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20 Cards in this Set

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