic hypogonadism (pituitary tumour) 
PCOS 
premature ovarian failure (POF) 
infection 
endometriosis (narrowing of tubes)
71
Q

what is endometriosis

A

when womb lining sheds and goes backwards into fallopian tubes = blocks them (retrograde menstruation)

72
Q

aetiology of male infertility (5)

A 
drugs - alcohol, tobacco
idiopathic 
hypogonadotrophic hypogonadism (pituitary tumour, kallmans)
klinefelters (XXY)
chemo/radiotherapy

LOADS MORE!

73
Q

what BMI is a risk factor for infertility (hence part of management plan)

A

high BMI

want them to loose weight

74
Q

investigations for female infertility

A

pelvic exam
pelvic transvaginal ultrasound
look at tubes (radiograph or laparoscopy)

75
Q

investigation for male infertility

A

semen analysis (sperm count)

76
Q

azoospermic definition

A

no sperm in semen

77
Q

treatment for male infertility (2)

A

sperm bank

surgical sperm aspiration

78
Q

treatment for female infertility for POF

A

egg donation

79
Q

treatment for tubal disease causing female infertility

A

surgery to open up tube or IVF

80
Q

treatment for hypothalamic/pituitary cause of female infertility

A

hormone replacement therapy

81
Q

what type of hormone is oestrogen

A

steroid hormone

82
Q

apart from theca/granulosa cells, where else can oestrogen be made

(= cause of erectile dysfunction in men)

A

fat cells

83
Q

where is progesterone made in female

A

corpus luteum

84
Q

in females

what does LH production cause

where does this happen

A

androgen production

theca cells

85
Q

in females

what cells do FSH stimulate

what happens as a result

A

granulosa cells

androgen production

86
Q

apart from androgen production from granulosa cells, what else does FSH do in females

A

stimulates follicle maturation

87
Q

LH and FSH cause androgen (then oestrogen) production and follicle maturation

what does this overall result in

A

egg release

88
Q

what does low oestrogen (start of follicular phase of menstrual cycle) do to LH

by which mechanism

A

decrease it

negative feedback

89
Q

what does low oestrogen (start of follicular phase of menstrual cycle) do to FSH

by which mechanism

A

increase it

negative feedback

90
Q

what does oestrogen do to the endometrium

when

A

thickens it

increasing oestrogen in follicular phase = preparing endometrium for ovulation

91
Q

what does the LH spike in menstrual cycle trigger

A

ovulation

92
Q

what is a ‘dead follicle’ called

A

corpus luteum

93
Q

in which menstrual cycle phase is there follicles

A

follicular phase

94
Q

in which menstrual cycle phase is there a corpus luteum

A

luteal phase

95
Q

which 3 hormones does the corpus luteum produce

A

inhibin
oestrogen
progesterone

96
Q

what does inhibin do to FSH (comes from the corpus luteum so in the luteal phase)

A

decreases it (= stops more follicles being stimulated to become leading follicles)

97
Q

what does progesterone do to the hypothalamus (comes form the corpus luteum so in the first half of the luteal phase)

A

decreases secretion of GnRH

98
Q

what does lutenising hormone (LH) do in the menstrual cycle

A

stimulate ovulation = cause the LUTEAL phase to occur (bc of the corpus LUTEUM)

99
Q

in the second half of the luteal phase there is decreases progesterone bc the corpus luteum is degenerated

what does this do to GnRH

what is the overall result of this (generally speaking)

A

increase GnRH

stimulated new ovulation cycle

100
Q

why does the endometrium shed if no fertilisation (in terms of hormones)

A

all hormones are decreased = it cannot be maintained

101
Q

what is the main thing that happens in the follicular phase of the menstrual cycle

A

development of stimulation follicle

FOLLICULAR phase = FOLLICLE stimulation

102
Q

what is the main thing that happens in the luteal phase of the menstrual cycle

A

corpus luteum develops then degenerates

LUTEAL phase = corpus LUTEUM

103
Q

what do follicles secrete that peaks at the end of the follicular phase of the menstrual cycle

A

oestrogen

104
Q

what is the main hormone change in the follicular phase of the menstrual cycle

what does this cause

A

LH peak

ovulation (egg release)

105
Q

what is the follicle without an egg called (after ovulation)

A

corpus luteum

J Endocrine (12 decks)

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