Sex Hormones during life Flashcards by The Forbidden Fruit

What are the symptoms of menopause ?

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

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What are the effects of testosterone?

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

Sweat production; acne

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When does adrenarche start in relation to gonadoarche

2 yrs BEFORE; adrenaline contribute to development of hair.

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Why can’t men with prolactinoma cannot secrete milk?

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

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What must to do to accurately measure testosterone levels?

Measure before 11am

Measure with fasting

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Describe the pre ovulatory follicular phase of the menstrual cycle

Graffian follicle emerges
E2 increases; switch to positive feedback by E2
Induces LH surge
Causes ovulation

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What are the other hormonal changes during puberty?

Adrenarche

Gonadarche- activation of HPG axis

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What is the significance of DHT?

More potent ligand for Androgen Receptor (AR)

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What is used to measure testicular volume

Orchidometer

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What is pre mature menopause and explain its prognosis

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

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What are the congenital causes of secondary hypogonadism

Idiopathic hypogonadotrophic hypogonadism

Kallmann syndrome- LACK of smell with CHH

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Describe the “Follicular” phase of the menstrual cycle?

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

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

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

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What are the markers of primary hypogonadism?

Low E2/testosterone

Hence high LH/FSH

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What is secondary hypogonadism? What are the potential causes?

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

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What is the boys prepubertal and adult size testicular size

Prepubertal- lower than 4 mls

Adult size- higher than 15mls

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What is common for secondary amenorrhea?

Irregular/anovulatory period for the 1st 18 months

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What could be the cause of congenital primary hypogonadism?

Clinfekter syndrome- extra X chromosome

Cryptorchism- Testicles does not descend fro abdomen

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What is the purpose of progesterone in the SECRETORY PHASE?

Maintains endometrium; angiogenesis

It inhibits HPG axis hence LH and FSH is low

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What is primary amenorrhea?

No menarche after 16yrs; abnormal

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What are the symptoms of testosterone deficiency?

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

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What is androstenedione aromatised to?

Oestrone

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Explain the late onset hypogonadism in MEN

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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

What is testosterone aromatised to?

Study These Flashcards

17B-Oestradiol

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

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

What tests needs to be done to confirm hypogonadism for men

LH, FSH | Testosterone and SHBG

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

Age, obesity Insulin Gonadotrophins Alcohol

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

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

What are the effects of oestradiol?

Skin, hair, sexual function, bone health

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

Chronic alcohol use Chronic disease- stress Senescence due to ageing

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

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.

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

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

What could be the causes of low libido in men?

Primary or secondary hypogonadism

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

1st- Thelarche | Late- Menarche

What is secondary amenorrhea?

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

Describe the puberty tanner staging for both genders?

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

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

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

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

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

What are the acquired causes of secondary hypogonadism?

Tumour, head injury, opioids- drugs

What are the treatment to alleviate menopause symptoms?

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.

Describe what affects testosterone secretion levels

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

Explain how menopause primary hypogonadism affects HPG axis?

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

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

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

At what age does menopause occur?

45-55 years

What happens during luteal phase?

Corpus luteum secrete progesterone and oestradiol

What are the acquired causes of primary hypogonadism?

Trauma, mumps- disease | Chemotherapy

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

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

How can females check exactly the date of ovulation?

LH measured in URINE and look for SURGE

What is the ovarian reserve marker? Explain its significance

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

What is the definition of puberty?

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

What’s the evidence of ovulation?

Midluteal D21 progesterone

What is Hypogonadism?

Decreased oestrogen in woman | Decreased testosterone in man

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

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

What is Oligo-menorrhea?

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

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

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

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

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

What are the potential causes of POI?

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

Sex Hormones during life Flashcards

(57 cards)