-
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
oestrogen
-
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
- anosmia
-
name two developmental causes of hypergonadotrophic hypogonadism?
-
what is klinefelter's syndrome?
XXY males
-
what is turner's syndrome?
45X females
webbed neck
-
name some acquired causes of hypergonadotrophic hypogonadism?
- chemo
- mumps
- TB
- haemochromatosis
-
what tests do you do for delayed puberty?
- bloods:
- LH
- FSH
- male - testosterone/female - oesrogen
wrist Xray for bone age
chromosome analysis
-
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?
never menstruated
-
causes of primary amenorrhoea?
- delayed puberty
- endometrial hypoplasia
- vaginal agenesis
-
causes of secondary amenorrhoea (cessation of menstruation)?
- same as causes for hypogonadism
- PCOS
- 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
- lethargy
- muscle weakness
- reduced hair growth
- gynaecomastia
- 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?
- testosterone
- not oral! and measure PSA first!
-
what hormone do you give if you want to encourage spermatogenesis for fertility treatments?
hCG
-
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?
- cimetidine
- digoxin
- spironolactone (anti-androgen!)
- steroids
-
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?
no
-
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?
- BP
- BMI
- US for PCOS
- bloods for:
- -testosterone
- -PRL
- -LH
- -FSH
-
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?
- seminomas
- teratomas
- leydig cell tumours
-
where do seminomas spread to via lymphatics?
prognosis?
- 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
v malignant
-
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?
radiotherapy
-
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?
finasteride
-
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
-
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?
- HTN
- hirsuitism
- ace
- dyslipidaemia
- glucose intolerance
-
what med is given in PCOS to increase fertility?
clomipine
-
one in how many girls have turner's syndrome?
2500
-
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
hypergonadotrophic
-
treatment for klinefelter's?
give androgens
-
treatment for turner's?
- prophylactic gonadectomy (risk of gonadoblastoma)
- give oestrogens for puberty
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