Reproductive endocrinology Flashcards
(107 cards)
1
Q
What are the key reproductive hormones?
A
- GnRH
- LH
- FSH
- Oestrogen
- Progesterone
- Testosterone
2
Q
What are the 2 main reproductive hormones realised by the anterior pituitary?
A
- FSH
- LH
3
Q
Explain the effect of FSH in males?
A
- causes testes to produce sperm
4
Q
Explain the effect of FSH in females?
A
- causes growth of ovarian follicles and causes the secretion of oestrogen
5
Q
What is the effect of LH in males?
A
- causes the testes to secret testosterone
6
Q
What is the effect of LH in females?
A
- causes ovulation
- progesterone production by corps luteum
7
Q
GnRH is released in what manner?
A
-pulsatile manner
8
Q
Explain the release of GnRH in males and females?
A
- males: constant frequency
- females: varies during menstrual cycle
9
Q
High frequency GnRH secretes?
A
- LH
10
Q
Low frequency GnRH secretes?
A
- FSH
11
Q
Follicle growth affect on GnRH
A
- oestrogen secreted
- increases pulsatile nature
- LH secreted
12
Q
LH causes an increase in progesterone which causes what?
A
- decrease in pulsatile nature
- FSH increases
13
Q
GnRH is regulated by what receptor?
A
- kisspeptin
14
Q
How many days on average is the menstrual cycle?
A
- 28 days
15
Q
What is the first phase of the menstrual cycle known as?
A
- follicular phase
- follicular growth = oestrogen
16
Q
What is the second phase of the menstrual cycle known as?
A
- luteal phase
- LH surge = ovulation
- increases progesterone
17
Q
Explain a follicle?
A
- an oocyte surrounded by follicular cells
18
Q
Explain follicular growth?
A
- the oocyte does not grow
- it is the follicular cells around that increase in number
19
Q
What occurs to the endometrium under the influence of oestrogen?
A
- thickens
20
Q
What is the progestational hormone?
A
- progesterone
- without = no pregnancy
21
Q
Thea cells are sensitive to what?
A
- LH
22
Q
What do Thea cells produce?
A
- androgens
23
Q
Granulosa cells are sensitive to??
A
- FSH
24
Q
What is the role of granulosa cells?
A
- convert androgens to oestrogen.
25
There is both a FSH independent and FSH dependant stage during folliculognesis?
True or false?
- true
26
When does the LH surge occur?
- 34-36hours before ovulation
27
With increasing LH levels what else increases?
- progesterone
28
What does LH do to the corpus luteum?
- LH stimulates angiogenesis
| - LH stimulates enzymes involved in conversion of cholesterol to progesterone
29
What is the role of oestrogens?
- thickens vaginal wall
- regulates LH surge
- decreases viscosity of cervial mucus
30
What is the role of progesterone
- maintains thickness of endometrium
| - responsible for infertile thick mucus
31
What 2 cells are in close contact for spermatogenesis development?
- Sertoli cells and germ cells
32
What is the role of the blood testes barrier?
- prevents immune system interference and prevents immune suppression
33
What is the role of testosterone?
- maintains integrity of blood testes barrier
| - releases mature spermatozoa
34
Infertility is defined as?
- failure to achieve a clinical pregnancy after 12 months of trying
35
What are hormonal levels of anorexia?
-low FSH, LH and oestradiol
36
What are the symptoms of PCOS?
- weight gain
- acne
- hirsutism
- abnormal menstrual cycle
37
What is the 2/3 diagnostic criteria for PCOS?
- Chronic anovulation
- polycystic ovaries
- hyperandrogenism
38
Symptoms of premature ovarian failure?
- hot flushes
- night sweats
- amenorrhoea
39
Hormonal levels of premature ovarian failure?
- high FSH
- High LH
- low oestrogen
40
What is endometriosis?
- presence of endometrial glands outside uterine cavity
41
A chocolate cyst may be seen in what?
- endometriosis
42
If a patient presents with hirsute what should be examined?
- testosterone
43
What stimulates the hypothalamus to produce GnRH?
- Kisspeptin
44
FSH in males is responsible for what?
- spermatogenesis
45
What cells in males are responsible for spermatogenesis and what hormone regulates?
- Sertoli cells
| - FSH
46
What cells in males are responsible for testosterone production and what hormone regulates?
- Leydig cells
| - LH
47
The majority of testosterone in males is bound to what?
- SHBG
| - Sex hormone binding globulin
48
What is the form of highly active testosterone?
- dihydrotestosterone
49
Male hypogonadism is what deficiency?
- testosterone deficiency
50
What blood results would be expected in primary male hypogonadism?
- Testosterone low
- LH/FSH, GnRH high
- Hypergonadotropic hypogonadism
51
What is mainly affected in hypergonadotropic hypogonadism?
- spermatogenesis
| - primary male hypogonadism
52
What is mainly affected in hypogonadotropic hypogonadism?
- spermatogenesis and testosterone production
53
What blood results would be expected in secondary male hypogonadism?
- low testosterone
- low FHS/LH
- Low GnRH
54
What are some congenital causes of male primary hypogonadism?
- Klinefelters
| - cryptorchidism
55
What are some causes of acquired primary male hypogonadism?
- testicular trauma
- chemotherapy
- varicocele
- mumps
56
Klinefelter's syndrome is caused by what?
- nondysjunction
57
What is the karyotype of Klinefelter's syndrome?
- 47 XXY
58
What are some congenital causes of male secondary hypogonadism?
- Kallmann's syndrome
| - prader-willi syndrome
59
What are some acquired causes of secondary male hypogonadism
- pituitary disease
| - hyperprolactinaemia
60
Explain Kallmann's syndrome
- isolated genetic deficiency of GnRH
| - Causes secondary male hypogonadism
61
Symptoms associated with Kallmann's syndrome?
- loss of smell (anosmia)
- colour blindness
- unilateral renal agenesis
62
Symptoms of male hypogonadism?
- small male sexual organs
- gynaecomastia (breast development)
- decreased body/pubic hair
63
Diagnosis of male hypogonadism?
- semen sample if infertile
- 2xtestosterone AM samples
- FSH/LH
- Prolactin and pituitary hormones
- MRI?
64
What time should testosterone be measures?
- between 8-11am
65
What is the management of male hypogonadism?
- testosterone replacement therapy
66
Name 2 different types of testosterone replacement therapies?
- Nebido
| - sustanon
67
What is testosterone replacement therapy contraindicated in?
- hormone responsive cancer (breast or prostate)
- haematocrit
- sleep apnoea
- heart failure
68
What folic acid dosage should be recommended to women trying to conceive with low risk neural tubal risk?
- 400micrograms
| - before conceiving to 12 weeks into pregnancy
69
What dosage of folic acid should be given to patients with high risk neural tubal defects or diabetes?
- 5mg
70
What supplements should be given before conception/pregnancy?
- folic acid (400micromg or 5mg)
| - vitamin D
71
What is the affect on rubella on a child?
- microcephaly
- PDA
- cataracts
- rashes
72
What is the advice regarding the MMR vaccine and pregnancy?
- not to get pregnant within a month of vaccine as it is a live attenuated vaccine
73
Treatment of chlamydia?
- doxyxycline
74
At what day of a cycle should you check progesterone levels?
- day 21
75
Irregular periods may be suggestive of ___
-anovulation
76
Explain group 1 ovulation disorders?
- hypothalamic
- anorexia
- excessive exercise
77
Explain group 2 ovulation disorders?
- hypothalamic pituitary dysfunction
| - PCOS
78
PCOS is what group of ovulation disorders?
- group 2
79
Explain group 3 of ovulation disorders?
- ovarian failure
80
Management of hypothalamic anovulation?
- stabilise weight
- pulsatile GnRH
- daily gonadotrophin FSH and LH injections
81
Treatment of PCOS?
- lifestyle changes
- clomifene citrate
- gonadotrophin therapy
- laparoscopic surgery
82
Letrozole and tamoxifen are drugs used to treat?
- PCOS
83
What is the role of pelvic adhesions divisions?
- maintains patency
84
Explain hydrosalpinx?
- water cyst in tube
| - reduces pregnancy rate
85
Treatment of hydrosalpinx?
- laparoscopic salpingectomy
86
When is a hysteroscopy recommend in IVF?
- after 2 failed attempts
87
What is a uterine fibroid?
- benign lump on the womb
88
Treatment of a submucosal fibroid?
- hysteroscopically
89
Treatment of a subserosal fibroid
- little affect on fertility
| - leave
90
Explain the outlines of IVF treatment?
- hormonal injection to produce many eggs
- USS guided collection of follicles from ovary
- culture media of egg and sperm
- embryo transfer
91
At what day is an embryo regarded as a blastocyst?
- day 5
92
On what day of the menstrual cycle does ovulation occur?
- day 14
93
Define oligomenorrhoea?
- cycles >42 days
| - less than 8 periods per year
94
Define amenorrhea?
- absent menstruation
95
When does LH peak?
- peak levels stimulate ovulation
96
Ovulation predictor kit measures what hormone?
- Measures LH levels
| - LH surge prior to ovulation
97
What is oestrogen secreted by?
- ovarian follicles
- adrenal cortex
- placenta
98
Oestrogen __increased/decreases__ viscosity of cervical mucus?
- oestrogen decreases viscosity
99
Progesterone __increases/decreases__ viscosity of cervical mucus?
- progesterone increases viscosity
100
Explain the spinnbarkeit criteria for ovulation?
- cervical mucus becomes thinner during ovulation (oestrogen)
- basal body temp increases (progesterone)
- progesterone >30nmol/l
101
Explain the progesterone challenge test?
- to distinguish between group 1 ovulation disorders and other causes
- progesterone given to stimulate a period
- if bleeding = normal oestrogen
102
What are the symptoms of ovarian hyperstimulation?
- ovaries swell and become painful
103
Premature menopause is before what age?
- before the age of 40
104
What treatment is given to premature menopause?
- HRT (Bone density)
| - assisted conception
105
What is another pituitary cause of amenorrhea?
- hyperprolactinaemia
106
What are the investigations of hyperprolactinaemia?
- high prolactin
- normal or low FSH/LH
- low oestrogen
107
Treatment of prolactinaemia?
- dopamine agonist
| - cabergoline
