Endocrine - Sex Hormones

Question 1

Menstrual Cycle

Answer 1

– energy-costly and inefficient
o Follicular Phase
 FSH induces follicles to start developing  squamous granulosa cells  columnar  multilaminar columnar granulosa cells  fluid-filled antrum
 Dominant (Graffian) follicle secretes more and more estrogen as it grows
 Dominant follicle ruptures during mid-cycle LH sure triggered by mid-cycle positive feedback switch between estrogen and LH
o Uterus – Proliferative Phase – thickening its endometrium; growth of blood vessels
o Luteal Phase
 Corpus luteum is source of estrogen and progesterone
 Progesterone helps maintain the endometrium and other “pro-pregnancy” actions

Question 2

Gonadotrophs through the Ages

Answer 2

o FSH and LH are high in utero and as an infant when the sex organs are developing
o Low levels of FSH and LH as a child until puberty
o Menopause – FSH/LH levels continue to rise to push out last few good eggs
 Weight gain is common due to lack of fat burn during menstrual cycle
 Estrogen and progesterone are low

Question 3

Cervical Cancer

Answer 3

– HPV responsible for almost 100% of cervical cancers
o Sexual activity  HPV  HPV exposure
 Low Risk HPV (6, 11) episomal infection  condyloma
 High Risk HPV (16, 18) viral integration  progress to cancer
• Knock out p53 and retinoblastoma proteins (tumor suppressor proteins)
o Development of Cervical Transformation Zone – where cervical cancer develops
 Metaplastic epithelium – between columnar epithelium and squamous epithelium
o Treatment: HPV vaccine  VIRUS vaccine (NOT CANCER VACCINE)

Question 4

Endometriosis

Answer 4

– endometrial tissue outside of the endometrium
o Potential origins of endometrial material and sites of endometrial implantation
 Endometrial cells can enter the pelvic cavity during retrograde menstruation
 Endometrial cells can spread to distant locations hematogenously (via blood/lymph)
o Treatment: birth control pills  inhibits proliferation of endometrium

Question 5

Leiomyomas

Answer 5

(uterine fibroids) – NOT cancerous; tumors of smooth muscle
o Occur in 30-50% of women; more common in older women
o Can occur anywhere in body
o Symptoms range from asymptomatic to extremely painful
o Treatment: hysterectomy or individual removal of fibroids (preserves birth option)

Question 6

Endometrial Cancer

Answer 6

– tumor fills the endometrial cavity
o Most common cancer of female reproductive tract
o Commonly affects postmenopausal women
o Early clinical sign involves bleeding

Question 7

Salphingitis

Answer 7

– inflammation of fallopian tubes
o Almost always a component of pelvic inflammatory disease – inflammation of either fallopian tube and/or ovary
o Often caused by infection (chlamydia, gonorrhea, tuberculosous) or endometriosis

Question 8

Amenorrhea - Normal Ovarian Hormones

Answer 8

 Pregnancy

 Uterine dysfunction caused by: hysterectomy, uterine adhesions

Question 9

Amenorrhea - Increased Ovarian Hormones

Answer 9

– ovarian dysfunction

 Caused by: feminizing tumors, masculinizing tumors, polycystic ovary syndrome

Question 10

Amenorrhea - Decreased Ovarian Hormones with High Gonadotropin Levels

Answer 10

• Menopause
• Congenital ovarian failure – gonadal dysgenesis; resistance to gonadotropins
• Acquired ovarian failure caused by:
o Autoimmune disease, chemotherapy, resistance to gonadotropins

Question 11

Amenorrhea - Decreased Ovarian Hormones with Low Gonadotropin Levels

Answer 11

• Secondary ovarian failure caused by:
o Hyperprolactinemia – inhibits menstrual cycle
o Intrinsic hypothalamic-pituitary disorders – tumor, head trauma
o Extrinsic hypothalamic-pituitary disorders – starvation/low body fat, psychogenic disturbance (stress), endocrine disease
 10% body fat – abnormal periods; <8% body fat – no periods

Question 12

Polycystic Ovarian Syndrome (PCOS)

Answer 12

o High LH and Low FSH  excess androstenedione (masculinizing hormone)  converted to estrone (in peripheral fat)  further inhibits FSH production
 no FSH production = no estradiol  no positive feedback to trigger LH surge
o Symptoms: irregular/no menstruation, excess androgens, enlarged ovaries with cysts
o Treatments: contraceptives

Question 13

Ovarian Tumors and Cancer

Answer 13

Ovarian Tumors – poor survival rate (lack of symptoms prevents early diagnosis)
o Origin: surface epithelial cells, germ cells (teratoma), stroma, metastasis to ovaries

Ovarian Cancer – large malignant ovarian tumor and metastasis of ovarian cancer
o Can cause mass abdominal distension
o Can spread to peritoneum, colon, omentum, stomach, liver, diaphragm, pleura
o BRCA1 mutation increases risk

Question 14

Teratoma

Answer 14

– arise from germ cells and are rarely malignant
o Differentiation into multiple cell types but without a “plan”
o Has various components of a person (hair, bone, etc.)

Question 15

Ectopic Pregnancy

Answer 15

– implantation outside of body of uterus
o Implantation in fallopian tube is most common
o Ectopic pregnancies do not go to term due to lack of trophic support
o Can destroy the fallopian tube and potentially cause exsanguination

Question 16

Hydatiform Mole

Answer 16

– can progress to cancer; produces lots of hCG
o Complete – all chorionic villi are vesicular; no fetus or embryonic tissue – diploid paternal DNA
o Partial – some chorionic villi are vesicular; deformed fetus present (not viable) – triploid – 3 copies of all chromosomes

Question 17

Pre-eclampsia

Answer 17

o 5-10% of pregnancies due to shallow egg implantation
o Inadequate blood flow/nutrients to fetus – inadequate development of placental spiral arteries
o Hypertension, proteinuria, and edema
o Develops in 3rd trimester – during maximal growth

Question 18

Breast Cancer

Answer 18

o Incidence is increasing but mortality is staying same (~30%)
o BRCA1 mutation have lifetime risk of ~85% compared to ~14% normally

Question 19

Benign Prostatic Hyperplasia

Answer 19

o Condition becomes problematic as prostatic tissue compresses the urethra
o Develops in central zone

Question 20

Carcinoma of Prostate

Answer 20

o Common sites of metastasis: lymph nodes, bones, lungs, liver, adrenals, rectum, urinary bladder
o Often palpable during digital examination of rectum
o Develops in peripheral zone – affects urine flow very late
o More men die WITH prostate cancer than FROM prostate cancer