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endocrine > Lec 21 Reproductive III > Flashcards

Lec 21 Reproductive III Flashcards

1
Q

What is role of leptin in puberty?

A

increased fat tissue –> increased leptin –> triggers puberty

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2
Q

What is role of kisspeptin in puberty?

A

agonist for GPR54 receptor in brain; may initiate pulsatile GnRH secretion

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3
Q

What is effect of FSH in puberty?

A

FSH increases E2 levels

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4
Q

What happens in female puberty?

A
  • growth spurt [androgens and E2] before menarche
  • breast budding stimulated by ovarian E2
  • pubic hair stimulated by adrenal and ovarian androgens
  • uterus elongates and ovaries enlarge
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5
Q

When is normal menarche?

A

age 12-16 yrs (avg 12.5)

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6
Q

When is first day of bleeding in menstrual cycle?

A

day 1

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7
Q

What is follicular phase? How long?

A

period from onset of menses to ovulation

variable duration avg 14 days

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8
Q

What is luteal phase? duration?

A

period from ovulation to onset of bleeding

constant length of 14 days

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9
Q

When is estradiol highest in menstrual cycle?

A

at time of ovulation

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10
Q

When is progesterone highest in menstrual cycle?

A

after ovulation in luteal phase

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11
Q

What happens in follicular phase?

A

LH stimulates theca cells to produce androgens

androgens diffuse to granulosa cells and serve as substrate for E2 production

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12
Q

What is effect of LH surge in ovulation?

A
  • stimulates completion of meiosis
  • stimulates luteinization of granulosa cells
  • stimulates progesterone production by corpus luteum
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13
Q

What is effect of progesterone rise in ovulation?

A
  • causes synthesis of prostglandins in follicel necessary for ovulation
  • enhances production of proteolytic enzymes for digestion and rupture of follicular wall
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14
Q

What is effect of FSH mid cycle surge prior to ovulation?

A
  • induces production of plasmin
  • frees oocytes from the follicle wall
  • increases expression of LH receptors
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15
Q

What are clinical signs of ovulation?

A
  • mittelschmerz [main from follicle rupture]
  • ferning of cervical mucus
  • increased spinnbarekit
  • rise in basal body temp
  • increased libido
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16
Q

What is most fertile time period?

A

the 1 or 2 days before ovulation

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17
Q

What is role of progesterone in luteal phase?

A

secreted by corpus luteum
corpus luteum is maintained by LH (hCG in pregnancy)
promotes secretory endometrium, edema, angiogenesis

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18
Q

What is luteolysis?

A

apoptosis of corpus luteum in luteal phase –> leads to progresterone decrease

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19
Q

What happens to E2 and P in luteal phase?

A

abrupt decrease in E2/P
local secretion of prostaglandins –> vasospasm and ischemic necrosis –> menstrual bleeding
prostaglandins induce uterine contractions

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20
Q

What is PMS?

A

complex of symptoms at end of luteal phase only in ovulating women; remission within 3 days after onset of menses

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21
Q

What is primary amenorrhea?

A

absence of menses by age 16 or no menses and no development of secondary sex characteristics by age 14

22
Q

What is secondary amenorrhea?

A

no menstrual period for > 6 mos

23
Q

What is oligomenorrhea?

A

infrequent periods; cycle > 35 days

24
Q

What is the main etiology of primary amenorrhea?

A

pregnancy

25
Q

What is long term treatment for untreated amenorrhea?

A

osteoporosis from hypoestrogenism

26
Q

What is treatment for hypothalamic amenorrhea?

A

treat cause; oral contraceptives

27
Q

What is treatment for primary ovarian failure?

A

oral contraceptives

28
Q

What are the source of androgen in normal female?

A
  • ovary produces small amount of T –> converted to DHT

- ovary/adrenals secrete larger amount of weaker androgens DHEA/androstenedione

29
Q

What is control of ovarian androgens?

A

LH control –> produced by theca cells as pre-hormone for estrogens

30
Q

What is control of adrenal androgens?

A

under ACTH control

31
Q

What happens if increased SHBG?

A

increase free E2:T ratio

seen in liver disease, thyrotoxicosis

32
Q

What happens if decreased SHBG?

A

increase free T:E2 ratio

seen in obesit, hypothyroidism

33
Q

What are clinical manifestations of hyperandrogenism in women?

A
  • amenorrhea/oligomenorrhea
  • mild –> hirsuitism
  • severe –> virilization
34
Q

What is hirsuitism?

A

excess hair growth in females in area where not normally found

35
Q

What is virilization?

A

hirsuitism + masculinization
usually associated wtih testosterone > 150 ng/dl
have temporal balding, increased muscle mass, deepening of voice, clitoromegaly

36
Q

What are 2 ovarian causes of hyperandrogenism?

A
  • polycystic ovary syndrome

- androgen producing ovarian tumor

37
Q

What are 3 adrenal causes of hyperandrogenism?

A
  • congenital adrenal hyperplasia
  • androgen producing adrenal tumors
  • cushings syndrome
38
Q

When do you need to rule out tumor as cause of hyperandrogenism?

A

serum T > 200 or virilization present

39
Q

What are the signs of polycystic ovarian syndrome?

A

oligomenorrhea/amenorrhea
signs of hyperandrogenism
multiple cysts on ovary ultrasound
LH:FSH ratio > 2

40
Q

What are complications associated with polycystic ovarian syndrome?

A
  • obesity
  • insulin resistance
  • hyperlipidemia
41
Q

What are treatments for polycystic ovarian syndrome?

A
  • oral contraceptive agents and anti-androgens [aldactone]
  • if pregnancy desired: ovulation induction via clomiphene citrate
  • if insulin resistance: metformin
42
Q

WHat is menopause?

A

last episode of menstrual bleeding induced by cyclic endogenous secretion of ovarian hormones

43
Q

What is perimenopause?

A

period immediately before and 1st year after menopause

44
Q

What is etiology of menopause?

A

follicular depletion

45
Q

What is average age of menopause?

A

51 yo in USA

46
Q

What happens in perimenopause?

A

anovulatory cycles –> decreased progesterone –> unopposed estrogen –> endometrial hyperplasia and breakthrough bleeding

estrogen levels fluctuate leading to intermittent hypoestrogenic symptoms [hot flashes, mood changes, vaginal dryness]

47
Q

What happens ot gonadotropin levels in menopause?

A
  • increase in FSH > LH reflecting lack of inhibin and E2 feedback
  • low estrogens
  • low androgens
48
Q

What are signs/symptoms of menopause?

A
  • vasomotor symptoms = hot flashes
  • atrophic GU tract
  • skin and hair changes = thinning and wrinkling
  • loss of REM sleep
  • mood changes
49
Q

What are longterm complications of menopause?

A

osteoporosis

CV disease –> increased total cholesterol and LDL; HDL unchanged

50
Q

What are benefits of HRT therapy?

A
  • symptom relief
  • decrease bone loss
  • better lipids (higher HDL, lower LDL)
51
Q

What are risks of HRT therapy?

A

endometrial hyperplasia/cancer [can be prevented if combined with progestins

endocrine (21 decks)

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