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20 Cards in this Set
- Front
- Back
Hypothalamic-Pituitary Axis in Fetus
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FETAL-->differentiates, functional by 28 weeks gestation
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Hypothalamic-Pituitary Axis in Childhood
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CHILDHOOD-->axis suppressed (hypersensitivity to low estrogen levels, intrinsic inhibitory effect at hypothalamic level)
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Hypothalamic-Pituitary Axis in Puberty
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PUBERTY-->reactivated axis by decreasing estrogen sensitivity and reversing intrinsic inhibition (leads to pulsatile nocturnal GnRH secretion followed by FSH and LH)
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Menarche
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First menses:
Occurs when Gn promote enough estrogen secretion from ovary so that endometrium proliferates and sheds |
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Regular menses
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regular ovulatory menstrual cycles:
Hypothalamic-Pituitary axis develops positive mid-cycle response to estrogen feedback, causing surge in LH |
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Sequence of sexual maturation
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Thelarche (first sign of breast development)-->Pubarche (pubic and axillary hair)-->Peak Height Velocity-->Menarche
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Menstrual Cycle
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Follicular Phase-->Ovulation-->Luteal Phase-->Menses
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Follicular Phase
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Ovarian follicular growth and maturation
Length varies depending on how long it takes follicle to mature-->determines length of entire cycle Dominant follicle is selected Endometrium undergoes proliferative changes |
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Ovulation
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Release of ovum from ruptured ovarian follicle ~12 hours after LH peak--> fertilizable for 12-24 hours
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Luteal Phase
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Presence of functional corpus luteum
Always 14 days in duration Secretory change of endometrium |
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Menses
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First day of menstruation is called "Day 1" of the cycle
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Primary Amenorrhea
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No menses by age 15 in presence of secondary sexual characteristics OR no menses by age 13 in absence of secondary sexual characteristics
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Secondary Amenorrhea
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No menses for 6 months in woman who has been menstruating
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Causes of Amenorrhea
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Physiologic-pregnancy, lactation
Pathologic-anatomic, endocrine disorders (hypothalamus, pituitary, ovary, uterus/outflow tract) Neither-pharmacologic |
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Hypothalamic Amenorrhea
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Caused by low GnRH secretion due to:
anorexia nervosa, Kallman's syndrome (congenital GnRH deficiency), female athletic triad |
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Female Athletic Triad
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Disordered Eating
Amenorrhea (from fall in body fat below critical level and intense exercise impacting GnRH secretion) Osteoperosis |
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How to treat Female Athletic Triad?
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Decrease exercise intensity
Increase nutritional intake Decrease risk for osteoperosis (may be irreversible though) and fracture with weight gain, hormones |
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Pituitary causes of amenorrhea
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Prolactinoma-prolactin inhibits GnRH secretion (primary or secondary amenorrhea)
Sheehan's Syndrome (acute necrosis) |
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Ovarian causes of amenorrhea
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Ovarian failure caused by inability to respond to gonadotropins:
Turner's Syndrome (primary or secondary amenorrhea) Injury from chemo, radiation |
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Uterine/Outflow tract causes of amenorrhea?
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Absence or abnormality of uterus, cervix, vagina:
Congenital absence Androgen in sensitivity Imperforate hymen (primary amenorrhea, bulge at introitus) Transverse vaginal septum (primary amenorrhea, no bulge at introitus) |