Reproductive Disorders

Question 1

ratio of LH:FSH in early follicular phase

Answer 1

equal days 1-5

Question 2

granulosa cells make….?

luteal cells make…?

Answer 2

estradial

androgens: DHEA, androstendione, test, progesterone

Question 3

folliculogenesis growth factors produced by ovary?

Answer 3

inhibin –> inhibit FSH

activin –> activate FSH

Question 4

Inhibin during different parts of cycle

Answer 4

inhibin a –> luteal phase

inhibin b –> follicular phase

Question 5

How to evaluate a woman with distrubance in menstrual cycle? (5 things)

Answer 5

• exclude pregnancy with BhCG
• r/o prolactinoma
• androgen levels if hirsutism/acne
• GnRH stim only in precoicious puberty
• Draw LH/FSH in first 5 days after menses

Question 6

If there’s no menses, what can you use to induce bleeding?

Answer 6

medroxyprogesterone or estrogen + prog to trigger a follicular phase

Question 7

hypogonadotropic hypogonadism (labs)

Answer 7

• low LH, FSH, estradiol

- amenorrhea

Question 8

hypothalamic amenorrhea

Answer 8

• acquired GnRH def of pulses
• most common
• due to stress, exercise, poor nutrition

Question 9

hypergonodotropic hypogonadism (labs)

Answer 9

• high FSH and/or LH
• low estradiol
• amenorrhea

Question 10

hypergonodotropic hypogonadism (types)

Answer 10

• turners

- premature ovarian insufficiency

Question 11

premature ovarian insufficiency

Answer 11

Ovarian failure before age 40

-req eventual HRT

Question 12

signs and sx of POI

Answer 12

• irregular menses without molimal sx
• FSH rise BEFORE LH rise (loss of inhibin)
• look for other AI d/os

Question 13

hyperandrogenic anovulation - what can cause this?

Answer 13

PCOS
tumors
obesity induced anovulation

Question 14

PCOS (labs)

Answer 14

timed gonadotropin levels on day 1-5 of cycle

• labs show HIGH ratio of LH/FSH > 2.5/1
• increased androgens: test (ovarian) and DHEAS (adrenal)

Question 15

risks assoc with PCOS

Answer 15

• endometrial cancer (estrogen unopposed by prog)
• insulin resistance
• htn
• premature cardiac dz

Question 16

goals in PCOS treatment

Answer 16

• ensure endometiral shedding to prevent endometrial CA

- block effects of hyperandrogenization

Question 17

Tumors that cause hirsituism

Answer 17

• virilizing tumors of ovary make testosterone (>200ng/dl)
• virilizing tumors of adrenal make DHEA-s (>800 ng/dl)
• RAPID ONSET/ pace of sx like male pattern balding, hair on chest and back, clitorromegally

Question 18

obesity induced anovulation

Answer 18

• often misdx for PCOS
• normal puberty cycle until they exceed weight set point –> develop acne and hirsituism
• will have NORMAL/EQUAL LH/FSH
• xsaromatase and 5areductase activity in fat tissue

Question 19

treatment for female hypogonadism

Answer 19

• no treatment
• estrogen
• fertility drugs
• pulsatile GnRH

Question 20

how long until bone loss occurs after onset of estrogen defeicits?

Answer 20

6 months

Question 21

Estrogen therapy

Answer 21

-BCP

Question 22

how is estrogen therapy used in congenital defects?

Answer 22

low dose E alone for 12-18 mo to develop breasts

-add prog in cyclic fashion to develop ductules

Question 23

progesterone alone therapy?

Answer 23

use for dysfunctional uterine bleeding and hyperandrogenic anovulation in pt who are not esstrogen deficient

Question 24

HRT in women with POI?

Answer 24

give est and prog in physiologic manner similar to menopausal hormone therapy

Question 25

clomiphene citrate (clomid)

Answer 25

- fertility drug - mixed estrogen agonist/antagonist - augments folliculogensis in pts with muted GnRH pulse generator - fools repro axis into thinking there is est deficiency

Question 26

on what days of the cycle and at what dose d you give clomiphene citrate

Answer 26

5-9 50-150 mg/day -must monitor for anti-est effects on cervical mucus and ovulation rates

Question 27

drug combo that stimulates folliculogenesis and ovulation for in vitro prp

Answer 27

``` human gonadotropins (pergonal) or recombinant FSH (menotropin) + hCG (profasi) -monitor with daily blood samples ```

Question 28

pulsatile GnRH tx

Answer 28

- to induce ovulation in women with hypothalamic amenorrhea to replace bunk GnRH pulse generator - IV admin with mump to mimic cycle signals

Question 29

fertility drugs in women with PCOS

Answer 29

- prog - GnRH agonist --> continuious Lupron to downreg GnRH receptor - give above for ONE MONTH to suppress endogenous GnRh - then give pulsative GnRH - metformin or thiazoladinedione to improve ovulation rates