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34 Cards in this Set
- Front
- Back
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What are follicular cysts, corpus luteum cysts, and PCOS each due to?
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Follicular cyst: due to excessive LH & FSH. CL cyst due to insufficienlty strong LH peak. PCOS due to excess inhibin.
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Growth of follicles is under the control of __. Ovulation & formation of the corpus luteum are under control of __. Ovarian cysts are problems of __ & __.
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FSH; LH; FSH & LH
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A __ cyst is a follicle that persists and grows beyond ovulation. A __ cyst is a corpus luteum that refuses to collapse into a __ __.
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Follicular cyst; Corpus luteum; corpus albicans
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Describe the pathophys of a follicular cyst.
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Normally, 1 follicle becomes dominant (Graafian follicle) & the remainder undergo atresia. If follicle is overstim'd by too much FSH & LH, it becomes too thick to be ovulated by LH promoted proteases (~1"). It can then grow as lg as a baseball & persist for 60d.
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What will eventually happen to a follicular cyst?
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It will break.
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What happens to menses w/ a follicular cyst? Why?
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Menses is very delayed bcs no corpus luteum was formed & therefore no progesterone produced.
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In the case of a follicular cyst, describe what happens to ovulation, progesterone, LH & FSH levels
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No ovulation, No progesterone, Very high LH & FSH levels
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Explain the endocrinology of a follicular cyst
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Overdoses of pulses of GnRH or failure of GnRH nn to be regulated by E2 & P feedback results in excessive LH & FSH. Inhibin isn't being produced in the luteal phase (bcs no CL), so it can't feedback to the pituitary to shut off FSH.
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Describe the pathogenesis of a Corpus Luteum cyst.
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Ovulation & formation of the corpus luteum is under control of LH. If LH surge is lg enough to allow ovulation but not proper differentiatn of theca & granulosa cells or CL formation, a cyst will form. CL fills w/ blood p ovulation, but can't diff or collapse into a corpus albicans. Can grow as lg as a baseball.
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What happens to menses with a corpus luteum cyst?
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It is blocked or delayed; Can cause amenorrhea
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In the case of a corpus luteum cyst, describe what happens to ovulation, progesterone, LH & FSH levels
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Ovulation occurs, Progesterone is produced, FSH & LH remain normal in follicular phase, LH peak is poor
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What is the most common cause of female infertility and of hirsuitism?
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PCOS
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What is the pathogenesis of PCOS?
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>2x inhibin in foll phase feeds back & limits pituitary FSH early. Limited FSH prevents dom follicle from being selected & several small follicles persist. Follicles are still being acted on by LH (bcs inhibin doesn't limit it). LH & inhibin promote androstenedione prodxn by theca cells, but there is limited FSH-stim'd estrogen prodxn by gran cells, leading to insuff estrogen to promote LH peak, so no ovulation. Multiple foll's continue to grow under LH influence.
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The result of PCOS is excess __/__ & thus __. The lack of ovulation leads to failure of __ or menstrual __.
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Androstenedione/Androgen; hirsuitism; progesterone; decidualization
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In endocrinology of PCOS, w/o FSH, __ in the granulosa cells can't turn testosterone into __, resulting in lack of feedback by __ to turn off __. This backs up the pathways & lots of __ & __ are released. Lots of follicles in foll phase = lots of gran cells. Gran cells in foll phase produce __, so there is too much __, which feeds back to turn off __.
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Aromatase; Estradiol; granulosa; GnRH; androstenedione & testosterone; Inhibin; inhibin; FSH
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What is a complete hydatidiform mole?
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Pregnancy comprising only placenta or trophoblast cells
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What is the epidemiology of complete hydatidiform moles?
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1 in 900 pregnancies, with rates higher (up to 1/100) in areas where pregnancy occurs at v young ages
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What is the nl hCG in a 10w pregnancy? What is it in a 10w hydatidiform mole?
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May peak at 100,000 nlly. In molar pregnancy, 1,000,000 bcs complete pregnancy is placenta, which produces hCG.
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What is the pathophys of a complete hydatidiform mole?
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LH promotes 1st meiotic division in ovary, so an inappropriate LH rise will not promote meiosis. If there's enough LH for ovulation, you will ovulate an ovum w/o genetic material. 2 sperm penetrate & combine, resulting in a diploide XX or XY lifeform of dispermic diandrogenous origin. Can get to morula, but not blastocyst stage bcs no inner cell mass.
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What is the tx for a complete hydatidiform mole?
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It will eventually spontaneously abort or can be removed by a D&C. Bcs the trophoblast is invasive by nature, ~40% of cases require hysterectomy or chemo to remove all tissue or stop tissue invading after evacuation of the mole.
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What is the risk of Down's Syndrome?
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1/830. If >35yo, 1/220
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What is the risk of abortion with amniocentesis?
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~1/220
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When & how is Down's Syndrome screened for? What is the principle test? What does a positive result indicate?
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2nd trimester; Triple Screen test: hCG (principal) + alpha-FP + estriol. (+) result is indicator of high risk (~1/90)
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Why is hCG the principal test to screen for Down's Syndrome?
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There is restricted differentiation of trophoblast cells in Down's, with a buildup of intermediate syncytioTB cells, the optimal hCG producing cells. This leads to a 2-fold increase in hCG in the 2nd trimester in DS cases.
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What is the cause of gestational diabetes?
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Hyperglycemia due to hPL & estrogens, which raise maternal BGL in pregnancy to provide glc to the fetus for anabolism & growth.
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What is the rate of gestational diabetes?
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1/30. It is one of the top health concerns in pregnancy
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What happens if gestational diabetes isn't treated?
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Respiratory distress syndrome, preeclampsia, future DM for mother & child
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How is gestational diabetes treated?
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Dietary changes & exercise. Extreme cases may require daily insulin.
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2nd or 3rd trimester, HTN, proteinuria
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Preeclampsia
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Leading cause internationally of maternal & infant illness & death; 8% of all pregnancies
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Preeclampsia
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What causes preeclampsia?
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Failed or ineffective 2nd implantation. This is necessary to give the vascular supply needed for development. W/o effective 2nd implantation, poor nutrition & anorexia occur, leading to preeclampsia.
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What is precocious puberty?
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Signs of puberty before normal age. Ex: breast budding or pubic hair development in a 4yo girl.
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What is the cause of precocious puberty?
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Fat kids. Fat tissue increases leptin, which removes the NPY block from GnRH pulsation, resulting in FSH & LH release, etc.
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What does precocious puberty result in in the adult? Why?
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Shorter height. When puberty starts early it ends early, so growth stops at an earlier age than nl. Initial growth spurt may make them tall compared w/ peers, but they stop growing too soon.
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