206/207 - Endocrine Control of Female Reproduction I & II Flashcards Preview

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Flashcards in 206/207 - Endocrine Control of Female Reproduction I & II Deck (40)
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1

When during the menstrual cycle does progesterone peak?

7 days after ovulation

(When the corpus luteum is chugging along making progesterone)

2

How will levels of the following hormones change in ovarian failure?

  • Estradiol:
  • LH/FSH: 

  • Estradiol: low
  • LH/FSH: high

 

Vs. hypothalamic amenorrhea, will have low estradiol AND low LH/FSH

3

Which ovarian cells aromatize androgen to estrogen?

Which gonadotropin stimulates the development of these cells?

Granulosa cells

FSH

 

4

How will levels of the following hormones change in hypothalamic amenorrhea?

  • Estradiol:
  • LH/FSH: 

  • Estradiol: low
  • LH/FSH: low

 

Vs. ovarian failure, will have low estradiol and HIGH LH/FSH

5

How is PCOS diagnosed?

Requires 2/3 of:

  • Oligo and/or anovulation
  • Signs of hyperandrogenism
  • Ultrasound with ≥12 2-9 mm follicles in each ovary OR increased ovarian volume
    • The immature follicles look like cysts

 

Note: criteria has historically been 12 follicles, but I think she mentioned that now with improved imaging techniques we can see follicles better so we may actually see a lot more, and if someone has 12 follicles but no sx of PCOS probably do not need to diangose

 

 

6

List the phase of follicular development and predominant hormone that loosly aligns with the following phases of the endometrial cycle:

  • Menses:
  • Proliferative phase:
  • Transition between proliferative and secretory:
  • Secretory phase

 

  • Menses
    • Follicular phase
    • Low estradiol and progesterone
  • Proliferative phase:
    • Follicular phase
    • High estrogen
  • Transition between proliferative and secretory:
    • Ovulation 
    • High estrogen, progesterone beginning to rise
  • Secretory phase
    • Luteal phase
    • High progesterone, estrogen falls

 

 

7

List 3 things that increase levels of sex hormone binding globulin

  • Hyperthyroidism
  • Pregnancy
  • Estrogen treatment (OCPs)

 

All will decrease the effect of sex hormones; bound to SHBG = not biologically active

8

Which gonadotropin supports the corpus luteum?

Which hormone is produced as a result?

LH

Progesterone

 

Corpus luteum produces progesterone

Note: LH also stimulates theca cells to produce androgens

9

Which ovarian cells secrete androgens?

Which gonadotropin stimulates these cells?

Theca cells

LH

10

Which hormone supports early pregnancy?

Progesterone from the corpus luteum

11

 [hormone]  stimulates proliferation of the uterine lining

 [hormone]  stimulates differentiation of the uterine lining

 Estrogen  stimulates proliferation of the uterine lining

 Progesterone  stimulates differentiation of the uterine lining

12

After ovulation, what happens to the granulosa cells and theca cells that are left in the follicle?

They re-organize to become luteal cells

  • Angiogenesis! Blood supply needed for delivery of cholesterol precursors for steroid synthesis
  • More smooth ER and mito!

This forms the corpus luteum -> progesterone production

 

 

13

List 2 causes of gonadal dysgenesis

Turner syndrome (45, XO)

Fragile X carrier

Swyer syndrome (46XY)

 

Thank you @Ben Gastevich!

14

Describe the positive feedback loop that triggers ovulation

  • Sustained high estrogen + progesterone bump
    • Beginning of progesterone rise increases the pituitary response
  • -> LH surge
    • Normally, LH is inhibited by increased estrogen/progesterone
  • -> Ovulation!

 

 

15

How does hypothyroidism affect menstruation?

(Describe the pathway)

Hypothyroidism = low thyroid horomone

  • -> Upregualted TRH secretion from hypothalamus
  • -> High TRH increases TSH and prolactin secretion
  • Prolactin inhibits GnRH pulses
  • -> No FSH/LH
  • -> No ovulation
  • -> No menstrual cycles 

 

16

What is the most common cause of secondary amenorrhea?

Pregnancy

 

Secondary amenorrhea = used to have normal menstruation, but it stopped

17

Before treating a patient with PCOS, what diagnostic evaluation must be done?

Rule out other causes of high androgens

  • Very high testosterone => Testosterone-secreting tumor
  • High DHEAs => adrenal source
  • High 17-OH-progesterone => Congenital adrenal hyperplasia
  • Elevated free cortisol in urine => Cushing syndrome

 

18

How is hypothalamic amenorrhea treated?

  • To relieve symptoms (ex: low bone mineral density)
    • Hormone replacement
  • To induce fertility
    • Injectable gonadotropins
    • Pulsatile GnRH

Also, behavioral therapy

 

Note: Leptin is NOT currently a therapeutic option

19

Which gonadotropins are favored by the following GnRH secretion patterns?

  • High frequency:
  • Low frequency:
  • Continuous:

  • High frequency: LH secretion
  • Low frequency: FSH secretion
  • Continuous: No secretion
    • Desensitization inhibits both LH and FSH 

 

20

Why is it important to treat patients with PCOS, even if they don't want to become pregnant and are unbothered by hirsutism and/or acne?

PCOS = unopposed estrogen

-> incresed risk of endometrial cancer

 

  • Must induce ovulation (or theoretically give periodic progesterone?) to protect the endometrium

21

Will people with PCOS have a positve or negative progestin challenge?

Positive

  • Estrogen is present, but abnromalities in hormone signaling prevent progesterone production, LH surge

 

22

Which hormone suppresses prolactin?

Dopamine

  • Dopamine tonically inhibits prolactin release

 

Decreased dopamine -> increased prolactin

23

What does a positive progestin challenge imply about the cause of a patient's secondary amenorreha?

Implies normal outflow tract, adequate estrogen

=> Cause of amenorreha is not enough progesterone to induce ovulation

 

Progestin challenge mimics little rise in progesterone before ovulation

24

How is menopause diagnosed?

(lab test, assuming consistent clinical picture)

High FSH 

  • Due to lack of inhibin, lack of estrogen negative feedback

25

List 2 causes of hypothalamic amenorreha

  • Genetic defect: Kallman syndrome
    • GnRH neurons fail to igrate
    • -> Primary amenorrhea
       
  • Functional hypothalamic amenorrhea
    • May cause primary or secondary amenorrhea
    • Usually associated with increased stress
      (Nutritional, environmental, behavioral)

 

26

Why are estrogen-progestin challenges rarely done?

We can pretty easily measure estrogen levels in the blood

 

If normal and no bleed after progestin challenge, implies abnormal outflow tract

27

How does prolactin affect ovulation?

How is this adaptive (evolutionarily)?

Prolactin inhibits ovulation

  • Prolactin suppresses GnRH pulses
  • -> No LH/FSH
  • -> No positive feedback loop from estrogen
  • -> No ovulation 

 

Prolactin triggers lactation - adaptive to not be able to have another bably while breastfeeding a new one

28

What causes polyglandular autoimmune disease?

 

Auto-antibodies to endocrine organs

Can target ovaries -> premature ovarian failure

29

What is the most common cause of anovulation in teh setting of normal estrogen?

PCOS

 

  • Ovary is "stuck" in the follicular phase
  • Theca cells are making andorgens, but granulosa cannot keep up with aromatization
    • High estrogen AND androgens, but androgens interfere with signaling
    • Cannot select dominant follicle 

 

 

30

What defines menopause?

1 year has gone by since last menstrual period

 

Technically it's the last menstrual period, but hard to know if it *really* is the last one until a year has gone by