Clinical Notes Flashcards
What role does progesterone play in pregnancy?
Lecture: Steroid biosynthesis Correlation box p.247
- Supports gestation (pregnancy) & embryogenesis
- Is involved in the maintenance of the menstrual cycle.
- Regulates the voltage gated calcium channels on spermatozoa
- Prepares the uterus for implantation
- Causes smooth muscle relaxation
- Decreases maternal immune response
A decrease in progesterone precedes menstruation, labor & lactation
What is the correlation between glucocorticoids and infant respiratory distress syndrome (IRDS)
Lecture: Steroid biosynthesis Correlation box p.247
During delivery, a burst of glucocorticoids alters the lung structure in infants by stimulating the production of surfacants, which allows the air spaces to expand. In preterm neonates this process is defective, leading to IRDS. It can be prevented by giving glucocorticoids to expectant mothers.
How can licorice cause hypertension
Lecture: Steroid biosynthesis Correlation box p.247
Natural licorice roots contain isoflavones which are inhibitors of 11B-dehydrogeanse. This can cause hypertension due to salt retention.
What has Finasteride been used for?
Lecture: Steroid biosynthesis Correlation box p.247
- Treat benign prostatic hyperplasia
- Male pattern baldness (caused by accumulation of DHT in the scalp)
What is adrenal hyperplasia?
Lecture: Steroid Biosynthesis
Caused by deficiencies in the adrenal enzymes that are used to synthesize glucocorticoids which leads to the increased production of cortisol precurors and androgens from the adrenal gland
How can women present with adrenal hyperplasia?
Lecture: Steroid Biosynthesis
- Hirsutism (excess body hair)
- General oligomenorrhea (infrequent or light periods)
- Infertility
What is Primary Aldosteronism/Conn Syndrome
Lecture: Steroid Biosynthesis
Adrenal glands produces excessive levels of aldosterone which causes a loss of potassium and retention of sodium leading to hypertension:
- Body holds on to too much water
- Increases blood volume
- Increases blood pressure
What are some disorders associated with vitamin D
Lecture: Steroid biosynthesis Correlation box p.10
Insufficient Vitamin D
- Brittle bones (rickets) in children
- Osteomalacia in adults
- Hypocalcemic tetany (involuntary muscle contraction)
Excess Vitamin D
- Elevated calcium in blood and urine
- Appear dazed
- Loss of apetite
- Sarcoidosis
What is hypospadias
A common male birth defect that is a result of the failure of the urogenital (urethral) folds to close properly
Lecture: Development of the Reproductive System
What is Epispadias
Opening of the urethra on the superior aspect of the penis. Cause is unknown but may be due to improper ventral body closure or formation of too large of a cloacal membrane to be covered when it ruptures
Lecture: Development of the Reproductive System
What is didelphys
Double uterus
Lecture: Development of the Reproductive System
What is it called when an individual has testes but their phenotype appears female
46, XY DSDs
Lecture: Development of the Reproductive System
What are some causes of 46, XY DSDs
- Inadequate testosterone synthesis
- Androgen insensitivity syndrome
- 5 alpha-reductase deficiency
- Mutation in AMH or AMH receptor
* Lecture: Development of the Reproductive System*
What are the characteristics of androgen insensitvity syndrome
- Common cause is loss of functional androgen receptors (X linked recessive)
- They have testes but no spermatogensis. Testosterone levels may be high due to a lack of negative feedback.
- At puberty, the testosterone is metabolized to estradiol initiating female secondary sexual characteristics
- Produce AMH so paramesonephric system is supressed = no uterus or uterine tube and the vagina is short and ends blindly.
- Testes usually found in inguinal or labial regions
- Increased risk of tumor formation in gonads
* Lecture: Development of the Reproductive System*
What are the characteristics of 5- alpha-reducatse deficiency
- Autosomal recessive
- Have a 46 XY genotype
- Normal testis and duct system since there is AMH and testosterone
- Underdeveloped male external genitalia due to deficieny in DHT
- Lecture: Development of the Reproductive System*
What are the characteristics of 46 XX DSDs
- Presence of ovaries
- Fetus produces excess androgens
- Maculinzation of the female external genitalia; may even exhibit fusion of labia giving appearance of a scrotum.
- Most common cause is congenital adrenal hyperplasia
- Lecture: Development of the Reproductive System*
How does Congenital adrenal hyperplasia cause of 46 XX DSDs?
Deficiency in 21-hydroxylase leads to excess ACTH production (lack of negative feedback). Excess ACTH causes adrenal hyperplasia and excessive production of androgens.
Lecture: Development of the Reproductive System
What is male hypogonadism
A condition in which the body doesn’t produce enough of the hormone that plays a key role in masculine growth and development during puberty (testosterone) or enough sperm or both
Lecture: Male Reproductive Physiology
Distinguish between primary and secondary hypogonadism
Primary: Decreased T, Increased LH
Secondary: Decreased T & Decreased or normal LH
Lecture: Male Reproductive Physiology
What is Kallman’s syndrome?
GnRh neurons fail to migrate to the hypothalamus leading to delayed or absent puberty & loss of smell
Lecture: Male Reproductive Physiology
What is Klinefelter’s syndrome (Seminiferous tubular dysgenesis)?
47, XXY genotype
- Phenotypically male because of presence of Y chromosome
- At puberty, increased gonadotropins fails to induce normal testicular growth & spermatogenesis.
- Androgen production is usually low but gonadotropins are elevated, thereby indicating primary hypogonadism.
- Seminiferous tubules are largely destroyed, resulting in infertile
Lecture: Male Reproductive Physiology
What is ectopic implantation?
Implantation of embryo outside the fundus of uterus
- Mostly in oviduct
- No decidualization
- Can cause tissue rupture and hemorrhaging
- Lecture: Fertilization & Implantation*
What is it called when no mentruation has occured by the age of 13 w/o secondary sexual development or by age 15 with secondary sexual development
Primary amenorrhea
What is it called when there’s an absence of menstruation for 6 months or greater
Secondary amenorrhea
