Endocrine - Sex Hormones Flashcards
Menstrual Cycle
– 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
Gonadotrophs through the Ages
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
Cervical Cancer
– 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)
Endometriosis
– 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
Leiomyomas
(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)
Endometrial Cancer
– tumor fills the endometrial cavity
o Most common cancer of female reproductive tract
o Commonly affects postmenopausal women
o Early clinical sign involves bleeding
Salphingitis
– 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
Amenorrhea - Normal Ovarian Hormones
Pregnancy
Uterine dysfunction caused by: hysterectomy, uterine adhesions
Amenorrhea - Increased Ovarian Hormones
– ovarian dysfunction
Caused by: feminizing tumors, masculinizing tumors, polycystic ovary syndrome
Amenorrhea - Decreased Ovarian Hormones with High Gonadotropin Levels
• Menopause
• Congenital ovarian failure – gonadal dysgenesis; resistance to gonadotropins
• Acquired ovarian failure caused by:
o Autoimmune disease, chemotherapy, resistance to gonadotropins
Amenorrhea - Decreased Ovarian Hormones with Low Gonadotropin Levels
• 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
Polycystic Ovarian Syndrome (PCOS)
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
Ovarian Tumors and Cancer
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
Teratoma
– 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.)
Ectopic Pregnancy
– 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