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Reproduction Flashcards

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1
Q

When does oogenesis begin and begin again after suspension?

A

Begins in utero, begins again at puberty

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2
Q

When does oogenesis complete?

A

Fertilisation

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3
Q

When does oogenesis cease?

A

Menopause

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4
Q

What is the primordial germ cell?

A

Earliest recognisable germ cell

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5
Q

When do the primordial germ cells migrate to the genital ridge by?

A

Week 6 of embryo development

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6
Q

What are oogonia?

A

Small diploid cells which on maturation form primordial follicles

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7
Q

What does the presence of two polar bodies signify?

A

Sperm entry and completion of 2nd meiotic division

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8
Q

What are the two phases of the ovarian cycle?

A

Follicular phase and luteal phase

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9
Q

What happens in the follicular phase?

A

Maturation of egg, ready for ovulation at midcycle- ovulation signals end of follicular phase

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10
Q

What happens in luteal phase?

A

Development of corpus luteum. Induces preparation of reproductive tract for pregnancy

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11
Q

What is the primary follicle?

A

A structure made up of the primary oocyte surrounded by a single layer of granulosa cells

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12
Q

How many ovum is a primary follicle capable of producing?

A

1

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13
Q

How does the secondary follicle occur?

A

Oocyte grows and follicle expands and becomes differentiated under hormonal influence. After puberty about 400 will be ovulated, rest undergo atresia. Follicular phase ends with ovulation

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14
Q

What happens to follicular cells left behind after ovulation?

A

They undergo luteinisation- transformation into the corpus luteum

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15
Q

What does the corpus luteum secrete?

A

Progesterone

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16
Q

If no fertilisation occurs, how long will the corpus luteum survive?

A

No longer than 14 days after ovulation

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17
Q

What signals the start of a new follicular phase?

A

Degeneration of corpus luteum

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18
Q

What happens to the corpus luteum if fertilisation occurs?

A

It persists and produces increasing quantities of progesterone and oestrogen until after pregnancy

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19
Q

What is secreted from the hypothalamus that acts on the anterior pituitary?

A

GnRH

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20
Q

What does the anterior pituitary secrete with regards to ovarian action?

A

FSH and LH

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21
Q

What does FSH to do the ovary?

A

Stimulates follicular development, along with LH stimulates secretion of oestradiol and ovulation

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22
Q

What does LH do to the ovary?

A

Stimulates follicle maturation, ovulation and development of corpus luteum

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23
Q

What hormonal secretions happen in the follicular phase?

A

Hypothalamus secretes GnRH, in response Ant Pituitary secretes FSH and some LH. Rescues about 15 follicules- their granulosa and theca cells develop

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24
Q

What do the theca cells of the ‘rescued’ follicles do?

A

Produce androgen which is converted by the granulosa to oestradiol

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25
What does oestradiol do to the uterus?
Thickens endometrium/thins cervical mucus
26
What does oestrogen do to FSH?
Suppresses its production by ant. pituitary (dominant follicle selection)
27
What does granulosa in the dominant follicle express?
LH receptor
28
What does high levels of oestrogen mid cycle cause?
Hypothalamus to release GnRH, causes FSH/LH surge from AP
29
What happens to the corpus luteum at 12 days if there is no hCG production from an embryo?
Corpus luteum degenerates forming the corpus albicans, leading to progesterone and oestrogen levels falling
30
What does the developing embryo produce which maintains the corpus luteum?
hCG-Human Chorionic Gonadotrophin
31
What does the placenta take over at around 6 weeks?
Progesterone production from corpus luteum, it therefore degenerates forming the corpus albicans
32
Where does glandular oestrogen synthesis occur?
In the granulosa and theca cells of the ovaries, aswell as the CL
33
What is the pathway of pregnenolone to oestradiol?
Pregnenolone diffuses out of granulosa to adjacent theca cells. These cells express 17,20-lyase and 3B-HSD, which mediate pregnenolone to androstenedione conversion via DHEA. Most androstenedione returns to granulosa and is converted to oestrone by aromatase, then is converted to oestradiol by 17B-HSD
34
What is the expression of aromatase and 17B-HSD controlled by?
FSH stimulation
35
What does aromatase do outwith gonadal sites?
Facilitates peripheral aromatisation of androgens to estrone
36
What is progesterone synthesised by?
From pregnenolone by the action of 3B-HSD in the corpus luteum, by the placenta during pregnancy and by the adrenals, as a step in androgen and mineralocorticoid synthesis
37
What is oligomenorrhea?
Reduction in frequency of periods to less than 9/year
38
What is primary amenorrhea?
Failure of menarche by the age of 16 years
39
What is secondary amenorrhea?
Cessation of periods for >6 months in an individual who has previously menstruated
40
What are the causes of primary amenorrhea?
Congenital problems (Turner's, Kallman's)
41
What are the causes of secondary amenorrhea?
Ovarian: PCOS, POF. Uterine: uterine adehsions. Hypothalamic dysfunction: wt loss, over exercise, stress, infiltrative. Pituitary: high PRL, hypopituitarism
42
What should be asked about in the history of secondary amenorrhea?
Oestrogen deficiency symptoms: flushing, libido, dyspareunia. Hypothalamic: exercise, wt loss, stress. Features of PCOS/androgen excess: hirsutism/acne. Anosmia: Kallmans. Hypopituitarism/pituitary tumour symptoms: galactorrhea. Drugs associated with hyperprolactinaemia
43
What should be looked for in an examination of a patient with 2' amenorrhea?
Body habitus: Turners. Visual fields/anosmia. Breast development. Hirsutism/acne/androgen excess
44
How should amenorrhea be investigated?
LH/FSH/Oestradiol. TFT, PRL. Additional: ovarian US +-endometrial thickness. Testosterone if hirsutism. PFTs +MRI pituitary. Karyotype
45
How is female hypogonadism identified?
Low levels of oestrogen
46
What is seen in primary hypogonadism?
Problem with ovaries. High LH/FSH-hypergonadotrophic hypogonadism. e.g. POF
47
What is seen in secondary hypogonadism?
Problem with hypothalamus/pituitary. Low LH/FSH: hypogonadotrophic hypogonadism. e.g. high PRL, hypopituitarism
48
How does POF present?
Amenorrhea, oestrogen deficiency and elevated gonadotrophins occuring
49
How is POF diagnosed?
FSH >30 on 2 separate occasions > 1 month apart
50
What are the causes of POF?
``` Chromosomal abnormalities (e.g. Turner’s syndrome, Fragile X) Gene mutations (e.g. FSH receptor/LH receptor) Autoimmune disease (e.g. association with Addison’s, thyroid, APS1/2) Iatrogenic (radiotherapy/chemotherapy) ```
51
What are the causes of 2' hypogonadism?
Hypothalamic problem: Functional hypothalamic disorders, Kallman’s syndrome, Idiopathic hypogonadotrophic hypogonadism (IHH). Pituitary problems. Miscellaneous: Prader-Willi, Haemachromatosis
52
What can cause functional hypothalamic amenorrhea?
``` Weight change Stress Exercise Anabolic steroids Systemic illness Iatrogenic (surgery/radiotherapy) Recreational drugs Head Trauma Infiltrative disorders e.g sarcoidosis ```
53
How is idiopathic hypogonadotrophic hypogonadism identified?
By absent or delayed sexual development associated with inappropriate low levels of gonadotrophin and sex hormone levels in absence of anatomical / functional defects of hypothalamic-pituitary gonadal axis
54
What is Kallman's syndrome?
A genetic disorder characterised by a loss of GnRH secretion and anosmia or hyposmia
55
What are the ovarian causes of amenorrhea?
PCOS, ovarian failure, congenital problem with ovarian development
56
What are the causes of hirsutism?
PCOS, familial, idiopathic, non-classical congenital adrenal hyperplasia, adrenal or ovarian tumour
57
What is congenital adrenal hyperplasia?
CAH is an inherited group of disorders characterised by a deficiency in one of the enzymes necessary for cortisol synthesis-90% dye to 21a-hydroxylase deficiency. Autosomal recessive. Varied clinical presentation
58
What is the genetic abnormality in Turner's?
Females only have 1 x chromosome
59
What are the key clinical features of Turner's?
Short stature, webbed neck, shield chest with wide spaced nipples, cubitus valgus. Failure to progress though puberty
60
What are the CVS complications of Turner's?
Coarctation of aorta, bicuspid aortic valve, hypoplastic left heart
61
What are the GI complications of Turner's?
Bleed (vascular malformation), increased IBD
62
What are some non CVS/GI complications of Turner's?
Lymphoedema, AI hypothyroidism, osteoporosis, scoliosis, otitis media, renal abnormalities
63
How does male 1' hypogonadism present?
Low testosterone with high LH/FSH, Acquired and congenital causes
64
How does male 2' hypogonadism present?
Low testosterone with inappropriate low LH/FSH. Pit/hypothalamic disease
65
What is the karyotype in Klinefelter's?
47 XXY
66
What are the clinical featres of Klinefelter's?
``` Reduced testicular volume Gynaecomastia Eunuchoidism (intellectual dysfunction in 40%) (azoospermia) ```
67
What are the congenital/idiopathic causes of 2' hypogonadism?
Idiopathic hypogonadotrophic hypogonadism (IHH) including Kallman’s syndrome (i.e. with anosmia) Congenital adrenal hyperplasia
68
What are the functional causes of 2' hypogonadism?
Exercise, weight change, stress, systemic illness Infiltrative disorders – sarcoid, haemachromatosis, Cranial irradiation / trauma Drugs (e.g. anabolic steroids, opiates) Hyperprolactinaemia Hypothalamic or Pituitary tumours / surgery Prader-Willi syndrome
69
What are the benefits of testosterone replacement?
Improved sexual function, bone health, body composition/muscle strength, QOL and cognition, insulin sensitivity and diabetes. Will not aid fertility (may act as contraceptive)
70
What are the causes of gynaecomastia?
Physiological Drugs: Oestrogens, testosterone, spironolactone, digoxin +many more Hypogonadism Tumours; Oestrogen/androgen testicular or adrenal origin, hCG secreting (e.g. germinoma) Endocrine disorders (e.g. thyrotoxicosis, Cushings) Systemic illness Hereditary disorders
71
What investigations are carried out in gynaecomastia?
Testosterone, LH/FSH. Oestradiol, PRL, AFP, HCG, LFTs, SHBG. Breast imaging, testicular/adrenal imaging
72
What is the treatment of gynaecomastia?
Address underlying cause. Reassurance. Surgery, medication (e.g. anti-oestrogens)

Endocrine (14 decks)

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