3: Ovulatory disorders + male hypogonadism (Newey) Flashcards Preview

Endocrine Week 5 2017/18 > 3: Ovulatory disorders + male hypogonadism (Newey) > Flashcards

Flashcards in 3: Ovulatory disorders + male hypogonadism (Newey) Deck (44)
Loading flashcards...
1
Q

Looks like we were given the same lecture twice, most of this is a rehash but there are some male hypogonadism questions at the end, soz

A
2
Q

What is GnRH?

A

Gonadotrophin releasing hormone

released by hypothalamus

stimulates release of FSH and LH from anterior pituitary

3
Q

What sort of GnRH pulses stimulate the release of

FSH

LH?

A

FSH - LOW frequency pulses

LH - HIGH frequency pulses

4
Q

How long does the menstrual cycle last?

A

28 - 35 days

5
Q

What are the two phases of the menstrual cycle?

A

Follicular phase

Luteal phase

6
Q

When roughly does ovulation occur?

A

Around 14 days, midway between follicular and luteal phases

7
Q

Surge of which hormone triggers ovulation?

A

LH

8
Q

What is the dominant hormone in the luteal phase?

A

Progesterone

9
Q

Oestradiol peaks when?

Progresterone peaks when?

A

Oestradiol before ovulation

Progesterone after

10
Q

Which hormone causes thickening of the endometrium?

A

Oestrogen

11
Q

How does oestrogen affect gonadotrophin release in the follicular phase and luteal phase?

A

Pos feedback follicular

Neg feedback luteal

12
Q

Which hormone is secreted by the corpus luteum and maintains early pregnancy?

A

Progesterone

13
Q

A high serum progesterone level one week on Day 21 indicates what?

A

Woman has ovulated

14
Q

Irregular cycles cause ___.

A

anovulation

15
Q

Ovulation disorders cause which symptoms?

A

Oligomenorrhoea (cycles longer than 35 days)

Amenorrhoea (no period)

16
Q

Issues with which glands cause anovulation?

A

Hypothalamus

Pituitary

17
Q

What are the levels of FSH and LH in hypothalamic pituitary failure?

A

Low

because no GnRH produced

18
Q

Because no FSH and LH are released in hypothalamic pituitary failure, oestrogen is __.

A

low

19
Q

How can oestrogen deficiency be investigated?

A

Progesterone challenge test

Imitates peak in luteal phase, negative if no menstruation occurs afterwards

20
Q

How is hypothalamic-pituitary related anovulation treated?

A

GnRH injections (pulsatile)

OR

Gonadotrophin (LH/FSH) injections

21
Q

What is the most common endocrine disease in women and causes anovulation with a positive progesterone challenge test?

A

Polycystic ovary syndrome

22
Q

What are the three diagnostic criteria for polycystic ovary syndrome?

A

Oligo/amenorrhoea

Polycystic ovaries

Hyperandrogenism (acne, hirsutism due to increased testosterone)

23
Q

How is PCOS treated before ovulation is induced?

A

Weight loss

Lifestyle modification

Folic acid

Rubella immunisation

24
Q

Why do patients with PCOS take oestrogen tablets e.g Clomid?

A

Induces ovulation

25
Q

Apart from oestrogen tablets, what other treatments exist for PCOS?

A

Gonadotrophin injections

Ovarian drilling?!?!?!?!

26
Q

What, normally associated with diabetes, is also seen in the majority of PCOS patients?

A

Insulin resistance

big long list of reasons why, don’t really matter

27
Q

Which drug is used to address insulin resistance in PCOS?

A

Metformin

28
Q

Why does PCOS cause insulin resistance?

A

High levels of LH causes hyperinsulinaemia for some reason

Insulin lowers level of transporter which mops up testosterone

> Masculinisation (acne, hirsutism)

29
Q

What are some risks of using drugs like Clomid and gonadotrophin injections to stimulate ovulation?

A

Ovarian hyperstimulation

Multiple pregnancy (twins are evil)

Ovarian cancer

30
Q

Multiple pregnancy (twins, triplets) tend to be (premature / late) and can have lots of complications.

A

premature

complications - cardio, resp, disability

31
Q

Using ovulation induction for long periods of time has been linked to what?

A

Ovarian cancer

32
Q

What is ovarian failure?

A

Failure to produce new eggs

High FSH and LH, low oestrogen

Amenorrhoea

i.e the menopause

33
Q

What is premature ovarian failure?

A

Menopause before the age of 40

34
Q

Which genetic syndrome causes premature ovarian failure?

A

Turner syndrome

45 XO

35
Q

If a person with premature ovarian failure wanted to conceive, how would they go about this?

A

Combined oral contraceptive pill to replace oestrogen

Egg / embryo replacement because they don’t have any

Counselling

36
Q

What can cause testicular failure in men?

A

Klinefelter syndrome

47 XXY

37
Q

Men with ___ testes may have testicular failure.

A

undescended

38
Q

Apart from Klinefelter’s and undescended testes, what can cause testicular failure?

A

Trauma

39
Q

What pituitary problem can cause infertility?

A

Hyperprolactinaemia secondary to a pituitary tumour

40
Q

What are the tell tale signs of hyperprolactinaemia?

A

Amenorrhoea

Galactorrhoea

Visual field disruption

41
Q

What inhibits the release of prolactin normally?

A

Dopamine

So dopamine antagonists (anti-depressants) may cause hyperprolactinaemia

42
Q

What is an example of a drug used to treat hyperprolactinaemia?

A

Dopamine agonist

e.g cabergoline

43
Q

What is the most important test to determine whether or not a woman is ovulating?

A

Progesterone challenge test

If she’s not ovulating, then check all the other hormones

44
Q

Which scan is routine for all women with infertility?

A

Ultrasound pelvis