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Chemistry > Exam 8: Male/Female Reproductive + Thyroid hormones > Flashcards

Exam 8: Male/Female Reproductive + Thyroid hormones Flashcards

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1
Q

Role of Sertoli cells

A

Sperm production

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2
Q

Role of Leydig cells

A

Testosterone production

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3
Q

Role of LH and FSH in male reproductive system

A

LH –> acts on Leydig cells to make testosterone
FSH –> acts on Sertoli cells to make sperm

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4
Q

When is GnRH at its highest level due to diurnal variation?

A

In the morning

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5
Q

GnRH acts on ____ and ____ to stimulate ___________ and __________ production, respectively. (males)

A

LH and FSH to stimulate testosterone and sperm

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6
Q

What is low testosterone associated with?

A

low sex drive, poor sperm quality, bone mass loss, osteoporosis

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7
Q

Role of vas deferens

A

can contract or relax to increase or decrease length away from body based on ideal blood flow and temperature for spermatogenesis

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8
Q

Ideal temperature for spermatogenesis

A

2 degrees less than body temperature

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9
Q

What are the testes suspended by?

A

Spermic cords/vas deferens

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10
Q

What contains the sertoli cells/leydig cells?

A

Seminiferous tubules inside of the testes

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11
Q

What is Klinefelter Syndrome?

A

Men having extra X chromosome (XXY)

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12
Q

Signs/Symptoms of Klinefelter Syndrom

A

Men with increased estrogen, decreased bone density, and increased breast cancer risks. Men have small testes and enlarged breasts

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13
Q

Lab findings in Klinefelter Syndrome

A

Normal to decreased testosterone
Increased LH and FSH
Sperm quality suggests infertility

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14
Q

What is Androgen Insensitivity Syndrome (AIS)?

A

Androgen resistance due to mutation; cells not responding to FSH and LH

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15
Q

Signs/Symptoms of Androgen Insensitivity Syndrome (AIS)

A

Male patients have female external genitalia, hair, and fat distribution with undescended testes but no production of female internal genitalia due to anti mullerian hormone

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16
Q

Lab findings in Androgen Insensitivity Syndrome (AIS)

A

Normal to increased testosterone
Increased FSH and LH

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17
Q

What is 5 alpha reductase deficiency?

A

Enzymatic disorder causing androgen insensitivity on chromosome 2 that affects males – prevents testosterone conversion into DHT

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18
Q

S&S of 5 alpha reductase deficiency?

A

Prostate and external genitalia do not develop or grow as well - ambiguous genitalia at birth and male sexual development begins to occur at puberty

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19
Q

What is myotonic dystrophy?

A

Either DMPK mutation or CNBP mutation leaving males with hypogonadism, frontal balding, diabetes, muscle weakness, and dystonia. Puberty progresses normally but testicular failure occurs in the 20-30s

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20
Q

Lab findings in myotonic dystophy

A

Decreased sperm
Increased FSH and LH
Decreased testosterone

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21
Q

What viral infection can affect male fertility?

A

Mumps orthorubuavirus

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22
Q

What is sertoli cell only syndrome?

A

No production of sperm due to disconnect between FSH and sertoli cells

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23
Q

Lab values associated with Sertoli Cell Only syndrome (SCO)?

A

Increased FSH
Azoospermia
Normal testosterone

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24
Q

Hypogonadotropic Hypogonadism

A

Heavily increased testosterone, coupled with low GnRH, FSH, and LH

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25
Q

Lab tests for Hypogonadotropic hypogonadism (how to tell if its tertiary or secondary)

A

If LH does not increase 2.5x baseline = secondary (pituitary problem)
If LH increases 2.5x baseline = tertiary (hypothalmic problem)

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26
Q

Hypergonadotropic hypogonadism

A

Low testosterone, elevated FSH and LH, poor semen quality

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27
Q

Kallman’s Syndrome

A

Genetic: X-linked KAL1 mutation causing hypogonadism during puberty patient presents with microphallus, cryptorchidism, small testes (GnRH deficiency)

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28
Q

How is DM Type II associated with hypogonadotropic hypogonadism?

A

Decreased testosterone and low LH that are throught to arise from insulin resistance and high inflammation can cause increased estradiol levels

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29
Q

Males lose testosterone production abilities after age ____. Average decline of _____ ng/dL every ____ years thereafter.

A
    1. 10.
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30
Q

How does opioid usage affect males?

A

Decreases GnRH release causing decreased male fertility

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31
Q

Testosterone replacement therapy risks

A

Can increase risk of prostate cancer, but used to treat hypogonadism

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32
Q

Telarche

A

Breast tissue development - first sign of female sexual characteristic development

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33
Q

When does menarche typically start?

A

2-3 years after Telarche

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34
Q

Precocious sexual development in females

A

Premature sexualization of females

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35
Q

FSH and LH in females - what do they do

A

FSH stimulates ovarian follicle to grow
LH stimulates endometrial lining to either shed or prepare for fertilization and helps to transition graafian follicle to corpus luteum for production of progesterone following ovulation

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36
Q

What occurs in a female if fertilization of the egg does not occur?

A

Uterine lining is shed which results in menses

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37
Q

Menstrual cycle is normally between ______ days but with an average of ____.

A

25-35, average of 28

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38
Q

Primary vs secondary amenorrhea

A

Primary - women has never menstruated by 16
Secondary - women with a menstrual cycle every 3-6 months

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39
Q

Oligomenorrhea

A

irregular menstrual bleeding and prolonged menses stages

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40
Q

Type I Amenorrhea (WHO classification)

A

Hypothalmic hypogonadism - decreased GnRH and decreased FSH/LH (tertiary problem)

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41
Q

Type II Amenorrhea (WHO classification)

A

Estrogenic chronic anovulation (Normal FSH/LH) - due to ovary problem

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42
Q

Type III Amenorrhea (WHO classification)

A

Hyperthalamic hypogonadism (increased GnRH and increased FSH/LH) - tertiary problem

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43
Q

Etiology of hypogonadotropic hypogonadism in women

A

anorexia, excessive exercise, hypothyroidism

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44
Q

What is “Athlete’s Triad”?

A

Amenorrhea, low energy, and osteoporosis

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45
Q

What hormones increase/decrease during menopause, normally?

A

Increased FSH/LH, decreased estrogen

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46
Q

Polycystic ovarian syndrome

A

Infertility, hirsutism, chronic anovulation, glucose intolerance, hyperlipidemia, hypertension

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47
Q

Hirsutism

A

Abnormal/abundant terminal hair growth that is not normally found in women due to excess androgens, LH, body fat/obesity, or adrenal gland activity

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48
Q

Without the inheritance of the Y chromosome, the _____________ will not be inhibited, and female genitalia development will occur.

A

Mullerian ducts

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49
Q

What hormones does proper fetal development need during first, second, and third trimester?

A

First - increased hCG
Second and third - decreased FSH and LH, increased estrogen and progesterone

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50
Q

What is the one follicle that releases it oocyst during each cycle called?

A

Graafian follicle

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51
Q

After the graafian follicle releases the ovum, what does it become?

A

Corpus luteum

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52
Q

What does corpus luteum do?

A

Helps to produce progesterone and maintain the uterine wall for implantation

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53
Q

Primary estrogen produced by the ovaries

A

Estradiol

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54
Q

What is estrogen necessary for?

A

Follicular phase to function properly to increase endometrium growth
Development of breasts, uterine, and vaginal development but indirectly affects muscle, bone, and CNS

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55
Q

What is progesterone and what produces it?

A

Steroid hormone produced initially by the corpus luteum after released egg from graafian follicle

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56
Q

Function of progesterone

A

Strengthen and grow the endometrium for embryo implantation following fertilization

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57
Q

What is the dominant hormone responsible for the luteal phase?

A

Progesterone

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58
Q

What is “Day 1” of the menstrual cycle?

A

Menses

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59
Q

What are the two parallel developmental events occurring simultaneously during mesntruation?

A
  1. Development of the follicle/ovum (Follicular and luteal phases)
  2. Development of the endometrial lining of the uterus (proliferative and secretory phase)
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60
Q

Describe when the follicular phase occurs and the hormones levels during this time

A

Begins after onset of menses and ends the moment of the LH surge. (First 14 days)
Begins with low estrogen, but increased GnRH, LH, and FSH increase estrogen and eventually progesterone.

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61
Q

Describe when the luteal phase occurs and the hormones levels during this time

A

Marks the start of ovulation and occurs at day 14 of cycle.
Estrogen levels peak the day before this phase, which stimulates the LH surge triggering release of ovum

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62
Q

What is gravida and parity?

A

Gravida = number of times pregnant
Parity = number of live births

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63
Q

When do secretory and proliferative phases occur?

A

Secretory occurs Day 1-7 and again Day 14-28
Proliferative occurs day 7-14

64
Q

What are the 3 trimester weeks in pregnancy?

A

1st = conception through 12th week
2nd = 13th week through 26th week
3rd = 27th week through 40th week

65
Q

Briefly describe the steps of fetal development

A

Fertilization = zygote
Zygote undergoes rapid mitosis = blastocyst
After implantation of blastocyst = embryo

66
Q

What does the placenta do?

A

Provides hormones, supplies oxygen and nutrients while removing fetal waste

67
Q

When does a fetus start developing organs and a heartbeat?

A

10 weeks

68
Q

When does the fetus grow the most in size and you can tell gender on imaging?

A

13-26 weeks

69
Q

When does the fetus start moving and breathing and storing fat?

A

27-40 weeks

70
Q

When is a fetus viable on its own? (lung development)

A

23-26 weeks

71
Q

What is needed to keep a pregnancy viable? What occurs near delivery?

A

Progesterone - at delivery, progesterone levels drop so that they no longer inhibit smooth muscle contractions of uterus

72
Q

What hormone increases during delivery?

A

Oxytocin

73
Q

What is used to induce labor and delivery?

A

Pitocin; synthetic oxytocin

74
Q

What happens to GFR during pregnancy?

A

Increase

75
Q

What happens to breathing during pregnancy?

A

Hyperventilation (Increased oxygen demand)

76
Q

What happens to plasma volume during pregnancy?

A

Increases (swollen body)

77
Q

What does HELLP syndrome stand for?

A

Hemolysis, elevated liver enzymes, low platelets

78
Q

How does the RAAS system affect pregnant women?

A

Increases aldosterone and ADH to increase sodium, water, and blood pressure

79
Q

How does cardiac output change during pregnancy?

A

Increases by 20% as HR increases by 10-20 bpm

80
Q

Estrogen/progesterone/LH/FSH levels during pregnancy

A

High estrogen, high progesterone
Low LH, Low FSH

81
Q

How does pregnancy affect insulin response?

A

Increased insulin resistance during second and third trimester

82
Q

How are triglycerides affected by pregnancy?

A

Increased due to increased liver synthesis

83
Q

How to test when a woman is ovulating?

A

Test serum LH and progesterone levels

84
Q

B-HcG

A

Early marker for pregnancy; highest in the first trimester and plateaus for the remainder of pregnancy

85
Q

Fetal Down Syndrome and HcG levels

A

Increased HcG 2x in amniotic fluid than maternal serum

86
Q

What are Increased alpha-fetoprotein levels associated with?

A

Neural tube disorders

87
Q

What are decreased alpha-fetoprotein levels associated with?

A

Down Syndrome and other trisomy

88
Q

AFP levels are usually reported using _______.

A

MoMs

89
Q

MoM for spinda bifida and anencephaly

A

7 and 20, respectfully

90
Q

How are unconjugated estriol levels useful?

A

Increased levels associated with determining gestational age
Decreased levels associated with down syndrome, preeclampsia, poor fetal growth, low birth weight

91
Q

What is included in a triple/quadruple screen?

A

AFP, hCG, and uE3 (unconjugated estriol)
Quadruple screen includes Inhibin A also

92
Q

What is Inhibin A?

A

Glycoprotein that suppresses FSH and is used for the evaluation of down syndrome with increased levels

93
Q

What will a triple screen look like for down syndrome babies?

A

Increased bHCG, decreased uE3, decreased AFP

94
Q

What will a triple screen look like for edwards syndrome babies?

A

Decreased bHCG, decreased uE3, decreased AFP

95
Q

What will a triple screen look like for anencephaly babies?

A

Decreased bHCG, decreased uE3, increased AFP

96
Q

What will a triple screen look like for open spina bifida babies?

A

Normal bHCG, Normal uE3, Increased AFP

97
Q

AChE levels in trisomy disorders?

A

Decreased

98
Q

AChE levels in spina bifida and anencephaly?

A

Increased

99
Q

What correlates with AChE levels?

A

AFP

100
Q

What is PAPP-A and what are DECREASED levels associated with?

A

Glycoprotein produced by placenta that promotes angiogenesis and dampens maternal immune responses against fetus
Decreased levels = Patua syndrome, edwards syndrome, and down syndrome

101
Q

What does FFN tell us?

A

Assess risk of pre-term delivery (High FFN is highly likely to delivery early)

102
Q

Describe pre-eclampsia

A

Hypertension, proteinuria, and edema in the second and third trimester
4X increase in vasopressinase that decreases ADH leading to diabetes insipidus

103
Q

What happens if preeclampsia is left untreated?

A

Seizures and convulsions

104
Q

Hyperemesis Gravidarum

A

Morning sickness that occurs until 15th week of gestation

105
Q

What is important to prevent Wernicke’s encephalopathy?

A

B1 (Thiamine)

106
Q

Ectopic pregnancy

A

Implantation somewhere other than the uterus; can include vaginal bleeding, lower quadrant pain, internal hemorrhage

107
Q

T/F: Ectopic pregnancies can never make a viable fetus

A

TRUE

108
Q

What prevents neural tube defects in fetuses?

A

B12 and Folate

109
Q

What is one of the most common birth defects affecting the developing fetus?

A

Neural tube defects - failure of the neural tube to close

110
Q

Edwards Syndrome vs Down Syndrome

A

Edwards - Trisomy 18
Down - Trisomy 21

111
Q

Which is more viable - Down syndrome or edwards syndrome?

A

Down syndrome. 50% of newborns with edwards will die within 5 days

112
Q

What is the thyroid responsible for and what hormones does it secrete?

A

Cellular metabolism - secretes thyroid hormone and calcitonin

113
Q

What is the affect of calcitonin and what cells secrete it?

A

Parafollicular cells (C cells) of the thyroid gland
It decreases blood calcium levels

114
Q

What is the role of thyroid hormone and what cells secrete it?

A

Functions in cellular metabolism and neurological development
Follicular cells of thyroid produce it

115
Q

What is essential for thyroid hormone synthesis and function?

A

Iodine

116
Q

Ovarian vs uterine phases

A

Ovarian: follicular and luteal
Uterine: secretory and proliferative

117
Q

Colloid contains ________ which interacts with iodine and is converted to ____ and _____ by ______.

A

Thyroglobulin; MIT and DIT; TPO (Thyroid peroxidase)

118
Q

What does TPO do?

A

Plays a role in converting T4 into T3

119
Q

How much T4 is converted into T3? What is the prehormone? What is the prohormone?

A

80%
prehormone = T4
prohormone = thyroglobulin

120
Q

The thyroid makes more _____, but ____ is more active and potent

A

T4; T3

121
Q

Where does T3 and T4 travel?

A

Liver and kidney

122
Q

How much T3/T4 is unbound, where is most of it found?

A

Only 0.4% unbound/free
Most are bound to proteins

123
Q

What proteins bind thyroid hormones?

A

thyroxine binding globulin
thyroxine binding prealbumin
albumin

124
Q

What is the most useful hormone for assessing thyroid functionality?

A

TSH

125
Q

When measuring T4, what is actually measured? Free or bound?

A

Free T4

126
Q

T/F: The thyroid creates more T4/T3 than the liver and kidney.

A

FALSE. liver and kidney create 80% of it

127
Q

Where is thyroglobulin stored?

A

Colloid of thyroid tissue

128
Q

Why are thyroglobulin levels tested?

A

Ideal tumor marker and post treatment assessment tool for remission/relapse

129
Q

What is Anti-Tg?

A

Autoantibodies directed against thyroglobulin which will decrease availability of the functional thyroid hormones in the blood

130
Q

What are Anti-Tg autoantibodies associated with?

A

Hypothyroid disorders such as Hashimoto’s thyroiditis

131
Q

What is Anti-TPO?

A

Activates complement that drives pathogenesis and destruction of the thyroid

132
Q

What is Anti-TPO associated with?

A

Hashimoto’s thyroiditis

133
Q

What is TRAb autoantibodies?

A

Autoantibodies directed against thyrotropin or TSH receptors associated with Grave’s Disease causing autoimmune thyrotoxicosis

134
Q

Symptoms associated with hypothyroidism

A

Cold intolerance
Low metabolism
Bradycardia
Weight gain

135
Q

Symptoms associated with hyperthyroidism

A

Heat intolerance
High metabolism
Tachycardia
Weight loss

136
Q

Most goiters result from ____________.

A

Iodine deficiency

137
Q

Signs and symptoms of Graves disease

A

Thyrotoxicosis with goiter, eye changes like inflammation, bulging, and rashes

138
Q

Function of serum calcium

A

Nervous tissue excitability
Muscle contractions
Coagulation
Hormone secretion

139
Q

What is calcium predominantly regulated by?

A

parathyroid hormone, calcitonin, vitamin d

140
Q

What hormones increase/decrease calcium?

A

Parathyroid hormone and vitamin D both increase calcium
Calcitonin decreases calcium

141
Q

What hormones does the parathyroid gland secrete?

A

Parathyroid hormone

142
Q

What is the primary target of PTH and what is its function?

A

Bone and the kidneys to increase blood calcium

143
Q

What affects does increased PTH have on the body?

A

Increased bone resorption = increased osteoclasts
Increased PO4 secretion in urine
Increased vitamin D absorption

144
Q

How does excessive Vitamin D affect bone calcium?

A

Decreases bone calcium and may lead to oseteoporosis, increased fracture

145
Q

What is the active form of Vitamin D?

A

1,25(OH)2D

146
Q

Vitamin D’s impact on PTH, GI system, and bone

A

PTH: decreases PTH in negative feedback system
GI system: increases calcium absorption
bone: increases osteoclasts to decrease bone calcium

147
Q

Hyperparathyroidism

A

Most common cause of hypercalcemia
Women 3X more likely than men
Causes cortical bone loss

148
Q

Lab diagnosis of hyperparathyroidism

A

Hypercalcemia
Hypophosphatemia
Increased PTH
Low 25-OHD and elevated 1,25(OH)2D
Increased urinary calcium

149
Q

25-OH-D vs 1,25(OH)2D

A

25-OH-D = liver form of vit D
1,25(OH)2D = renal form of vit D

150
Q

What is familial hypocalciuric hypercalcemia?

A

Benign condition resulting from germline mutation resulting in hypercalcemia

151
Q

PTH levels are _____ in patients with hyperthyroidism.

A

Low

152
Q

What are two common drugs that can induce hypercalcemia?

A

HCTZ (diuretic used to treat hypertension) and lithim (bipolar disorder)

153
Q

Excessive intake of vitamin D from supplements may result in _________ calcium levels.

A

Increased

154
Q

What is hypoparathyroidism most commonly the result of?

A

Neck surgery

155
Q

Ricketts vs Osteomalacia

A

Both vitamin D deficiencies
Ricketts - children
Osteomalacia - adults

156
Q

What is the most prevalent bone disorder of adults in the US? More likely in males or females?

A

Osteoporosis - 4X more likely in females

Chemistry (12 decks)

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