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78 Cards in this Set
- Front
- Back
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excessive terminal hair growth in locations where hair growth is normally minimal or absent
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hirsutism
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in the absence of gonadal androgen production, hair growth does not proceed which Tanner stage
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Tanner stage 2
*gonadal androgens are reponsible for normal progression from Tanner 3-5 |
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what does androgen stimulation do to terminal hair in scalp
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recede and turn to fine vellus hair
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what two enzymes do hair follicles contain and what do they form
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17-ketosteroid reductase (androstenedione --> testosterone)
5a-reductase (testosterone --> DHT) |
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what two androgens stimulate hair growth, pigmentation, and sebum production
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testosterone
dihydrotestosterone |
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what hirsute women have increased activity in what enzyme
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5a-reductase
*with normal serum androgen levels |
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what two hormones control androgen production in adrenals vs. ovaries
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adrenal production - controlled by ACTH
ovarian production - controlled by LH |
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3 androgens produced in women and their site of synthesis
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1. androstenedione - 50/50 andrenal and ovary
2. DHEA and DHEA-S - adrenal glands 3. testosterone - 25% ovaries and 75% extraglandular tissue from circulating androstenedione and DHEA |
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characteristics of virilization
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frontal balding
seborrhea acne clitoromegaly |
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what is the amount of virilization directly proportional to
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amount of androgen production
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most common cause for pathologic hirsutism and androgen excess in women
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polycystic ovarian syndrome
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clinical presentation of polycysitc ovarian syndrome
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obesity
hirsutism secondary amenorrhea insulin resistance |
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mechanism for increased androgen and estrogen in polycystic ovarian syndrome
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1. increased GnRH and LH favor production of androstenedione by ovarian theca cells
2. excess androstenedione is converted to testosterone by 17-ketosteroid reductase in theca cells and aromatized to estrone by ovarian granulsa cells 3. estrone is converted to estradiol by 17B-hydroxysteroid dehydrogenase in skin, adipose tissue, and breast tissue |
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what hormones are in excess in polycystic ovarian syndrome
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androstenedione
testosterone estrone estradiol |
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what is the LH/FSH ratio seen in polycystic ovarian syndrome
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LH/FSH > 2.5
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what does insulin resistance in polycystic ovarian syndrome lead to
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1. acts synergistically with LH to increase testosterone production by theca cells
2. decreases hepatic synthesis of sex-hormone binding globulin to increase free testosterone levels |
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what do excess insulin and estrone lead to in polycystic ovarian syndrome
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excess estrone and insulin - stimulate LH secretion
excess estrone - inhibits FSH secretion |
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what causes the chronic anovulation in PCOS
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excess LH and deficient FSH
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the risk of developing what cancer is increased in PCOS
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endometrial carcinoma due to increased estradiol
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what is the most sensitive lab measure of androgen excess in PCOS
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increased plasma free testosterone
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anti-estrogen drug that increases secretion of FSH and LH
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clomiphene
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differentiate developing of hirsutism in women with androgen-secreting tumors vs. PCOS
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androgen tumors - rapid development in their 3rd decade
PCOS - slow onset |
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differentiate androgen-secreting tumors in the ovary vs. adrenal gland
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ovary - markedly increased serum testosterone, no increase in DHEA or DHEA-S
adrenal - markedly increase levels of DHEA and DHEA-S, but slightly elevated testosterone |
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which congenital adrenal hyperplasia is associated with hypertension
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11B-hydroxylase deficiency due to excess DOC (deoxycorticosterone)
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hormone levels associated with 21a-hydroxylase deficiency
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decreased cortisol
increased ACTH increased DHEA and DHEA-S |
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what happens when patient with 21a-hydroxylase deficiency is given exogenous administration of ACTH
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causes marked elevations of 17a-hydroxyprogesterone
*diagnostic |
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what can prolactin stimulate production of
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DHEA-S
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medications associated with hirsutism
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minoxidil
cyclosporine phenytoin |
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what is the general cause of primary amenorrhea
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chronically low levels of estrogen
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3 categories of primary amenorrhea
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1. hypergonatotropic hypogonadism
2. hypergonatotrpic hypogonadism 3. structural abnormalities |
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4 causes for hypogonadotropic hypogonadism
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1. Turner's syndrome
2. pure gonadal dysgenesis 3. 17a-hydroxylase deficiency 4. resistant ovary syndrome |
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what does an arm span greater than body height signify
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hypogonadism because decreased estrogen is unable to close epiphyseal plates
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FSH, LH, and estrogen levels of person with Turner's
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elevated FSH and LH
decreased estrogen |
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two disorders associated with streak ovaries
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1. Turner's
2. pure gonadal dysgenesis |
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two disorders associated with being tall in stature due to decreased estrogen
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pure gonadal dysgenesis
17a-hydroxylase deficiency |
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FSH, LH, and estrogen levels in all hypergonadotropic hypogonadism disorders
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elevated FSH and LH
decreased estrogen |
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this disorder lacks normal FSH receptors
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resistant ovary syndrome
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two disorders with hypogonadotropic hypogonadism
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1. insufficient body fat to trigger menarche
2. Kallmann syndrome |
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this syndrome is associated with decreased FSH, LH, estrogen with anosmia
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Kallmann syndrome
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3 structural abnormalities associated with primary amenorrhea
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1. genital outflow obstruction (imperforate hymen or labial fusion)
2. Mullerian agenesis 3. androgen insenstivity syndrome |
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primary amenorrhea disorders with normal FSH, LH, and estrogen
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genital outflow tract obstruction
mullerian agnesis |
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this patient with primary amenorrhea presents with elevated LH and serum testosterone with sparse pubic and axillary hair growth
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androgen insensitivity syndrome
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absence of menstruation for a period of three months in a woman who has previously menstruated
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secondary amenorrhea
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causes of secondary amenorrhea (7)
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1. menopause
2. pregnancy 3. hypothalamic chronic anovulation 4. hyperprolactinemia 5. PCOS 6. premature ovarian failure 7. Asherman's syndrome |
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what causes secondary amenorrhea in female athlete's triad
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disturbance in pulsatile GnRH release by the hypothalamus
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Female athlete's triad
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disordered eating
amenorrhea osteoporosis |
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cause of secondary amenorrhea in prolactinoma
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elevated prolactin interferes with cyclic release of GnRH
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this disorder is associated with acanthosis nigricans
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PCOS
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this only secondary amenorrhea with elevated LH, androgens, and estrone
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PCOS
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genetic cause for secondary amenorrhea
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premature ovarian failure: deletions or structural abnormalities in the X chromosome, need two intact X chromosomes for maintenance of oocytes
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FSH and LH levels seen in premature ovarian failure
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elevated due to loss of negative feedback from sex hormones
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acquired secondary amenorrhea
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Asherman's syndrome due to uterine infections or scarring
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secondary amenorrhea associated with normal FSH, LH, and estrogen
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Asherman's syndrome
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first test in patient presenting with amenorrhea
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B-hCG
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patient presents with amenorrhea, medroxyprogesterone was administered and bleeding began a few days later after drug was stopped
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PCOS
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what should be measured if no bleeding occurs after medroxyprogesterone therapy
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FSH and LH
elevated FSH - premature ovarian failure normal/low - hypothalamic/pituitary disorder or anatomic abnormality |
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differentiate if a patient bleeds after administration of OCP after medroxyprogesterone test
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bleed - chronic anovulation with low estrogen
no bleed - outflow tract obstruction or Asherman's syndrome |
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what causes chronic anovulation with excess estrogen
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PCOS
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the only congenital adrenal hyperplasia with elevated FSH and LH and sexual infantilism
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17a-hydroxylase deficiency
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what three hormone levels should be tested in a patient presenting with secondary amenorrhea
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B-hCG
prolactin TSH |
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period of irregular menstrual cycles in the premenopausal period
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climacteric
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elevated gonadotropin in climacteric period
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FSH
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FSH, LH, estrogen, and testosterone levels in menopause
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elevated FSH, LH, and testosterone
decreased estrogen |
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predominant estrogen in postmenopausal woman
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estrone
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androgen/estrogen ratio in menopause
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increased due to large reduction in estrogen synthesis and mild reduction in androgen synthesis
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where is nearly all the estorgen derived from in menopause
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aromatization of adrenal androstenedione
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what causes hot flashes
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CNS norepinephrine increase rests hypothalamic thermostat upward and causes reflex sweating and cutaneous vasodilation
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cholesterol levels in menopause
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total and LDL cholesterol increase
HDL cholesterol decrease |
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what directly causes osteoporosis in menopause
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hypoestrogenism
*estrogen helps converse Ca in both the GI and kidney, Ca wasting occurs and PTH rises secondarily |
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what do osteoblasts secrete to inhibit binding of RANKL
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osteoprotegerin
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what does estrogen deficiency do to production of RANKL and osteoprotegerin
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increase in RANKL production
decrease in OPG production |
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receptor activation of nuclear factor kB on the osteoclast membrane
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RANK
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what are the three categories of germ cell tumors and associated with tumors
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no differentiation - dysgerminoma
embryonic tissue - teratoma extraembryonic tissue - endodermal sinus or choriocarcinoma |
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which germ cell tumor is associated with lymphocytes present in fibrous stroma of the tumor
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dysgerminoma
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these tumors are associated with secreting high levels of chorionic gonadotropin (hCG)
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choriocarcinoma
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what do choriocarinomas and hydatidiform moles have in common
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both secrete high levels of B-hCG
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what ovarian tumor is associated with secreting a-FP
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endodermal sinus tumor
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which hydatidiform mole is associated with progression to choriocarcinoma
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complete hydatidiform mole
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