uterine vessels are contained within
cardinal ligament
gubernaculum in females becomes
round ligament of uterus
products of sertoli cells
inhibin
androgen binding protein
anti mullerian hormone
cells in testicles that make testosterone
leydig cells
spermatogenesis vs spermiogenesis and where they occur
spermatogenesis - production of immature spermatids, occurs in seminiferous tubules
spermiogenesis - maturation of sperm, occurs in epididymis
LH and FSH stimulate what cells in the testes, respectively?
LH - leydig
FSH - sertoli
androgen made in adrenal glands
androstenedione
key enzyme in conversion of androgens to estrogen
aromatase
most potent androgen and enzyme that makes it
DHT, 5alpha reductase
which form of estrogen is an indicator of fetal well being during pregnancy
estriol (made in placenta)
FSH and LH and estrogen production in women - what hormone triggers what process in what cells
LH > stim desmolase in theca cell > convert cholesterol to androstenedione
FSH > stim aromatase in granulosa cell > convert androstenedione to estrogen
tanner stages
1 - child
2 - pubic hair appears, breast buds form
3 - pubic hair darkens and becomes curly; penis size/length inc; breast enlarges
4 - penis width inc; darker scrotal skin; development of glans; raised areolae
5 - adult; areolae no longer raised
estrogen and progesterone roles in endometrial tissue
estrogen stimulates proliferation
progesterone maintains endometrium
Mittelschmerz
blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
at what stage of division are primary oocytes kept until ovulation?
prophase of meiosis 1
at what stage of division are secondary oocytes kept until fertilization?
metaphase of meiosis 2
how long between ovulation, fertilization, and implantation?
fertilization occurs w/in 1 day of ovulation, and implantation occurs 6 d after fertilization
source of hCG
syncytiotrophoblast of placenta
function of hCG in pregnancy
maintains corpus luteum (progesterone source) for first trimester until placenta can make estriol and progesterone
best test to confirm menopause
very high FSH
MCC primary amenorrhea
turner’s syndrome
non-gonadal findings in Turner’s syndrome
shield chest, bicuspid aortic valve, webbed neck, lymphedema in feet/hands, coarctation of aorta, horseshoe kidney, dysgerminoma
causes of female and male pseudo-hermaphrodism
female - excessive exposure to androgenic steroids in early gestation
male - androgen insensitivity syndrome is most common
5 alpha reductase def - inheritance, presentation
AR, only in genetic males
ambiguous genitalia until puberty when inc testosterone causes masculinization
Kallmann syndrome
defective migration of GnRH cells and olfactory bulb > anosmia and GnRH def > hypogonadism
“honeycombed uterus” or “cluster of grapes”
hydatidiform mole
“snowstorm” appearance on sonogram
hydatidiform mole
abruptio placentae
premature detachment of placenta from implantation site, may be assoc w/ DIC. Presents as painful bleeding in 3rd TM. Risk of bleeding out for both fetus and mother
2 etiologies of polyhydramnios
esophageal/duodenal atresia
anencephaly
koilocytes
HPV infected dysplastic cervical cells
“chocolate cysts”
endometriosis
adenomyosis
endometrium inside of myometrium. sx like endometriosis but uterus is enlarged. tx w/ hysterectomy.
MC tumor (across the board) in females
fibroids
incidence and mortality of gynecologic cancers in US
incidence: endometrial > ovarian > cervical
mortality: ovarian > cervical > endometrial
hormone findings in PCOS
inc LH, dec FSH, inc testosterone, inc estrogen
theca-lutein cysts are assoc w/
choriocarcinoma and moles
dermoid cyst on ovary =
mature teratoma
Schiller Duval bodies
yolk sac tumors
struma ovarii
teratoma containing functional thyroid tissue > causes hyperthyroidism
markers for choriocarcinoma and yolk sac tumor
chorio - hCG
yolk sac - AFP
general ovarian CA marker
CA125 (not good for screening!)
“coffee bean” nuclei
Brenner tumor (ovarian)
brenner tumor
ovarian tumor that is benign and unilateral. looks like bladder. “coffee bean” nuclei
Meig’s syndrome
triad of ovarian fibroma, ascites, and hydrothorax
Call Exner bodies
granulosa cell tumor of ovary
Krukenberg tumor
GI malignancy that mets to ovaries, signet cell adenoCA
sarcoma botryoides
variant of rhabdomyosarcoma in vagina of <4 yo girls
MC breast tumor in <35 yo
fibroadenoma
benign breast tumor causing nipple discharge
intraductal papilloma
Phyllodes tumor
benign breast tumor that is large, bulky mass of CT and cysts, leaf-like projections. some may become malignant
most important prognostic factor for breast CA
axillary LN involvement
comedocarcinoma
subtype of ductal carcinoma in situ in breast. features caseous necrosis
MC type of breast CA
invasive ductal
“Peau d’orange”
orange peel skin seen in inflammatory breast CA
drugs causing gynecomastia
Some Drugs Create Awkward Knockers spironolactone digitalis cimetidine alcohol ketoconazole
benign prostatic ____
hyperplasia
which lobe is most likely to get prostate CA?
posterior lobe
MCC scrotal enlargement in adult males
varicocele
what side is varicocele often most of the time?
left
“bag of worms” appearance
varicocele
MC type of and specific testicular tumor
germ cell tumors - seminoma
marker for seminoma
PLAP (placental alk phos)
painful testicular tumor
embyronal carcinoma
tumor containing Reinke crystals
Leydig cell tumors
MC testicular cancer in older men
testicular lymphoma
Peyronie’s dz
bent penis due to acquired fibrous tissue formation
leuprolide - mech, uses
GnRH analog
pulsatile dosing used for infertility, continuous dosing used to suppress gonadal axis
finasteride - mech, use
5alpha reductase inhib
used in BPH and male pattern baldness
flutamide - mech, use
competitive inhib of androgens
prostate CA
ketoconazole - how does it have effects on gonadal axis?
inhibits steroid synth
clomiphene - mech, use
SERM that is partial estrogen agonist at hypothal. > inc release of LH and FSH > stimulates ovulation
used for infertility and PCOS
anastrozole/exemestane - mech/class
aromatase inhibs
mifepristone - mech, use
(RU-486)
competitive inhib of progesterone
termination of pregnancy w/ misoprostol
how OCPs work (3 main mechs)
estrogen and progestins inhib LSH/FH > no estrogen/LH surge > no ovulation
progestins thicken cervical mucus
progestins inhib endometrial proliferation > less suitable for implantation
terbutaline - mech, use
beta 2 agonist that relaxes uterus used to stop premature uterine contractions
tamsulosin - mech, use
alpha 1 antagonist
treats BPH
tox of PDE5 inhibs
HA, flushing, dyspepsia, impaired blue/green color vision
life threatening hypotension if taken w/ nitrates
danazol - mech, use
synthetic androgen, partial agonist
endometriosis and hereditary angioedema