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LCRS Endo > Endocrinology of pregnancy > Flashcards

Endocrinology of pregnancy Flashcards

1
Q

what hormone controls tubular fluid reabsorption from the testis to epipdymis?

A

oestrogen

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2
Q

what hormone controls nutrient and glycoprotein secretion in to epididymal fluid?

A

androgen

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3
Q

function of epididymal fluid?

A

Provide energy for journey and coat the surface of the spermatozoa (protection).

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4
Q

what does semen consist of?

A

o Spermatozoa – 50-150x106/ml.
o Seminal fluid – 2-5ml (made in the prostate)
o Leucocytes
o potentially viruses, e.g. hepatitis B, HIV.

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5
Q

where is seminal fluid produced? [2]

which has the smaller contribution?

A

Epididymis/testes (small contribution): including inositol and glycerylphosphorylchline.

Accessory sex glands (major contribution)
• Seminal vesicles – produce fructose and fibrinogen.
• Prostate – produce citric acid (Ca2+ chelator, acid phosphatase, fibrinogenase).
• Ampulla.
• Bulbourethral.

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6
Q

how much of the spermatozoa enter the cervix?

A

1%

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7
Q

how does the sperm differ in its capability to fertilise depending on location?

A

seminiferous tubule: incapable

vas deferens: capable of movement, little capability to fertilise

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8
Q

how do sperm become ready to fertilise?

A

after capacitation in the oviduct

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9
Q

what is the process of capacitation?

A

o Loss of glycoprotein coat.
o Change in surface membrane characteristics.
o Whiplash movements.

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10
Q

what is the process of capacitation dependent on?

A

oestrogen and Ca2+

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11
Q

where does fertilisation occur?

A

in fallopian tubes

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12
Q

what is the result of fertilisation

A
  • explusion of the second polar body after undergoing second meiosis
  • degradation of ZP3 to prevent further binding (calcium dependent where Gp mediated action and progesterone enable influx of calcium)
  • cortical reaction, breakdown of zone pellucida by digestive enzymes
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13
Q

what happens when spermatozoa bind to ZP3

A

penetrate zona pellucida by releasing haluronidase

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14
Q

what is the conceptus

A

fertilised ovum

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15
Q

transformation of the conceptus along the fallopian tube

A

o Conceptus continues to divide as it travels down the fallopian tubes (oviduct) – 3-4 days.
o Receives nutrients from the uterine secretions.
o This phase can last from 9-10 days.
o The conceptus first compacts to an 8-16 cell morula.
o Then it becomes a blastocyst – 2 separate cell populations; inner mass (becomes the embryo) and outer trophoblast (becomes the chorion).

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16
Q

what is the final stage of development of the conceptus

A

transfer to uterus to bind to endometrium

facilitated by increased progesterone: oestrogen ratio in the luteal phase

17
Q

what are the two processes that occur in implantation

A

o Attachment phase – outer trophoblast cells contact uterine epithelium.
o Decidualisation – of underlying stromal tissue.

this requires progesterone dominance in the presence of oestrogen

18
Q

what two substances enable attachment of the conceptus to the uterus?

A

o Leukaemia Inhibitory Factor (LIF) from endometrium (and blastocyst) stimulates adhesion of blastocyst to endometrium.
o IL-11 is also released into uterine fluid (may be involved).

19
Q

what happens in decidualisation?

A

 Invasion of underlying uterine stromal tissue by outer trophectoderm cells of the blastocyst.

20
Q

what are the changes in decidualisation?

A

Within hours:
increased vascular permeability in invasion region (oedema)
localised changes in intracellular composition (glycogen accumulation in cytoplasm)
progressive sprouting and growth of capillaries

(the DECIDUALISATION reaction).

21
Q

factors involved in decidualisation

A

IL-11
histamine
prostaglandins
TGF-beta (angiogenesis).

22
Q

what happens in the first 5-6 weeks of pregnancy in terms of gonadal steroids?

A

o Maternal ovaries release gonadal steroids.
o Circulating progesterone and oestradiol concentrations are high and rising and inhibit the release of maternal LH and FSH.
- As LH and FSH are inhibited, the stimulatory role on the corpus luteum is taken over by hCG produced by the developing blastocyst.

23
Q

from day 40

A

o Ovariectomy has no effect on pregnancy.

o Role of corpus luteum taken over by foetalplacental unit.

24
Q

which maternal hormones increase?

A

o ACTH – pregnancy activates stress-axis so more ACTH.
o Prolactin – prolactin supresses GnRH.
o Iodothyronines – pregnancy increases metabolic rate. Driven by hCG and NOT TSH, which is why TSH falls.
o Adrenal steroids – more ACTH thus more cortisol.
o PTHrp (parathormone related peptide) – more calcium requirement for lactation.

25
Q

which maternal hormones decrease?

A

o Gonadotrophins –LH and FSH
o TSH – falls as hCG stimulates high T4 production instead
o hCG – placental variant increases.

26
Q

how does oxytocin enable parturition?

A

increases intracellular calcium to enable contractions of myometrium

27
Q

how does oestrogen enable the increase in intracellular calcium

A

Oestrogen (progesterone inhibits this) stimulates phospholipase A2 which stimulates arachidonic acid to PGF2a production to raise intracellular calcium from microsomes. Calcium can also just enter from outside.

28
Q

how does contraction occur in parturition

A

Contraction occurs by calmodulin activating calmodulin-myosin kinase which contracts actin-myosin.

29
Q

what hormone stimulates milk ejection?

A

oxytocin

30
Q

which hormone stimulates milk synthesis?

A

prolactin

31
Q

what is the cortical reaction?

A

granule molecules degrade the zona pellucida (fertilisation triggers this)

32
Q

what does the conceptus become when it moves down tubes?

A

morula–> blastocyst

33
Q

what mediator stimulated blastocyst adhesion to the endometrium?

A

Leukaemia inhibitory factor

34
Q

what mediatory is involved in decidualisation?

A

IL-11

35
Q

what are some changes in the decidualisation stage of attachment?

A
  • Glandular epithelial secretion
  • Glycogen accumulation in stromal cell cytoplasm
  • Growth of capillaries
  • Increased vascular permeability (oedema)
  • Involves IL11, histamine, prostaglandins, TGFb (promotes angiogenesis)
36
Q

what hormones allow parturition?

A

oxytocin

37
Q

what else apart from oxytocin can bind to the oxytocin receptor to stimulate contraction?

A

foetal cortisol
placental oestrogen

oestrogen also increases calcium to lead to contraction

38
Q

what are the hormones involved in…

  • milk synthesis
  • milk ejection ?
A
  • milk synthesis–> prolactin

- milk ejection–> oxytocin

LCRS Endo (18 decks)

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