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23 Cards in this Set
- Front
- Back
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Effects of LH in both sexes? FSH?
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stim gonadal steroid secretion
- m: leydig cells --> T - f: theca cells --> T --> E by granulosa cells; stim ovulation and corpus luteum --> progesterone supports gamete development - m: sertoli cells and sperm development - f: stim granulosa cells and follicle development. |
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What leads to AMH production at 9wks of gestation? where is this produced?
- what does it cause? |
SRY on Y crsm; by Sertoli cells.
- regression of mullerian ducts on a male fetus. |
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What do inhibins (A and B) do?
- what secretes A and B in women? - men? |
inhibit FSH production by pituitary
- primordial follicles (B); dominant follicle (A) - Sertoli cells (B); No known role for Inhibin A in men |
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What metabolizes T --> E?
T--> DHT? - fx of DHT? What stimulates embryonic development of Wolffian duct organs (epididymis, vas deferens, ejac duct)? |
aromatase
5-a-reductase - b/ more strongly to androgen receptor; stim puberty and external genital development. Testosterone. |
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____ stimulates ____ cell to make
Testosterone which acts with ___ on ____ Cell to stimulate Spermatogenesis |
LH, leydig, FSH, Sertoli
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Is Estrogen important for CV? how/why?
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Important for endothelial function
Increases clotting factors |
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Which is more prevalent @ menses, FSH or LH?
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FSH
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What are causes of physiologic hypogonadism?
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Energy restriction
(dieting, starving, anorexia nervosa) - causes fewer pulses, and the ones that happen have higher amplitude. Severe illness Aging |
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What effect does *continuous* GnRH have on LH and FSH?
- drugs w/ this effect? |
suppressess them.
- leuprolide, gosarelin |
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What does continuous sex hormone (E or T) do to the HPG axis?
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turns it off
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- What happens if no AMH in XY male <6wks?
- <8wks no T? - <12wks no DHT? Hypogonadal XX? |
- “female” Mullerian internal structures persist
- lack of Wolffian development - female/ambig ext. genitalia still has female internal and external genitals. |
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How can XX appear male?
What happens to pre-birth hypergonadal XY? |
- SRY translocation to X
- CAH - Cross placental exposure to maternal androgen excess. Appears normal male. |
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How do we define precocious puberty in boys and girls?
what are possible etiologies? |
f: thelarche <8, menarche <9
m: pubic hair and testicular enlargement <9. - GnRH dependent (hypothal tumor, etc) - Gonadotropin dependent (hCG secreting tumors actv LH receptors; LH receptor constit. actv in boys --> ^T; primary hypothyroidism) - sex steroid dependent: McCune Albright syndrome, CAH, ovarian or adrenal tumors making T or E, |
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What is McCune Albright syndrome?
- when do we suspect it? |
post-zygotic mutation of the gene GNAS1, which is involved in G-protein signalling. This mutation, often a mosaicism, prevents downregulation of cAMP signalling.
When these three things are present: * (autonomous) endocrine hyperfunction such as precocious puberty * Polyostotic fibrous dysplasia (bone dz that occurs more freq in craniofactial area) * Café-au-lait spots |
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What is heterosexual percocity?
- potential causes? |
virilization of girls or feminization of boys.
- virilization: CAH, ovarian tumors --> Androgens, exogenous androgens - feminization: testicular tumors making hCG, feminizing adrenal tumors, exogenous estrogens, hypogonadism, physiological pubertal gynecomastia. |
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What 3 types of etiologies can cause delayed pubery?
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absent GnRH, Hypopituitarism, Gonadal failure
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What is Kallman's syndrome?
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Olfactory nerve fails to migrate through cribiform plate, GnRH neurons don’t migrate to hypothalamus, causing failure to initiate puberty, and anosmia
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Klinefelter's XXY, Turner's XO, gonadal injury, infiltrative dz, AI, systemic dz... can call cause ___ gonadal failure.
Kallman's, pituitary dz (caused by all sorts of stuff), Xrt, Alcohol...? |
primary gonadal failure
secondary. |
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Pt present with low estrogen and wnl-to-low LH and FSH. Type of hypogonadism?
Pt presents w/ low E and high LH and FSH? Remember that LH and FSH levels are ___ before puberty, and ___ after menopause. |
secondary
primary. low, high. |
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How can we restore fertility in hypogonadism? (2)
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GnRH administration by sc pump
Needs to be pulsatile, at sex and cycle-specific frequency Requires intact pituitary LH and FSH administration by daily injection - Women: FSH daily and LH at midcycle - men: post pubery LH is often effective w/o FSH |
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What are some risks of Estrogen replacement therapy?
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DVT, Gallbladder dz, Ht dz, Breast cancer, Endometrial cancer (not increased when women w/ a intact uterus is given concurrent progesterone)
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Erythrocytosis, BPH, prostate cancer, sleep apnea, gynecomastia, and skin reactions are all possible SE of replacement tx for which hormone?
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Testosterone.
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Should we ever tx with Oral Testosterone? why not?
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17-a-alkyl group delays metabolism by the liver, allowing T to be taken orally... BUT -->
- this is associated with liv dz: ^LFTs, peliosis hepatis, hepatoma, cholestatic juandice. |
