Lec 21 Reproductive III

Question 1

What is role of leptin in puberty?

Answer 1

increased fat tissue –> increased leptin –> triggers puberty

Question 2

What is role of kisspeptin in puberty?

Answer 2

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

Question 3

What is effect of FSH in puberty?

Answer 3

FSH increases E2 levels

Question 4

What happens in female puberty?

Answer 4

• 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

Question 5

When is normal menarche?

Answer 5

age 12-16 yrs (avg 12.5)

Question 6

When is first day of bleeding in menstrual cycle?

Answer 6

day 1

Question 7

What is follicular phase? How long?

Answer 7

period from onset of menses to ovulation

variable duration avg 14 days

Question 8

What is luteal phase? duration?

Answer 8

period from ovulation to onset of bleeding

constant length of 14 days

Question 9

When is estradiol highest in menstrual cycle?

Answer 9

at time of ovulation

Question 10

When is progesterone highest in menstrual cycle?

Answer 10

after ovulation in luteal phase

Question 11

What happens in follicular phase?

Answer 11

LH stimulates theca cells to produce androgens

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

Question 12

What is effect of LH surge in ovulation?

Answer 12

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

Question 13

What is effect of progesterone rise in ovulation?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

What are clinical signs of ovulation?

Answer 15

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

Question 16

What is most fertile time period?

Answer 16

the 1 or 2 days before ovulation

Question 17

What is role of progesterone in luteal phase?

Answer 17

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

Question 18

What is luteolysis?

Answer 18

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

Question 19

What happens to E2 and P in luteal phase?

Answer 19

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

Question 20

What is PMS?

Answer 20

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

Question 21

What is primary amenorrhea?

Answer 21

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

Question 22

What is secondary amenorrhea?

Answer 22

no menstrual period for > 6 mos

Question 23

What is oligomenorrhea?

Answer 23

infrequent periods; cycle > 35 days

Question 24

What is the main etiology of primary amenorrhea?

Answer 24

pregnancy

Question 25

What is long term treatment for untreated amenorrhea?

Answer 25

osteoporosis from hypoestrogenism

Question 26

What is treatment for hypothalamic amenorrhea?

Answer 26

treat cause; oral contraceptives

Question 27

What is treatment for primary ovarian failure?

Answer 27

oral contraceptives

Question 28

What are the source of androgen in normal female?

Answer 28

- ovary produces small amount of T --> converted to DHT | - ovary/adrenals secrete larger amount of weaker androgens DHEA/androstenedione

Question 29

What is control of ovarian androgens?

Answer 29

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

Question 30

What is control of adrenal androgens?

Answer 30

under ACTH control

Question 31

What happens if increased SHBG?

Answer 31

increase free E2:T ratio | seen in liver disease, thyrotoxicosis

Question 32

What happens if decreased SHBG?

Answer 32

increase free T:E2 ratio | seen in obesit, hypothyroidism

Question 33

What are clinical manifestations of hyperandrogenism in women?

Answer 33

- amenorrhea/oligomenorrhea - mild --> hirsuitism - severe --> virilization

Question 34

What is hirsuitism?

Answer 34

excess hair growth in females in area where not normally found

Question 35

What is virilization?

Answer 35

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

Question 36

What are 2 ovarian causes of hyperandrogenism?

Answer 36

- polycystic ovary syndrome | - androgen producing ovarian tumor

Question 37

What are 3 adrenal causes of hyperandrogenism?

Answer 37

- congenital adrenal hyperplasia - androgen producing adrenal tumors - cushings syndrome

Question 38

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

Answer 38

serum T > 200 or virilization present

Question 39

What are the signs of polycystic ovarian syndrome?

Answer 39

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

Question 40

What are complications associated with polycystic ovarian syndrome?

Answer 40

- obesity - insulin resistance - hyperlipidemia

Question 41

What are treatments for polycystic ovarian syndrome?

Answer 41

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

Question 42

WHat is menopause?

Answer 42

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

Question 43

What is perimenopause?

Answer 43

period immediately before and 1st year after menopause

Question 44

What is etiology of menopause?

Answer 44

follicular depletion

Question 45

What is average age of menopause?

Answer 45

51 yo in USA

Question 46

What happens in perimenopause?

Answer 46

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]

Question 47

What happens ot gonadotropin levels in menopause?

Answer 47

- increase in FSH > LH reflecting lack of inhibin and E2 feedback - low estrogens - low androgens

Question 48

What are signs/symptoms of menopause?

Answer 48

- vasomotor symptoms = hot flashes - atrophic GU tract - skin and hair changes = thinning and wrinkling - loss of REM sleep - mood changes

Question 49

What are longterm complications of menopause?

Answer 49

osteoporosis | CV disease --> increased total cholesterol and LDL; HDL unchanged

Question 50

What are benefits of HRT therapy?

Answer 50

- symptom relief - decrease bone loss - better lipids (higher HDL, lower LDL)

Question 51

What are risks of HRT therapy?

Answer 51

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