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session 3 Flashcards

1
Q

Changes in the Male at Puberty

A

Genital development begins

  • Pubic hair growth (Adrenarche)
  • Spermatogenesis begins
  • Growth spurt (10cm/year)
  • Genitalia adult
  • Pubic hair adult
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2
Q

the change of puberty the male starts at age?

A

9

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3
Q

Changes in the Female at Puberty

A 
* Breast bud (Thelarche) – the first sign that
puberty has begun.
* Pubic hair growth (Adrenarche)
* Growth spurt (9cm/year)
* Onset of menstrual cycles (Menarche)
* Pubic hair adult
* Breasts adul
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4
Q

the change of the puberty at the female start at the age —–?

A

8

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5
Q

the physiological changes at puberty ?

A

Pulsatile GnRH secretion leads to rise in FSH and
LH

the start ofpuberty is associated with a steady rise in FSH and LH secretion.

-Rise in GnRH could be reduction in sensitivity to
–‘ve feedback by steroids, or (more likely) due
to ‘maturation’ of central mechanisms

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6
Q

why the GnRH hormone increase at the puberty

A

-Rise in GnRH could be reduction in sensitivity to
–‘ve feedback by steroids, or (more likely) due
to ‘maturation’ of central mechanisms

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7
Q

Critical weight is———- for menarche

A

47kg

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8
Q

Growth spurt start weight is——- for girls and—–for boys

A

30kg , 55kg

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9
Q

what is the important hormone release by the adipose tissue initiate secretion of the GrRH AND important for puberty

A

leptain

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10
Q

Adrenarche (Pubic and Axillary hair) occur dueto the effect of

A

adernogen in both sexs

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11
Q

the female are shorter than man why?

A

Oestrogen closes epiphyses earlier in girls.
Oestrogen is needed to initiate the growth spurt,
but once levels reach a certain point it causes the
epiphyses to fuse.

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12
Q

Growth Spurt depend on

A

growth hormones and steroids

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13
Q

Thelarche (Breast Development depend on

A

estrogen

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14
Q

the development of male genitalia in puberty depend on

A

testosterone

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15
Q

the tanner staging measure the puberty according to

A

breast,
genitals
and pubic hair development

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16
Q

Precocious Puberty

A

The development of the signs of

puberty before the age of 8 in Girls or 9 in Boys

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17
Q

there are two types of precocious puberty?

A

central (true ) and peripheral (pseud) precocious puberty

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18
Q

what is the True (central) precocious puberty

A

due to neurological causes. Early
stimulation of central maturation giving early, inappropriate
GnRH secretion. The cause of the majority is unknown, but
they can be due to neurological causes:
1-CNS tumors
meningitis
trauma

late treatment of CAH ( ACT AS trigger )

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19
Q

what is the peripheral precocious puberty

A

uncontrolled Gonadotrophin or steroid secretion like * Hormone secreting tumours or hormonal ingestion

-mc- cune - testotoxcosis 
adreanl tumors 
CAH IN male 
gonadal tumors 
HCG  secreting Hepatoplastoma 
]sex hormones ingestions (oral contraceptive )
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20
Q

Treatment for the precocious puberity

A

Explanation & reassurance n idiopathic causes
i
Stop the causative

drug——GnRH agonist

removalof tumor

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21
Q

what is the Pre-Menopause

A

it is the period after the 40 years and before the menopause

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22
Q

in the pre-menopause there is —–

  • decrease in fertility
  • increase in fertility
  • absence of fertility
A

decrease in fertlity

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23
Q

The Menopause

A

Cessation of menstrual cycles

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24
Q

in menopause the increase of FSH more than LH due to the effect of ——

A

decreae of the inhibin hormone

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25
Effects of Menopause
( I ) Vascular Hot flushes affect ~80% to some degree Transient rises in skin temperature and flushes ``` II ) Oestrogen Sensitive Tissues Uterus Regression of endometrium Shrinkage of myometrium Shrinks away into a very small organ cervix thinning of cervix Vagina rugae lost Thinner, less distensible Breast Involution of some breast tissue Changes in skin Bladder Reduction in bladder tone ``` Bone mass reduces by 2.5% per year for several years. Increased resorption relative to production Osteoporosis
26
Advantiges=of the hormonal replacement therapy
Relieves symptoms of the menopause _Easy administration Orally or topically by patch or gel _Can limit osteoporosis, but no longer recommended for first line protection (Biphosphonates now recommended) _Not advised for cardio-protection
27
Disadvantages of HRT
HRT increases the risk of malignancy due to effect of estrogen specially endometrial and breast malignancies also cardiovascular diseases such as coronary artery diseases and thromboembolism (DVT)
28
Menorrhagia
excessive (>80 ml) & /or prolonged | bleeding at regular intervals.
29
Metrorrhagia
irregular menstrual bleeding.
30
Menometrorrhagia
excessive, prolonged & irregular | bleeding.
31
Oligomenorrhoea
infrequent menses occurring at > | 35 days interval.
32
Polymenorrhoea
frequent menses occurring at < 21 | days interval.
33
Intermenstrual bleeding
bleeding between normal | menstrual periods.
34
Dysmenorrhoea
Painful menstruation
35
Postmenopausal bleeding
bleeding that occurs > 1 yr after | menopause, or at irregular intervals while on HRT.
36
Cryptomenorrhoea
menstruation occurs but not visible due | to obstruction in outflow tract
37
Dysfunctional Uterine Bleeding(DUB)
Abnormal bleeding, | no obvious organic cause
38
Amenorrhoea–
Absence of periods for at least 6 months
39
Anovulatory Cycles
No ovulation/ Oligo/Amenorrhoea +/- | Menorrhagia
40
Ovulatory Cycles
usually regular menstrual cycles +/- Menorrhagia + dysmenorrhea/mastalgia (sore breasts)
41
what actually occut imHypothalamic/Pituitary Amenorrhoea?
inadequate FSH hormones secretion leaf to inadequate ovaries stimulation which then fail to produce enough oestrogen to stimulate the endometrium of the uterus
42
Primary Hypothalamic Amenorrhoea causes
- Constitutional delay: exclude other causes. * Kallmann Syndrome – Inability to produce GnRH ( LH & FSH subsequently
43
Secondary Hypothalamic Amenorrhoea causes
* Exercise or stress-related amenorrhoea * Eating disorders and weight loss ( anorexia or bulimia). CNS neoplasm, trauma or infilterating disease such as TB or sarcoidosis . * Drugs affecting HPG axis.
44
what the drugs affect the HAG AXIS
progesterone , HRT and the dopamine antagonist
45
Secondary Pituitary Amenorrhoea causes
Sheehan syndrome – --necrosis of piutary gland due to severe obstetric bleeding ------- Hypopituitarism * Hyperprolactinaemia (adenoma)(inhbiti release of FSH and LH ) * Haemochromatosis – ‘Iron overload
46
how hypothyroidism cause amenorrhea
thyroxine is important for the stimulation for the progesterone's to release by the granulosa cells the decrease of thyroxine lead to adverse effects the decrease of thyroxine lead to to stimulate relase of TRH which increase level of the prolactin and cause decrease in the FSH and LH secretion
47
how the hyperthyrodism lead to amenorrhea
it lead to trigger high sex -binding proteins production lead to decrease active estrogen that can act on endometrium of uterus .
48
Gonadal/End-Organ Amenorrhoea | primary type causes
Primary Gonadal/End-Organ Gonadal dysgenesis – e.g. Turner Syndrome (45, Xo) Androgen Insensitivity Syndrome Receptor abnormalities for FSH and LH
49
Secondary Gonadal/End-Organ | causes of gonadal amenorrhea
``` premature menopause (ovarian failure) Polycystic Ovarian Syndrome ```
50
IV. Outflow Tract Amenorrhoea | Primary Outflow Tract Obstruction
* Uterine – Mullerian agenesis i.e. absent vagina & uterus (Rokitansky syndrome)=15% of primary amenorrhoea * Vaginal – Vaginal atresia or transverse septum, imperforate hymen
51
Secondary Outflow Tract Obstruction
* Cervical stenosis as in case of conization of the cervix * severe vaginal adhesion following vaginal surgery * uterine causes - Intrauterine Adhesions (Asherman’s syndrome) - Endometrial TB
52
Rokitansky syndrome
Mullerian agenesis i.e. absent vagina & uterus | (Rokitansky syndrome)=15% of primary amenorrhoea
53
(Asherman’s syndrome)
Intrauterine Adhesions
54
Menorrhagia occur secondary to the
It isusually secondary to distortion of the uterine cavity, leaving the uterus unable to contract down on open venous sinuses in the zona basalis.
55
causes of the menorrhagia
It may may be due to dysfunctional uterine bleeding (DUB) & usually ovulatory. Other causes include organic, endocrine, haemostatic
56
Causes of the menorrhagia
``` 1-DUB / (Bleeding of Endometrial Origion) 2-Fibriod 3-adenomyosis 4-Endometrial polyp 5-Coagulation disorder (von Willebrands disease ) 6-Pellvic inflammatory disease ( PID ) 7-Thyriod disease 8- Drug therapy ( warfarin ) 9-intrauterine contraceptive device 10-Endometrial /Cervical carcinom ```
57
Anovulatory DUB
There is no corpus luteum formation & Progesterone production. As a result E2 is produced continuously, causing overgrowth of the uterine endometrium & subsequent bleeding .
58
difference in the causes between the perimenarchal adolescents, vs perimenopause IN THE aovlatory DOB
it is due to immaturity ofHPG axis(unable to respond to E2 with an LH surge In perimenopausal women it is due to declining ovarian function.
59
Ovulatory DUB causes
altered life span of corpus luteum or abnormal progesterone production Disordered endometrial prostaglandin production also has been implicated, as have abnormalities of endometrial vascular development
60
DIGNOSIS OF THE DOB
BHCG, TSH – Exclude pregnancy, thyroid Coagulation workup Smear if appropriate – Exclude cancer ( Cervical ) Sample endometrium ( D & C )
61
Dysmenorrhea (painful periods) | ATEOLOGIES
endometriosis and adenomyosis; • pelvic inflammatory disease; • cervical stenosis and haematometra (rare).

reproductive system (3 decks)

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