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Y2 Endocrine > Week 5 > Flashcards

Week 5 Flashcards

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1
Q

What are the hormones involved in the menstrual cycle

A

GnRH
FSH
LH
Oestrogen
Progesterone

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2
Q

What are the 2 phases of the menstrual cycle

A

Follicular Phase
Luteal Phase

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3
Q

If a woman’s menstrual cycle is not 28 days, the length of which phase out of the 2 would change

A

Follicular phase can vary in length whereas luteal phase is always 14 days

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4
Q

Describe how GnRH is released from the hypothalamus in females and males

A

Released in a pulsatile manner at different frequencies in females
Released in a pusaltile manner at constant frequency in males

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5
Q

Why is GnRH released in a pulsatile manner in females

A

Because females have the menstrual cycle. Releasing GnRH at different frequencies induces secretion of different hormone

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6
Q

GnRH secreted in pulses at high frequency induces the secretion of

A

LH

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7
Q

GnRH secreted in pulses at low frequency induces the secretion of

A

FSH

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8
Q

FSH and LH are secreted by

A

Anterior pituitary gland

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9
Q

Which phase occurs first in the menstrual cycle

A

Follicular phase

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10
Q

What occurs in the follicular phase

A

Follicle develops

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11
Q

What occurs in the luteal phase

A

Ovulation - egg released from ovary
Corpus luteum forms

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12
Q

In which phase is oestrogen released

A

Follicular phase

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13
Q

In which phase is progesterone released

A

Luteal phase

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14
Q

What controls the pulsatility of GnRH

A

Oestrogen and Progesterone through activating receptors on Kisspeptin neutrons

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15
Q

Why are kisspeptin neurons needed to regulate the pulsatility GnRH

A

Because the GnRH neurons do not have oestrogen or progesterone receptors.

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16
Q

Which hormone is predominant in follicular phase

A

FSH

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17
Q

Which hormone is predominant in luteal phase

A

LH

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18
Q

Describe the follicular phase

A
  1. FSH stimulates follicular growth
  2. This causes an increase in oestrogen
  3. The initial increase in oestrogen exerts a negative feedback to lower FSH temporarily
  4. As oestrogen reaches the threshold, it exerts positive feedback on both FSH and LH
  5. This causes the surge in LH and an increase in FSH
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19
Q

FSH causes the growth of multiple follicles but in the end, only 1 follicle matures completely. Why is that

A

Due to the fall in FSH as oestrogen level increases initially.
Only the follicle that can withstand the fall in FSH will develop completely as FSH rises again but the others will be lost

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20
Q

Describe the Luteal phase

A
  1. Surge in LH causes ovulation
  2. Egg leaves follicle = follicle becomes corpus luteum
  3. Corpus luteum produces and releases progesterone
  4. Progesterone causes the drop in LH by decreasing pulsatility of GnRH
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21
Q

What happens to the endometrium under the influence of oestrogen

A

Oestrogen causes the thickening of endometrium

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22
Q

What happens to the endometrium under the influence of progesterone

A

Progesterone also causes the thickening of endometrium and turns it into a secretory tissue

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23
Q

Thickening of endometrium allows

A

Implantation of fertilised egg -> pregnancy

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24
Q

What happens to the hormones if there is pregnancy

A

LH will be substituted by HCG which maintains the corpus luteum hence progesterone will still be released

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25
Why should the corpus luteum be maintained during pregnancy
So that progesterone will still be released and maintain the thickness of endometrium to prevent miscarriage
26
What happens to the hormones if there is no pregnancy
LH level drops hence corpus luteum cannot be maintained So progesterone is not released -> endometrium thickness not maintained so it breaks down -> causing menstrual period
27
What is the threshold of oestrogen needed to cause LH surge
200 pg/ml
28
What is the precursor of progesterone and oestrogen
Cholesterol
29
What happens to the viscosity of cervical mucus under the influence of oestrogen and why
Viscosity decreases To allow better sperm penetration to form fertilised egg
30
hat happens to the viscosity of cervical mucus under the influence of progesterone and why
Viscosity increases To prevent more sperm penetration To prevent infection
31
What structures in the cervix can make sperm penetration harder
Grooves and folds
32
Types of grooves in the cervix
Primary groove Secondary groove
33
What structures in the cervix can make sperm penetration harder
Thicker mucus in cervical canal Concentrated immune cells in cervical canal
34
What is the optimal route for a sperm to pass through the cervix and fertilise the egg
Through primary and secondary grooves and avoid cervical canal
35
Where are sperm made in the testes
seminiferous tubules
36
Where are sperm stored in the testes
epididymis
37
What is considered as infertility
Failure to achieve pregnancy after 12 months of regular intercourse without contraception
38
What is primary infertility
In women that have never had a child
39
What is secondary infertility
In women who had conceived before but unsuccessful (miscarriage / ectopic pregnancy)
40
Risk factors for infertility
Age over 30 Obesity Male infertility Smoking Drug usage Diseases
41
Common causes of secondary infertility
Endometriosis Pelvic inflammatory diseases Fibroids Obesity
42
Conditions that can cause infertility
Anovulatory infertility PCOS Endometriosis Premature Ovarian failure Pelvic inflammatory diseases Fibroids
43
What is anovulatory infertility
Infertility due to absence of ovulation
44
Causes of anovulatory infertility
Eating disorders - anorexia / bulimia Hyperprolactinaemia Abnormal TSH level PCOS Premature ovarian failure Drugs
45
How does hyperprolactinaemia cause infertility
High prolactin levels causes low oestrogen level -> follicles do not mature -> egg not released
46
Endocrine features of PCOS
High androgen level High LH Insulin resistance - High insulin
47
Clinical features of PCOS
Obesity Hirsutism Acne Abnormal menstrual cycles Infertility Anovulation Acanthosis nigricans
48
What is acanthosis nigricans
Dry, dark discoloration in body folds and creases esp in groin, axilla and neck
49
Risk factors for PCOS
Genetics Weight gain
50
PCOS increases risk of
Diabetes Infertility NAFLD
51
Which criteria is used to diagnose PCOS
Rotterdam criteria
52
What is considered as premature ovarian failure
Menopause before the age of 40
53
Endocrine feature of premature ovarian failure
Hypergonadotrophic hypogonadism
54
What is hypergonadotrophic hypogonadism
Under activity of the ovaries (gonad) causing lack of negative feedback on the pituitary gland leading to excess FSH and LH
55
Causes of premature ovarian failure
Turner syndrome Chemotherapy / Radiotherapy Infections
56
What infections may cause premature ovarian failure
Mumps CMV TB
57
Symptoms of premature ovarian failure
Amenorrhea Irregular menstrual periods Hot flushes Night sweats Vaginal dryness Infertility
58
Which symptoms of premature ovarian failure is due to lack of oestrogen
Hot flushes Night sweats Vaginal dryness
59
What would the FSH and LH levels be in premature ovarian failure
High
60
Premature ovarian failure increases the risk of
Osteoporosis Dementia Parkinson
61
Investigations for premature ovarian failure
FSH/LH level Oestrogen level
62
What would the oestrogen level be in premature ovarian failure
Low because ovaries produce oestrogen hence abnormal ovaries cannot produce oestrogen even if there is high FSH
63
Management for premature ovarian failure
Oestrogen therapy
64
What is endometriosis
Ectopic endometrial tissue outside the uterus
65
What are endometrioma in ovaries often called
Chocolate cysts
66
What are the potential causes of endometriosis
1. Retrograde menstruation 2. Spread of endometrial cells via lymphatics 3. metaplasia of cells outside uterus
67
What is retrograde menstruation and how may it cause endometriosis
When the endometrial lining flows backwards during menstrual period and flows out of the fallopian tubes into peritoneum and pelvis
68
Why do patients with endometriosis experience cyclical pelviv / abdominal pain
Because the endometrial cells outside the uterus responds to the hormones the same way. This means that the ectopic endometrial tissue will shed and bleed too during menstrual cycle, causing inflammation of surrounding tissues
69
Why may patients with endometriosis experience chronic non-cyclical pain
Adhesion may occur. Inflammation of surrounding tissues induces formation of scar tissue which can cause organs to stick together and become irritated
70
Symptoms of endometriosis
Cyclical abdominal / pelvic pain Non-cyclical pain Dysmenorrhea (painful periods) Pain on deep sexual intercourse Infertility Cyclical bleeding from other sites causing haematuria and bloody stool
71
How may endometriosis cause haematuria and bloody stool
If the endometrial cells deposit in the intestines / bladder
72
Investigations for endometriosis
Ultrasound Biopsy of the lesions via laparoscopy
73
Management of endometriosis
Laparoscopic surgery
74
What are causative pathogens of pelvic inflammatory diseases
Gonorrhea Chlamydia Syphilis TB
75
What are fibroids
Benign smooth muscle tumour that grows in the uterus from its muscle layers
76
Cause of fibroids
Oestrogen and progesterone
77
Non-obstructive causes of male infertility
Klinefelter syndrome Hypogonadism Hyperprolactinaemia Chemotherapy / radiotherapy Varicocele Ejaculatory failure Erectile dysfunction Undescended testicles
78
What is varicocele
Varicose veins (enlarged veins) within the skin that holds the testicles = ineffective blood circulation, deoxygenated blood pooling in the veins
79
What are undescended testicles
Testicles that have not descended into the scrotum. This increases risk of trauma due to pubic bone putting pressure on the testicles
80
Obstructive causes of male infertility
Cystic fibrosis Ejaculatory duct obstruction Post vasectomy

Y2 Endocrine (6 decks)

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