Sex Hormones during life

Question 1

What are the symptoms of menopause ?

Answer 1

Skin dryness/ hair thinning 
Hot flushes - go red; lasts for many years but treatable
Mood disturbance 
Osteoporosis; E2 stimulate osteoblasts 
Sexual dysfunction 
Weight gain 
Amenorrhea 
Climacteric- irregular periods approaching menopause

Question 2

What are the effects of testosterone?

Answer 2

Hair growth, sexual function, muscle mass and voice- deep

Sweat production; acne

Question 3

When does adrenarche start in relation to gonadoarche

Answer 3

2 yrs BEFORE; adrenaline contribute to development of hair.

Question 4

Why can’t men with prolactinoma cannot secrete milk?

Answer 4

Men don’t have oestrogen in breast area to prime the breast for secretion unlike females. Prolactin is dependent on oestrogen for milk secretion.

Question 5

What must to do to accurately measure testosterone levels?

Answer 5

Measure before 11am

Measure with fasting

Question 6

Describe the pre ovulatory follicular phase of the menstrual cycle

Answer 6

6. Graffian follicle emerges
7. E2 increases; switch to positive feedback by E2
8. Induces LH surge
9. Causes ovulation

Question 7

What are the other hormonal changes during puberty?

Answer 7

Adrenarche

Gonadarche- activation of HPG axis

Question 8

What is the significance of DHT?

Answer 8

More potent ligand for Androgen Receptor (AR)

Question 9

What is used to measure testicular volume

Answer 9

Orchidometer

Question 10

What is pre mature menopause and explain its prognosis

Answer 10

Menopause before 40 yr- 1% women have this.
Premature ovarian insufficiency
Conception can still happen(20%)
High FSH of more than 25iU/L

Question 11

What are the congenital causes of secondary hypogonadism

Answer 11

Idiopathic hypogonadotrophic hypogonadism

Kallmann syndrome- LACK of smell with CHH

Question 12

Describe the “Follicular” phase of the menstrual cycle?

Answer 12

1. FSH rises
2. Two or 3 follicles start to grow
3. The follicles produce E2 and inhibin B
4. They reduce FSH by negative feedback
5. Restrict FSH window and non-dominant follicles underdo atresia

Question 13

What might be the causes of primary hypogonadism in men and women

Answer 13

Man- infection/trauma/ cancer of testis
Woman- menopause
The sex glands are the ones affected

Question 14

What are the markers of primary hypogonadism?

Answer 14

Low E2/testosterone

Hence high LH/FSH

Question 15

What is secondary hypogonadism? What are the potential causes?

Answer 15

Low LH/FSH
Low E2/testosterone
Cause by pituitary tumour or high prolactin

Question 16

What is the boys prepubertal and adult size testicular size

Answer 16

Prepubertal- lower than 4 mls

Adult size- higher than 15mls

Question 17

What is common for secondary amenorrhea?

Answer 17

Irregular/anovulatory period for the 1st 18 months

Question 18

What could be the cause of congenital primary hypogonadism?

Answer 18

Clinfekter syndrome- extra X chromosome

Cryptorchism- Testicles does not descend fro abdomen

Question 19

What is the purpose of progesterone in the SECRETORY PHASE?

Answer 19

Maintains endometrium; angiogenesis

It inhibits HPG axis hence LH and FSH is low

Question 20

What is primary amenorrhea?

Answer 20

No menarche after 16yrs; abnormal

Question 21

What are the symptoms of testosterone deficiency?

Answer 21

Sexual dysfunction; loss of morning wood
Decreased Hair growth- frequency of shaving
Energy levels go down 
Mood disturbance 
Increased fat and low muscle mass 
Decreased bone health
Breast enlargement 
Low spermatogenesis

Question 22

What is androstenedione aromatised to?

Answer 22

Oestrone

Question 23

Explain the late onset hypogonadism in MEN

Answer 23

Free testosterone levels in man go down with age
SHBG goes up; as testosterone blinded to SHBG is unavailable to tissues
Total testosterone levels is still the same

Question 24

What is testosterone aromatised to?

Answer 24

17B-Oestradiol

Question 25

What drugs are used to treat breast cancer and prostrate cancer respectively?

Answer 25

Breast- aromatase Inhibitor- Tamoxifen Prostrate- 5 alpah reductase inhibitor- Fibestride

Question 26

What tests needs to be done to confirm hypogonadism for men

Answer 26

LH, FSH | Testosterone and SHBG

Question 27

What factors stimulate the conversion of testosterone to 17-b oestradiol or androstenedione to oestrone? I.e. affect aromatase enzyme

Answer 27

Age, obesity Insulin Gonadotrophins Alcohol

Question 28

In male puberty what is the 1st and 2nd stage

Answer 28

1st- testes enlargement | 2nd- pubic hair tanner

Question 29

What are the effects of oestradiol?

Answer 29

Skin, hair, sexual function, bone health

Question 30

What could be the cause of BOTH primary and secondary hypogonadism?

Answer 30

Chronic alcohol use Chronic disease- stress Senescence due to ageing

Question 31

What are the abnormal onset of puberty and what time and what proportion of male and female have it?

Answer 31

Precocious- BEFORE 8 yrs, pubarche has eat in. More girls have precocious than boys Delayed- after 14 yrs; more boy undergo delayed puberty than girls.

Question 32

What enzyme converts testosterone to DHT and where can you find them?

Answer 32

``` 5 alpha reductase converts testosterone to Di-Hydro Testosterone Can be found in: Teste- seminal vesicles and epididymis Prostrate Skin- scalp; baldness Liver ```

Question 33

What could be the causes of low libido in men?

Answer 33

Primary or secondary hypogonadism

Question 34

What is the 1st and late sign of puberty in girls

Answer 34

1st- Thelarche | Late- Menarche

Question 35

What is secondary amenorrhea?

Answer 35

Period STARTS but then stop for at least 3-6 months. | Periods can be irregular

Question 36

Describe the puberty tanner staging for both genders?

Answer 36

Thelarche and Pubarche- girls ; stage 1-5 Genitalia and pubarche-boys; stage 1-5 Arche- onset of

Question 37

What is the mean age for menarche? When does it occur in relation to PHV and thelarche

Answer 37

Mean age- 12.7years Occurs 2-3 yrs after thelarche Soon after peak height velocity

Question 38

What are the secondary sexual characteristics devoted by males during puberty? What chemical causes this?

Answer 38

TESTOSTERONE Deepening of voice Hair growth- pubic then axillary, facial Sweat gland composition- skin oiliness/acne Changes to external genitalia

Question 39

What are the acquired causes of secondary hypogonadism?

Answer 39

Tumour, head injury, opioids- drugs

Question 40

What are the treatment to alleviate menopause symptoms?

Answer 40

HRT- with oestrogen ADD progesterone if endometrium (womb)is intact; this is to prevent endometrial hyperplasia or cancer. Give cyclically to simulate menstrual cycle or give continuously in order to maintain endometrium and prevent it from growing.

Question 41

Describe what affects testosterone secretion levels

Answer 41

``` Diurnal rhythm;. Highest in the morning Glucose affects (decreases) secretion levels by 20% ```

Question 42

Explain how menopause primary hypogonadism affects HPG axis?

Answer 42

Low inhibin and E2 | High FSH and LH; FSH increases more significantly as its the gametes that’s affected with increased age

Question 43

In What tissues are the aromatised testosterone present? Where aromatase is present

Answer 43

``` Adipose tissue Adrenal glands Ovaries-granulosa cells Testes- Sertoli cells Brain, bone, skin ```

Question 44

At what age does menopause occur?

Answer 44

45-55 years

Question 45

What happens during luteal phase?

Answer 45

Corpus luteum secrete progesterone and oestradiol

Question 46

What are the acquired causes of primary hypogonadism?

Answer 46

Trauma, mumps- disease | Chemotherapy

Question 47

Describe the hormonal changes in release of GnRH AFTER mini puberty to adult hood

Answer 47

Mini puberty- foetal to infant; high GnRH Childhood- quiescence of HPG axis Puberty- increased nocturnal GnRH pulsatility Adult- normal pulsatility GnRH secretion

Question 48

How can females check exactly the date of ovulation?

Answer 48

LH measured in URINE and look for SURGE

Question 49

What is the ovarian reserve marker? Explain its significance

Answer 49

ANTI-MULLERIAN HORMONE (AMH) made by granulosa cells in ovaries Peaks in early adult life and very low in menopause (or POI) Very v high levels show polycystic ovarian syndrome

Question 50

What is the definition of puberty?

Answer 50

Maturation of reproductive organs Production of sex steroids-testosterone/Oestradiol Develop secondary sexual characteristics Attain capability to reproduce

Question 51

What’s the evidence of ovulation?

Answer 51

Midluteal D21 progesterone

Question 52

What is Hypogonadism?

Answer 52

Decreased oestrogen in woman | Decreased testosterone in man

Question 53

What happens if there’s a continuous non-pulsatility administration of GnRH? Whats the evidence from the menstrual cycle?

Answer 53

Decreased LH/FSH secretion | In luteal phase; frequency of GnRH pulses is lower than in follicular phase. Hence less LH and FSH secreted by pituitary

Question 54

What is Oligo-menorrhea?

Answer 54

Few periods (Infrequent) Cycle lasts for more than 35 days 4-9cycles a year

Question 55

What is the mean time for onset of puberty for boys and girls respectively?

Answer 55

Boys- 9-14yrs | Girls; 8-13yrs

Question 56

What are the secondary sexual characteristics developed by females during puberty? What chemical causes it?

Answer 56

``` Caused by OESTRADIOL Breast development Hair growth- pubic and axillary Sweat gland composition- acne/skin oiliness Changes to external genitalia ```

Question 57

What are the potential causes of POI?

Answer 57

Autoimmune Genetics; turner’s syndrome or Fragile X syndrome Cancer therapy