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Endo Exam 9
Polycystic Ovarian Syndrome (PCOS) Mechanism
Mechanism
Hyperinsulinemia Increases GnRH Pulse Frequency
Large Increase in LH
Small Decrease in FSH
Increased Androgen Production From Theca-Lutein Cells
Polycystic Ovarian Syndrome (PCOS) Symptoms and Diagnosis
Symptoms
Most Common Cause of Infertility in Women
Amenorrhea
Acne
Hirsutism
Obesity
Diagnosis
Enlarged, Cystic Ovaries
LH:FSH Ratio of 3:1
"String of Pearls" on Ultrasound
1 min
Polycystic Ovarian Syndrome (PCOS) Treatment
Weight Loss
Oral Contraceptives
Clomiphene Citrate
Anti-androgens
Cyclic Progesterone for Endometrial Protection
Metformin
1 min
Sheehan's Syndrome
Postpartum Pituitary Gland Necrosis
Agalactorrhea
Amenorrhea
Secondary Hypothyroidism with Cold Intolerance
1 min
Turner Syndrome
Signs and Symptoms
Female (XO)
Short stature
Shield Chest
Cystic Hygroma (Webbing of Neck)
Lymphedema in Hands and Feet
Ovarian Dysgenesis
Streak Ovary
Decreased Estrogen
Increased FSH
Increased LH
Dysgerminoma
Bicuspid Aortic Valve
Preductal Coarctation of the Aorta
Horseshoe Kidney
Menopause before Menarche
Amenorrhea
5 mins
Steroid Hormones
Characteristics
Nuclear Membrane
Long-Lived and Slow-Acting
Cholesterol-Derived
Intracellular Receptors
DNA Transcription
Examples
Testosterone
Aldosterone
Estrogen
Cortisol
2 mins
Leuprolide
Mechanism
GnRH Agonist (Pulsatile Use)
GnRH Antagonist (Continuous Use)
Upregulates FSH And LH
Downregulates FSH And LH
Indications Pulsatile
Infertility
Indications Continuous
Prostate Cancer
Precocious Puberty
Uterine Fibroids
Endometriosis
Side Effects
Anti-androgenic Effects
2 mins
Androgen Insensitivity (Complete)
Defect in Androgen Receptor
Phenotypically Female
(46, XY)
Female External Genitalia
Rudimentary Vagina
Scant Sexual Hair
Testes Often in Labia Majora
Testes Surgically Removed to Prevent Malignancy
Increased Estrogen, Testosterone, and LH
Absent Uterus and Fallopian Tubes
3 mins
Aromatase Inhibitors
Indications
Estrogen Receptor-positive (ER+) Breast Tumors
Systemic Metastases
Drugs
Reversible, non-steroid
Letrozole
Anastrozole
Irreversible, steroid
Exemestane
Side Effects
Osteoporosis
Arthritis
1 min
Tamoxifen
Mechanism of Action
Selective Estrogen Receptor Modulator (SERM)
Antagonist on Breast Tissue
Indications
ER-positive Breast Cancer
Side Effects
Decreased Risk of Osteoporosis
Increased Risk of Endometrial Cancer
Increased Risk of Venous Thromboembolism (VTE)
1 min
Ovulatory Hormones I - Follicular Phase
Characteristics
0-14 Days
GnRH Stimulates FSH and LH
Follicle Secretes Estrogen
Negative Feedback from Estrogen
Increased Estrogen Leads to Positive Feedback
FSH and LH Surge
LH Spike Leads to Ovulation
2 mins
Ovulatory Hormones II - Luteal Phase
Days 15-28
Corpus Luteum
Secretes Progesterone
Negative Feedback inhibits FSH and LH
No pregnancy forms Corpus Albicans
Stops Estrogen Secretion
Endometrial Sloughing - Menses
GnRH secretion produces new follicular phase
2 mins
5 Alpha Reductase Deficiency
Autosomal Recessive
Inability to Convert Testosterone to DHT
Normal Internal Genitalia
Ambiguous External Genitalia until Puberty
Masculinization During Puberty with Growth of External Genitalia
LH can be Increased
Normal Estrogen, LH, and Testosterone levels
2 mins
Testes
Characteristics
FSH Stimulates Sertoli Cells
Inhibin B Release
LH Stimulates Leydig Cells
Leydig Cells Secrete Testosterone
Testosterone Causes Male Development
2 mins
Klinefelter's Syndrome
Pathophysiology
Male (XXY)
Signs and Symptoms
Eunuchoid Body Shape
Gynecomastia and Female Hair Distribution
Testicular Atrophy
Dysgenesis of Seminiferous Tubules
Possible Developmental Delay
Hypogonadism
Decreased Inhibin B
Increased FSH
Abnormal Leydig Cell Function
Decreased Testosterone
Increased LH
Increased Estrogen
Barr body (inactivated X chromosome)
6 mins
Spironolactone (Aldactone)
Mechanisms
Inhibition of Aldosterone
Potassium Retention
Indications
Hypertension
Edema
Heart Failure
Side Effects
Hyperkalemia
Endocrine Effects
Consideration
Avoid Potassium Supplements
2 mins
Varicocele
Pathophysiology
Dilation of Pampiniform Plexus Veins
Signs and Symptoms
Soft Left-Sided Scrotal Mass
Bag of Worms
Increased Size with Standing or Valsalva
Decreased Size while Supine
Testicular Atrophy
Subfertility
Diagnosis
Ultrasound
Retrograde Venous Flow
Treatment
Surgical Gonadal Vein Ligation
Scrotal Support
3 mins
Spermatogenesis
Seminiferous Tubules
Sertoli Cells
Spermatogonia
Mitosis
Primary Spermatocyte
Meiosis I
Secondary Spermatocyte
Meiosis II
Spermatid
Spermatozoa
Acrosome
Flagellum
2 mins
Oogenesis
Characteristics
Primary Oocytes From Birth
Meiosis I Once a Month
Secondary Oocyte Plus Polar Body
Frozen in Metaphase II, in Meiosis II
Ovulation
Fertilization by Sperm
Meiosis II
Ovum
Zygote Forms
2 mins
17 Alpha Hydroxylase Deficiency
Decreased Cortisol
Decreased Sex Hormones
Increased Mineralocorticoids (DOC)
Hypertension
Hypokalemia
XY Externally Phenotypic Female
No Internal Reproductive Structures Due to Mullerian Inhibitory Factor
XX Externally Phenotypic Female
Sexual Infantilism
2 mins
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