Endocrine - Sex Hormones Flashcards

1
Q

Menstrual Cycle

A

– 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

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2
Q

Gonadotrophs through the Ages

A

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

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3
Q

Cervical Cancer

A

– 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)

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4
Q

Endometriosis

A

– 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

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5
Q

Leiomyomas

A

(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)

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6
Q

Endometrial Cancer

A

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

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7
Q

Salphingitis

A

– 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

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8
Q

Amenorrhea - Normal Ovarian Hormones

A

 Pregnancy

 Uterine dysfunction caused by: hysterectomy, uterine adhesions

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9
Q

Amenorrhea - Increased Ovarian Hormones

A

– ovarian dysfunction

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

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10
Q

Amenorrhea - Decreased Ovarian Hormones with High Gonadotropin Levels

A

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

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11
Q

Amenorrhea - Decreased Ovarian Hormones with Low Gonadotropin Levels

A

• 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

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12
Q

Polycystic Ovarian Syndrome (PCOS)

A

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

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13
Q

Ovarian Tumors and Cancer

A

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

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14
Q

Teratoma

A

– 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.)

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15
Q

Ectopic Pregnancy

A

– 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

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16
Q

Hydatiform Mole

A

– 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

17
Q

Pre-eclampsia

A

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

18
Q

Breast Cancer

A

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

19
Q

Benign Prostatic Hyperplasia

A

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

20
Q

Carcinoma of Prostate

A

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