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77 Cards in this Set
- Front
- Back
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what are the impt regulators of the hypothalamic pituitary gonadal axis
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GnRH pulse generator
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how can the relative amts of FSH and LH secreted from the pituitary be altered
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by changing the frequency of the GnRH pulse generator
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a slow GnRH pulse frequency
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leads to more FSH release relative to LH
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a high GnRH pulse frequency leads to
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more LH
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acts of FSH
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incr in LH receptors on follicle
follicular growth |
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actions of LH
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ovulation
progesterone secretion |
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actions of progesterone
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neg feedback on pituitary and hypothalamus
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what is responsible for LH surge
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positive feedback of estrogen on hypothalamus
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what controls GnRH pulse generator
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stress hormone
CRH domaine kisseptin nutrition |
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how many germ cells are in a female fetus
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7 million
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how many germ cells are in a female during menarche
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400,000
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what happens with attrition in turner's syndrome
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it is accelerated
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what happens during mid puberty to GnRH pulse generator
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elevated pulses during sleep and low pattern during day
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hypothalamic amenorrhea can be induced by
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severe stress, exercise
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what is the first sign of puberty
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breast budding (10 yrs old)
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what is the second sign of puberty in girls
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onset of pubic hair due to incr adrenal androgen secretion (adenarchy)
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what is the third sx of female puberty
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growth spurt
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what is the last sign of female puberty
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menarchy
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what are the two phases of the menstural cycle
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follicular
luetal |
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when are estrogen levels and FSH, and LH levels low
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during menstration (onset of new menstral cycle)
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what happens to estrogen during luetal phase
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dcr
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what causes fall of progesterone
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genetically programmed attrition of corpus luteum
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what causes menstration
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the drop in progesterone, and estrogen
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what cause the incr in FSH and LH prior to menstral cycle
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low estrogen
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how can you monitor menstrual cycle
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a biphasic basal body temp (highest in luteal phase)
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if a women b/cms pregnant
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hCG (similar to LH) stimulates corpus luteum and progesterone and estrogen will be secreted
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polycystic ovarian syndrome leads to high estrogen menorrhea
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and the lack of estrogen surge prevents positve feedback leading to LH surge
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the early stages of development of the primordial follicle are
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hormone independnet
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androstenedione is aromatized to
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estrone
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how do you evaluate amenorrhea
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is pt pregnanat
if estrogen is low, is gondatrophin high, indicating ovarian failure? or low indicating hypothalmic failure? if estrogen is high, does she make progesterone? are there uterus or outflow track disorders? are androgens elevated? |
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what are indices of estrogen secretion
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breast development
body fat distribution bone maturation vaginal cell cornification cervical mucus proliferative endometrium withdrawl bleeding after progesterone |
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what are the incdices of progesterone secretion
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incr in basal body temperature
viscous cervical mucus secretory endometrium progesterone greater than 200mg/ml = ovulation |
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what are indices of androgen secretion
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hirsutismn
acne temporal balding *voice deeping *chagnes in body habitus *clitoromegaly **menstrul dysfunction *indicates very high androgen levels ** common in PCOS |
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if testerone levels are high, this means;
if DHEA is high.. |
there is a problem in the ovaries;
there is a problem in the adrenl gland |
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what are the causes of increased androgen secretion
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polycystic ovarian disease
androgen producing tumors of the ovary cushing's adrenal hyperplasia |
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if a pt has PCOD rule out
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cushing with a dex supression test
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what is adrenal hyperplasia
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enzyme abnormalites, esp 21 hydroxylase deficency; cortisol is not made so adrenal androgens build up
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what are classic sx of PCOD
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amenorrhea
dysfunctional bleeding hirsutism infertility obesity |
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what is acanthosis nigricans
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velvety darkening found in creases of the skin;
a sign of insulin resistance |
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what are the biochemical features of PCOD
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high LH:FSH ratio, due to incr in GnRH pulse frequency
incr estrogen incr androgens dcr sex hormone binding globulin insulin resistance |
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what are the characteristics of PCOS
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-estrogen levels are at a positive feedback level, leading to high GnRH pulse frequency
-LH/FSH ratio incr -a lot of androgens are made that are not aromatized -several follicles are made but no dominate follicle since androgens cause atresia and there is low FSH -high fat aromatizes the androgens, continuing positive feeback -in the presence of high androgens, liver makes less SHBG so androgen in blood incr |
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what is insulin's effect on ovary
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incr androgen production
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what is tx for PCOD
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clomiphene (clomid) -- an antiestrogen
acts on hypothalamus to make GnRH think there is less estrogen metformin-- a drug that incr insulin resistance, will dcr androgen secretion and lead to ovulation |
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what are the objectives in tx PCOD
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restoration of fertility
tx of hirsuitism tx of endometrial hyperplasia tx of metabolic syndrome |
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what is hypothalamic amenorrhea
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happens in women with stress and wt loss (leptin maintains GnRH pulses)
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what are the causes of hypothalamic amenorrhea
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diet/wt loss
exercise stress hyperprolactinemia |
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what is a cause of primary amenorrhea
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turner syndrome
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what are characteristics of turner syndrome
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webbed neck
short stature no breast kidney and hrt problems widened carrying angle |
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what is the hallmark of menopause
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incr in LH and FSH
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what are problems associated with estrogen def
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vasomotor sx
genitourinary changes osteoporosis lipid and cardiovascular effects CNS effects |
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what are considerations for estrogen replacement
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clincial sx
osteoporosis breast cancer age/time of menopause presence of cardiovascular disease |
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hormones made by testes
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inhibin-- turns off FSH
testosterone-- turns off Lh and FSH |
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hormones made by ovaries
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estrodiol -- pos and neg feedbak
progesterone -- neg feed back inhibin-- turns off FSH |
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GnRH has receptors for
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sex hormones
glutamate opoids CRH |
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what accounts for positive feedback in females
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estrodiol stimulates kisspeptin which is unique to female
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what happens when GnRH is infused continuously
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LH and FSH release is inhibited
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what is the effect on B-endorphin infusion on LH secretion
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dcr but will incr in response to GnRH
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how does CRH supress LH
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via an endogenous hormone mechanism
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what is the pattern of LH release in males
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hourly pusatile release of LH
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what makes testes determine factor
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gonadal primordium under the influence of the y chromosome'
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what makes antimullerian hormone and what is the effect
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sertoli cell
mullerian duct regression |
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what makes testosterone
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leydig cell
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what derives from the wolffian ducts
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epididymis
vas deferens seminal vesicles under the influence of testossterone |
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what forms under the influence of dihydrotestosterone
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penis
scrotum |
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what happens in male development if there is no 5a reductase
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-scrotum does not descend
-there is a blind vaginal pouch -testis are formed and there are secondary male characteristics |
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what are the levels of plasma testosterone during male development
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1-2nd trimester: high levles
ages 1-10: low post puberty: high old age: small decline |
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what is the pattern of LH secretion during puberty in males
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pulsitle LH release during sleep
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what is the sequence of changes during male puberty
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testes growth
penis growth growth spurt |
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what contributes to the majority of the volume of the testes
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seminiferous tubules
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what makes androgen binding protein
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sertoli cells
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why are high androgen binding proteins necessary for spermatogenesis
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to concentrate testosterone
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what do you ask in a male that is infertile
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do they make sperm
do they make androgen is the testes or pituitary affected |
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what are manifestations of testicular failure
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-small testes
-small penis and prostate -lack of scrotal rugae and pigmentation -eunuchoidal skeletal proportions -delayed bone age -high ptiched voice -female fate distribution -female fat distribution -female escutcheon -dcr facial and body hair -no temporal hair recession -dcr muscle mass -gynecomastia -dcr libido -osteopororosis later in life |
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what are the causes of male hypogonadism
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primary genetic:
klinefelter's androgen resistance enzymatic defects germinal cell aplasia primary acquired infection trauma radiation chemotherpy secondary : hypothalamic disease pituitary disease severe systemic illness |
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which cells are most sensitive to aquired causes of male hypogonadism
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sertoli cells
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why would you give a pt with klinefelter's syndrome a testicular biopsy
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to see if they have any sperm to tx infertility
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why does a pt with androgen insensitivy have high estrogen
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body keeps making testosterone since it cannot sense it
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