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where does FSH act?
man: Sertoli cells of seminiferous tubule, which then secrete inhibin for negative feedback to ant pituitary
woman: ovaries to produce oestrogen, egg to mature
where does LH act?
girl: ovaries to release eg
boy: leydig cells of interstitium to release testosterone
what does oestrogen do?
releases LH from pituitary
what does testosterone do?
encourage spermatogenesis in Sertoli cells
which hormone as two big peaks in the menstrual cycle? although the first one is bigger
which two hormones peak around days 12-14 of the menstrual cycle?
which peaks first?
LH AND FSH
LH first -> day 14 ovulation
what days of the menstrual cycle are menses?
what hormone levels being low leads to menses?
- days 0-5
- menses is due to the fall in progesterone
what are the two phases of the menstrual cycle?
days 0-14: follicular
days 14-28: luteal
where exacto are oestrogen and progesterone produced?
corpus luteum of the Graafian follicle in the ovaries
what is the definition of delayed puberty?
if it's onset is >2.5standard deviations after the national average;
what is constitutional delay of puberty?
- always been small
- growth is proportional to bone age
other than constitutional growth delay, name two types of causes of delayed puberty?
- hypogonadotrophic hypogonadism
- hypergonadotrophic hypogonadism
name causes of hypogonadotrophic hypogonadism?
- strucural problems: hypotha/pitui
- functional: chronic illness/anorexia/cushings
- low GnRH: kallmann's syndrome
what is kallmann's syndrome?
- congenital hypogonadotrophic hypogonadism
name two developmental causes of hypergonadotrophic hypogonadism?
what is klinefelter's syndrome?
what is turner's syndrome?
name some acquired causes of hypergonadotrophic hypogonadism?
what tests do you do for delayed puberty?
- male - testosterone/female - oesrogen
wrist Xray for bone age
what can you give to a delayed puberty kid to induce puberty?
oral oestrogen/oral testosterone
if you give too high a dose of oral oestrogen/testosterone to induce puberty, what will happen?
early fusion of epiphyses
what is primary amenorrhoea?
causes of primary amenorrhoea?
- delayed puberty
- endometrial hypoplasia
- vaginal agenesis
causes of secondary amenorrhoea (cessation of menstruation)?
- same as causes for hypogonadism
- androgen-secreting tumours
- asherman's syndrome
what is asherman's syndrome?
- adhesions/fibrosis in the endometrium
- after dilatation and curettage (miscarriage/trauma)
treatment for amenorrhoea?
treatment for menopausal amenorrhoea?
why do you monitor people on GnRH treatment with transvaginal US and blood oestrogen?
- risk of multiple ovulation
- hyperstimulation syndrome: capillary leak/circulatory shock/pleural effusions/ascites
what are the clinical presentations of male hypogonadism?
- decreased libido
- muscle weakness
- reduced hair growth
- anaemia of chronic disease
what test tells you if it's hypogonadotrophic or hypergonadotrophic gonadism?
- if they are low -> hypo and the prob is in the pituitary
- if they are high -> hyper and the prob is in the testes/ovaries
what is cryptochordism?
congenital abscence of testes
what hormone do you give to a man with hypogonadism to stop osteoporosis?
- not oral! and measure PSA first!
what hormone do you give if you want to encourage spermatogenesis for fertility treatments?
what is gynaecomastia?
what is it due to?
- asymmetrical glandular breast tissue in a man
- due to increased oestrogens
- and decreased androgens
name some drugs that cause gynaecomastia?
- spironolactone (anti-androgen!)
what could cause an oestrogen excess and thus gynaecomastia?
- liver failure
- oestrogen secreting tumour in testis
- hCG tumour in testis/lungs
can a prolactin excess cause gynaecomastia?
what test can you do to differentiate gynaecomastia from fat?
treatment for gynaecomastia in a teen vs an man?
- teen: it will resolve by itself
- man: give androgens/surgically remove
what is hirsuitism?
- increased thick, terminal hair
- in an androgen dependent distribution on a female
if the hirsuitism is of sudden onset what does this imply?
an androgen secreting tumour
what tests do you need to do for someone who presents with hirsuitism?
- US for PCOS
- bloods for:
2 common causes of hirsuitism?
rarer: CAH (congenital adrenal hyperplasia), cushings
5 in how many men get testicular tumours
what is the age of onset?
95% of testicular tumours are of which histology type?
seminoma - quite a good prognosis
what 2 things could testicular tumours secrete that are tumour markers?
what are the three types of testicular tumours?
- leydig cell tumours
where do seminomas spread to via lymphatics?
- to lungs
- low grade so good prognosis
which cell type do teratomas of the testes come from?
what is the prognosis?
from the germinal epithelium so the trophoblastic layer and can differentiate to any cell type
what is the only benign tumour of the testis, and what does it often secrete?
leydig cell tumour
secretes oestrogen ->gynaecomastia
what is first line therapy for a seminoma after an orchidectomy?
what is first line therapy for a teratoma after an orchidectomy? (3)
chemo: bleomycin, etosopide, cis-platin
name two androgen receptor antagonists used for hirsuitism?
- cyproterone acetate - hepatic side effects
- spironolactone - electrolyte side effects
name a 5-alpha reductase inhibitor used as an antiandrogen for hirsuitism?
oestrogen is given in anti-androgen therapy for hirsuitism but what does it increase the risk of?
- weight gain
- ca of breast/ovary
the diagnosis of PCOS requires 2 of which 3 symptoms?
- menstrual irregularities
- androgen excess
- multiple cysts in ovaries
PCOS can cause what other non-ovary symptoms?
- glucose intolerance
what med is given in PCOS to increase fertility?
one in how many girls have turner's syndrome?
what are 'streak ovaries'?
- fibrosis of ovaries
- seen in turner's syndrome
which causes short stature and which causes long legs?
- turners - short
- klinefelters - long legs due to failure of epiphyses to fuse
what kind of hypogonadism are turner's and klinefelter's syndromes
treatment for klinefelter's?
treatment for turner's?
- prophylactic gonadectomy (risk of gonadoblastoma)
- give oestrogens for puberty