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46 Cards in this Set
- Front
- Back
What hormones are pulsatile and therefore must be measured at specific times?
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Melatonin
ACTH Corisol |
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What nucleus secretes GnRH into the pituitary portal circulation?
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Arcuate nucleus
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What hormone is required for normal pituitary function?
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Pulsatile GnRH
-pulse frequency is slowed by progesterones and androgens, slow frequency favors FSH release -pulse amplitude is reduced by estrogens |
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What ovarian follicle cells have FSH receptors?
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Granulosa cells
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What ovarian follicle cells have LH receptors?
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Theca cells
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What are the structural similarites and differences of FSH and LH?
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Both hormones share alpha-subunits.
Functional specificity is conferred by beta-subunits |
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What is the effect of low-level estrogen on gonadotropin release from the pituitary?
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Favors gonadotropin release, predominantly FSH
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What is the effect of rising/high estrogen levels on gonadotropin release from the pituitary?
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Inhibits gonadotropin release, facilitates storage
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What is the effect of high estrogen with rising progesterone levels on gonadotropin release from the pituitary?
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facilitates mid-cycle gonadotropin surge
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What is the effect of high-level progesterone on gonadotropin release from the pituitary?
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inhibits LH release during luteal phase
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What is the role of LH during the follicular phase?
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activates Theca cells to produce androgens
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What is the role of FSH during the follicular phase?
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acts on Granulosa cells to:
-induce LH receptors -induce FSH receptors -mitosis -activation of aromatase enzyme system |
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Rising estrogen levels during the follicular phase have two effects.
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1. Negative feedback
2. Proliferation of the endometrium |
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What are the levels of estrogen and progesterone in the early Luteal phase? What effect does this have?
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Estrogen and progesterone are both at high levels.
The high levels provide endometrial changes in preparation for implantation. |
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Reproductive Endocrine Disorders (4)
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1. Menstrual disorders
2. Hyperandrogenic disorders 3. Hyperprolactinemic disorders 4. Infertility |
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Classification of Amenorrhea.
What is the differentiation based upon? |
FSH level
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Hypergonadotropic Primary Amenorrhea
causes (3) |
1. Prepubertal surgical ablation, infection, chemotherapy
2. Gonadal dysgenesis (Turner syndrome) 3. Androgen Insensitivity Syndrome |
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Turner Syndrome
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(45,X) genotype or mosaic variants
Elevated FSH and LH Gonadal dysgenesis due to accelerated postnatal follicular atresia. Multiple somatic abnormalities, infantile female genitalia. Nonfunctional ovaries, absent secondary sexual characteristics. |
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Androgen Insensitvity Syndrome
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(46,XY) with androgen receptor defect
Female external genitalia (failed masculinization) without female internal genitalia Gonadectomy after puberty to elimnate risk of tumor Hypergonadotropic Primary Amenorrhea |
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Eugonadotropic and Hypogonadotropic primary amenorrhea
-distinguish between endocrine vs. anatomical disorder |
Differentiate by presence of secondary sexual characteristics
-presence indicates anatomical cause (hormones are working) -absence indicates hypothalamic-pituitary cause |
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Steroid Challenge Tests
-progestin challenge |
Administer sufficient dose to cause secretory endometrial change, then withdraw.
Bleeding implies estrogen primed endometrium and confirms patent outflow tract |
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Steroid Challenge Tests
-estrogen-progestin challenge |
Administer sequential estrogen then progestin to cause endometrial proliferation then secretory change, then withdraw
Bleeding confims patent outflow tract |
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Eugonadotropic/Hypogonadotropic primary amenorrhea without normal sexual characteristics
-functional and organic causes |
Ovaries are presumed functional since FSH is not elevated
Functional causes: stress, extreme weight changes, excessive exercise, familial delay, systemic illnes Organic causes: craniopharyngioma, pituitary tumor, CNS infection, CNS inflammation, congenital (Kallman) - neurons dont migrate |
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Hypergonadotropic Secondary Amenorrhea
-main cause |
Acquired ovarian failure
-autoimmune, chemo, infection, incomplete gonadal dysgenesis -repetitive FSH > 45 with low Estrogen |
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Eugonadotropic/ Hypogonadotropic secondary amenorrhea
-causes (2) |
1. Acquired mullerian disorder (may present with progressive hypomenorrhea and dysmenorrhea before amenorrhea)
2. Dysfunction/failure of hypothalamic - pituitary center Differentiate via progestin/ estrogen-progestin challenge |
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Eugonaodotropic/Hypogonadotropic secondary amenorrhea
-Endocrine disorder -causes (4) |
Problems with GnRH secretion, action or response by pituitary gonadotropes.
Degree of abnormality reflected by basal FSH 1. Stress, systemic illness 2. Weight changes 3. Exercise 4. Pituitary tumor, infection, infiltration |
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Menstrual Disorders
-differentiation between causes (2) |
Differentiate organic causes of abnormal uterine bleeding from endocrine causes
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Dysfunctional Uterine Bleeding
-cause |
ALWAYS implies an endocrine cause
Endometrium is responding normally to abnormal endocrine signals -Estrogen/Progesterone withdrawl -Estrogen/Progesterone breakthrough |
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Hyperandrogenic Disorders
-sources of androgens (3) |
1. Ovary
2. Adrenal 3. Peripheral interconversion |
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Hyperandrogenic Disorders
-clinically significant androgens (3) |
1. Testosterone - most potent
2. DHEAS - most specific (adrenal secretion) 3. 17-dihydroxyprogesterone |
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Hyperandrogenic Disorders
-clinical manifestations(3) |
1. Hirsutism, skin changes
2. Menstrual abnormalitites 3. Insulin resistance |
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Hirsutism
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Irreversible conversion of vellus to terminal hair in a male distribution pattern
Increase androgen action at the hair follicle Progression of hyperandrogenic signs and symptoms -menstrual irregularity, skin changes -hirsutism -defeminization and masculinization |
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Adrenal Hyperandrogenism
-causes (4) |
1. DHEAS and other androgens elevated
2. Adrenocortical carcinoma 3. Cushing's Syndrome or Disease 4. Congenital Adrenal Hyperplasias -late onset exceedingly common (21-hydoxylase deficiency most common) |
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Congenital Adrenal Hyperplasia
-pathogenesis -symptoms -treatment |
Deficient glucocorticoid production upregulates ACTH, w/overproduction of androgenic intermediates
Androgen elevation leads to hirsutism, acne, menstrual irregularity Salt wasting or retention w/HTN Diagnose with ACTH stimulation test Treat with exogenous glucocorticoid |
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Ovarian Hyperandrogenism - Neoplasms
-cell-types -presentation of syptoms -diagnosis |
Granulosa cell, Hilar cell and Sertoli-Leydig cell (rare)
Testosterone elevations are significant and rapidly progessive, leading to significant signs and symptoms in a short time Diagnose with ultrasound/MRI, failure to supress using GnRH analogs |
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Polycystic Ovary Disease
-pathogenesis |
Overstimulation of theca with insuffcient aromatase activity to convert A --> E
Abnormal FSH/LH secretion maintained by hyperandrogenic state Chronic anovulation, hyperandrogenism, variable estrogens Insulin-resistence associated with dyslipidemias, atherogenesis and DM |
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Polycystic Ovary Disease
-Rotterdam Criteria |
At least two of the following:
-Menstural irregularity -- oligo/amonorrhea -Hyperandrogenism and/or hyperandrogenemia -Sonographic evidence of follicular atresia (cysts) and/or stromal hyperplasia |
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Polycystic Ovary Disease
-clinical presentation (5) |
1. Menstrual irregularity, possible endometrial hyperplasia, early endometrial adenocarcinoma
2. Central obesity 3. Enlarged, polycystic ovaries 4. Hyperandrogenic manifestations - hirsutism, acanthosis nigracans 5. Insulin resistance - metabolic syndrome |
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Polycystic Ovary Disease
-treatment (4) |
1. Lifestyle modification
2. Exogenously cycle enometrium (birth control) 3. Insulin sensitizing agents 4. Ovulation induction |
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Prolactin
-what tonically inhibits it? |
Dopamine
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Galactorrhea
-definition -causes |
Bilateral inappropriately timed lactation
Unilateral discharge or any other discharge requires investigation for breat pathology Hyperprolactinemia Frequently associated with ovulatory dysfunction and resulting menstrual disorders |
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Hyperprolactinemia
-causes (6) |
1. Nipple stimulation
2. Chest wall trauma 3. Chronic herpes zoster 4. Drugs that alter dopaminergic tone 5. Primary hyperthyroidism -TSH stimulates PRL release 6. Pituitary adenoma |
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Hyperprolactinemia
-evalutation -treatment |
Confirm hyperprolactinemia
Exclude primary hyperthyroidism or other causes Sellar imaging for adenoma Treat with dopamine agonists or surgery (rare) |
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Infertility
-definition |
One year of regular, unprotected intercourse without conception (10-12% incidence in couples trying to conceive)
Fertility declines in women with advancing age (not true with men until much later in life) |
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Infertility
-Male factors (40% of couples) (4) |
1. Hypothalamic-pituitary
2. Testicular - environment/viral/varicocele 3. Obstructive - vasectomy/infection 4. Ejaculatory - retrograde ejaculation in diabetes, autonomic dysfunction |
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Infertility
-Female factors (3) |
1. Ovulatory dysfunction or failure
2. Female reproductive tract abnormalities -Cervical -Uterine: polyps, fibroids -Fallopian tube: blockage, adhesions -Peritoneal: endometriosis, adhesions 3. Immunologic |