endo

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Author:
rdsmed
ID:
227094
Filename:
endo
Updated:
2013-07-14 18:45:26
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puberty hypogonadism
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  1. 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
  2. where does LH act?
    girl: ovaries to release eg

    boy: leydig cells of interstitium to release testosterone
  3. what does oestrogen do?
    releases LH from pituitary
  4. what does testosterone do?
    encourage spermatogenesis in Sertoli cells
  5. which hormone as two big peaks in the menstrual cycle? although the first one is bigger
    oestrogen
  6. which two hormones peak around days 12-14 of the menstrual cycle?
    which peaks first?
    LH AND FSH

    LH first -> day 14 ovulation
  7. 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
  8. what are the two phases of the menstrual cycle?
    days 0-14: follicular

    days 14-28: luteal
  9. where exacto are oestrogen and progesterone produced?
    corpus luteum of the Graafian follicle in the ovaries
  10. what is the definition of delayed puberty?
    if it's onset is >2.5standard deviations after the national average;

    • girl - 13yo
    • boy - 14yo
  11. what is constitutional delay of puberty?
    • always been small
    • growth is proportional to bone age
  12. other than constitutional growth delay, name two types of causes of delayed puberty?
    • hypogonadotrophic hypogonadism
    • hypergonadotrophic hypogonadism
  13. name causes of hypogonadotrophic hypogonadism?
    • strucural problems: hypotha/pitui
    • functional: chronic illness/anorexia/cushings
    • low GnRH: kallmann's syndrome
  14. what is kallmann's syndrome?
    • congenital hypogonadotrophic hypogonadism
    • anosmia
  15. name two developmental causes of hypergonadotrophic hypogonadism?
    • klinefelter's
    • turner's
  16. what is klinefelter's syndrome?
    XXY males
  17. what is turner's syndrome?
    45X females

    webbed neck
  18. name some acquired causes of hypergonadotrophic hypogonadism?
    • chemo
    • mumps
    • TB
    • haemochromatosis
  19. what tests do you do for delayed puberty?
    • bloods:
    • LH
    • FSH
    • male - testosterone/female - oesrogen

    wrist Xray for bone age

    chromosome analysis
  20. what can you give to a delayed puberty kid to induce puberty?
    oral oestrogen/oral testosterone
  21. if you give too high a dose of oral oestrogen/testosterone to induce puberty, what will happen?
    early fusion of epiphyses
  22. what is primary amenorrhoea?
    never menstruated
  23. causes of primary amenorrhoea?
    • delayed puberty
    • endometrial hypoplasia
    • vaginal agenesis
  24. causes of secondary amenorrhoea (cessation of menstruation)?
    • same as causes for hypogonadism
    • PCOS
    • androgen-secreting tumours
    • asherman's syndrome
  25. what is asherman's syndrome?
    • adhesions/fibrosis in the endometrium
    • after dilatation and curettage (miscarriage/trauma)
  26. treatment for amenorrhoea?
    treatment for menopausal amenorrhoea?
    • HRT
    • OCP


    for both!
  27. 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
  28. what are the clinical presentations of male hypogonadism?
    • decreased libido
    • lethargy
    • muscle weakness
    • reduced hair growth
    • gynaecomastia
    • anaemia of chronic disease
  29. what test tells you if it's hypogonadotrophic or hypergonadotrophic gonadism?
    • LH
    • FSH

    • 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
  30. what is cryptochordism?
    congenital abscence of testes
  31. what hormone do you give to a man with hypogonadism to stop osteoporosis?
    • testosterone
    • not oral! and measure PSA first!
  32. what hormone do you give if you want to encourage spermatogenesis for fertility treatments?
    hCG
  33. what is gynaecomastia?
    what is it due to?
    • asymmetrical glandular breast tissue in a man
    • due to increased oestrogens
    • and decreased androgens
  34. name some drugs that cause gynaecomastia?
    • cimetidine
    • digoxin
    • spironolactone (anti-androgen!)
    • steroids
  35. what could cause an oestrogen excess and thus gynaecomastia?
    • liver failure
    • oestrogen secreting tumour in testis
    • hCG tumour in testis/lungs
  36. can a prolactin excess cause gynaecomastia?
    no
  37. what test can you do to differentiate gynaecomastia from fat?
    • US
    • mammography
  38. treatment for gynaecomastia in a teen vs an man?
    • teen: it will resolve by itself
    • man: give androgens/surgically remove
  39. what is hirsuitism?
    • increased thick, terminal hair
    • in an androgen dependent distribution on a female
  40. if the hirsuitism is of sudden onset what does this imply?
    an androgen secreting tumour
  41. what tests do you need to do for someone who presents with hirsuitism?
    • BP
    • BMI
    • US for PCOS
    • bloods for:
    • -testosterone
    • -PRL
    • -LH
    • -FSH
  42. 2 common causes of hirsuitism?
    • obesity
    • PCOS

    rarer: CAH (congenital adrenal hyperplasia), cushings
  43. 5 in how many men get testicular tumours
    what is the age of onset?
    • 5 in 100 000
    • 20-40yo
  44. 95% of testicular tumours are of which histology type?
    seminoma - quite a good prognosis
  45. what 2 things could testicular tumours secrete that are tumour markers?
    • AFP
    • beta-hCG
  46. what are the three types of testicular tumours?
    • seminomas
    • teratomas
    • leydig cell tumours
  47. where do seminomas spread to via lymphatics?
    prognosis?
    • to lungs
    • low grade so good prognosis
  48. 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

    v malignant
  49. what is the only benign tumour of the testis, and what does it often secrete?
    leydig cell tumour

    secretes oestrogen ->gynaecomastia
  50. what is first line therapy for a seminoma after an orchidectomy?
    radiotherapy
  51. what is first line therapy for a teratoma after an orchidectomy? (3)
    chemo: bleomycin, etosopide, cis-platin
  52. name two androgen receptor antagonists used for hirsuitism?
    • cyproterone acetate - hepatic side effects
    • spironolactone - electrolyte side effects
  53. name a 5-alpha reductase inhibitor used as an antiandrogen for hirsuitism?
    finasteride
  54. oestrogen is given in anti-androgen therapy for hirsuitism but what does it increase the risk of?
    • VTE
    • HTN
    • weight gain
    • ca of breast/ovary
  55. the diagnosis of PCOS requires 2 of which 3 symptoms?
    • menstrual irregularities
    • androgen excess
    • multiple cysts in ovaries
  56. risk factors for PCOS?
    • family hx
    • obesity
  57. PCOS can cause what other non-ovary symptoms?
    • HTN
    • hirsuitism
    • ace
    • dyslipidaemia
    • glucose intolerance
  58. what med is given in PCOS to increase fertility?
    clomipine
  59. one in how many girls have turner's syndrome?
    2500
  60. what are 'streak ovaries'?
    • fibrosis of ovaries
    • seen in turner's syndrome
  61. which causes short stature and which causes long legs?
    • turners - short
    • klinefelters - long legs due to failure of epiphyses to fuse
  62. what kind of hypogonadism are turner's and klinefelter's syndromes
    hypergonadotrophic
  63. treatment for klinefelter's?
    give androgens
  64. treatment for turner's?
    • prophylactic gonadectomy (risk of gonadoblastoma)
    • give oestrogens for puberty

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