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MFM Written Boards > Endocrinology of Pregnancy and Placenta > Flashcards

Endocrinology of Pregnancy and Placenta Flashcards

1
Q 
Increase or decrease in pregnancy?
Calcium (total)
Calcium (ionized)
Calcitonin
Phosphate
PTH (in the first trimester)
PTH (in the second and third trimesters)
PTH-rP
Vitamin D
A
  • Decrease: Ca, PTH (1st trimester), Phosphate
  • Increase: active vitD, PTHrP, PTH 2-3rd trimester, calcitonin (slight)
  • No change: ionized Ca, magnesium

PTH overall goes down but made up for by PTHrP made by fetus

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2
Q

Deoxycorticosterone change during pregnancy

A

Increases due to kidney production

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3
Q

DHEA-S change during pregnancy?

A

Decreases due to (1) 16-alpha-OHase in mom liver and (2) steroid sulfatase in placenta aromatizing to estriol

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4
Q

Androstenedione change during pregnancy?

A

Total goes up due to more SHBG

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5
Q

Testosterone change during pregnancy?

A

Total goes up due to more SHBG

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6
Q

GnRH change during pregnancy?

A

Decreased response to it

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7
Q

Explain CRH / ACTH / cortisol changes during pregnancy

A

ACTH initially downregulated but then placenta produces some CRH so ACTH goes up. This + cortisol clearance rate slowing so serum level increases.

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8
Q

GH change during pregnancy?

A

Decrease in pituitary; increase in placental GH

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9
Q

The increase in which hormones promote lactation?

A

Insulin, cortisol, PRL

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10
Q

What metabolizes steroids in placenta?

A

11-beta-HSD-2 and CYP1A1

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11
Q

What increases and decreases decidual production of PRL (which enters AF)?

A

Increases: arachadonic acid.
Decreases: cytokines, growth factors (EGF, ET-1, IL-1, IL-2)
No effect: prostaglandins and dopamine stuff or TRH

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12
Q

Which placenta cell makes hPL

A

SCT

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13
Q

Which hormones is hPL similar to?

A

Pituitary GH (96%) and PRL (67%)

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14
Q

Which placenta cell makes all the steroid hormoens

A

SCT

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15
Q

Which placenta cell makes GnRH

A

Cytotrophoblasts

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16
Q

Which placenta cell makes leptin?

A

SCT and CT (though adipose makes more)

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17
Q

Describe path through a hemochorial placenta

A

Mom blood (capillary) -> intervillous space bathing -> SKIN-cytiotrophoblast -> cytotrophoblast -> fetal mesenchyme aka connective tissue -> fetal capillary endothelium -> fetal capillaries

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18
Q

How does this cross placenta? CO2

A

Passive diffusion

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19
Q

How does this cross placenta? Oxygen

A

Passive diffusion

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20
Q

How does this cross placenta? FFA

A

Passive diffusion

21
Q

How does this cross placenta? Glucose

A

Little bit of facilitated diffusion, little bit active GLUT-1

22
Q

How does this cross placenta? Lactate

A

Facilitated diffusion

23
Q

How does this cross placenta? Amino acids

A

Active transport via SCT

24
Q

How does this cross placenta? Calcium

A

Active transport via SCT

25
Q

How does this cross placenta? Iron

A

Active transport via SCT

26
Q

How does this cross placenta? Iodine

A

Active transport via SCT

27
Q

How does this cross placenta? Vitamin C

A

Active transport via SCT

28
Q

How does this cross placenta? IgG

A

Pinocytosis

29
Q

How does this cross placenta? Insulin

A

Pinocytosis

30
Q

How does this cross placenta? LDL

A

Pinocytosis

31
Q

How does this cross placenta? Transferrin

A

Pinocytosis

32
Q

How do most drugs cross the placenta?

A

Passive diffusion

33
Q

Which cells don’t express MHC Class I or II Ag?

A

SCT

34
Q

Which cells don’t express MHC Class II Ag but have Class I?

A

EVT

35
Q

What four enzymes does placenta have the are critical to making estrogen?

A
  1. 3-beta-HSD
  2. 17-beta-hydroxylase
  3. Steroid sulfatase
  4. Aromatase
36
Q

What enzyme does placenta have to make sex hormones that fetal adrenal lacks?

A

3-beta-HSD

37
Q

What estrogen version is in blood and circulating at term? What version has low SHBG affinity so is mostly cleared in the urine (and lots in urine)?

A

EstraDIol and EsTRIol

38
Q

Two ways to get 46 XX ambiguous genitalia

A
  1. Excess androgen (either tumor or exogenous)

2. CAH (21-OH most common > 17-OHase > 3-beta-HSD)

39
Q

Why give fetus at risk for 21-OH CAH dexa @ 4 wks?

A

Prevent virilization (i.e. only give it to female fetus).

40
Q

Ambiguous genitalia (in utero) work-up?

A

Karyotype + 7-DHS (for SLO evaluation)

41
Q

Name 3 things 11-Beta-HSD-2 inactivates

A

Cortisol -> cortisone
Corticosteroid -> 11-deoxycorticosterone
Prednisolone -> Prednisone

42
Q

How does PGF-2-alpha trigger a contraction?

A

Two ways: Increase CA via ATPase and release from sarcoplasmic reticulum

43
Q

How does PGE1 trigger a contraction?

A

Two way: Increases Ca and INHIBITS adenyl cyclase

44
Q

How does a decrease in Ca relax a uterus?

A

Myosin PHOSphatase takes that PO4 off and de-couple

45
Q

How do beta-2-adrenergic (like terbutaline) relax a uterus?

A

B2 activate adenyl cyclase turning ATP into cAMP which then activate PROTEIN KINASE A which then (1) deactivate MLCK by phosphorylation, (2) stop Ca influx (3) stop Ca-calmodulin binding

46
Q 
Which of these increase vs decrease contractions?
ANP
Calcium
Calcitonin
cAMP
cGMP
Cortisol
CRH
endothelin
EGF
Estrogen
Growth Factor
hCG
Mg
NO
Progesteorne
PTHRP
Relaxin
Prostacyclin
A
  • Increase ctxn: PGF > PGE, ADH, endothelin, epidermal GF, estrogen, cortisol, Ca (mnemonic: all the Es [endothelin, estrogen, epidermal GF] + stress]
  • Decrease ctxn: cAMP, cGMP, hCG, relaxin, prostacyclin, NO, ANP, progesterone, calcitonin, Mg
  • CRH and PTHrP do both
47
Q

How do IL1-beta + TNF-alpha increase contractions?

A

Increase prostaglandins by (1) inducing COX-1 expression in amnion/decidua and (2) inhibiting PGDH in chorion

48
Q

Where does PGE2, PGF2 alpha, and PGI2 come from?

A
  • Amnion: PGE2
    • Chorion: PGE2 (…and a little PGF2-alpha but most inactivated)
    • Decidua vera: PGF2-alpha (primary source in the uterus)&raquo_space; PGE2
    • Myometrium: PGI2
    • Placenta/cord: PGE2>PGI2

MFM Written Boards (9 decks)

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