Exam 8: Male/Female Reproductive + Thyroid hormones Flashcards
1
Q
Role of Sertoli cells
A
Sperm production
2
Q
Role of Leydig cells
A
Testosterone production
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
4
Q
When is GnRH at its highest level due to diurnal variation?
A
In the morning
5
Q
GnRH acts on ____ and ____ to stimulate ___________ and __________ production, respectively. (males)
A
LH and FSH to stimulate testosterone and sperm
6
Q
What is low testosterone associated with?
A
low sex drive, poor sperm quality, bone mass loss, osteoporosis
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
8
Q
Ideal temperature for spermatogenesis
A
2 degrees less than body temperature
9
Q
What are the testes suspended by?
A
Spermic cords/vas deferens
10
Q
What contains the sertoli cells/leydig cells?
A
Seminiferous tubules inside of the testes
11
Q
What is Klinefelter Syndrome?
A
Men having extra X chromosome (XXY)
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
13
Q
Lab findings in Klinefelter Syndrome
A
Normal to decreased testosterone
Increased LH and FSH
Sperm quality suggests infertility
14
Q
What is Androgen Insensitivity Syndrome (AIS)?
A
Androgen resistance due to mutation; cells not responding to FSH and LH
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
16
Q
Lab findings in Androgen Insensitivity Syndrome (AIS)
A
Normal to increased testosterone
Increased FSH and LH
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
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
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
20
Q
Lab findings in myotonic dystophy
A
Decreased sperm
Increased FSH and LH
Decreased testosterone
21
Q
What viral infection can affect male fertility?
A
Mumps orthorubuavirus
22
Q
What is sertoli cell only syndrome?
A
No production of sperm due to disconnect between FSH and sertoli cells
23
Q
Lab values associated with Sertoli Cell Only syndrome (SCO)?
A
Increased FSH
Azoospermia
Normal testosterone
24
Q
Hypogonadotropic Hypogonadism
A
Heavily increased testosterone, coupled with low GnRH, FSH, and LH
25
Lab tests for Hypogonadotropic hypogonadism (how to tell if its tertiary or secondary)
If LH does not increase 2.5x baseline = secondary (pituitary problem)
If LH increases 2.5x baseline = tertiary (hypothalmic problem)
26
Hypergonadotropic hypogonadism
Low testosterone, elevated FSH and LH, poor semen quality
27
Kallman's Syndrome
Genetic: X-linked KAL1 mutation causing hypogonadism during puberty patient presents with microphallus, cryptorchidism, small testes (GnRH deficiency)
28
How is DM Type II associated with hypogonadotropic hypogonadism?
Decreased testosterone and low LH that are throught to arise from insulin resistance and high inflammation can cause increased estradiol levels
29
Males lose testosterone production abilities after age ____. Average decline of _____ ng/dL every ____ years thereafter.
30. 100. 10.
30
How does opioid usage affect males?
Decreases GnRH release causing decreased male fertility
31
Testosterone replacement therapy risks
Can increase risk of prostate cancer, but used to treat hypogonadism
32
Telarche
Breast tissue development - first sign of female sexual characteristic development
33
When does menarche typically start?
2-3 years after Telarche
34
Precocious sexual development in females
Premature sexualization of females
35
FSH and LH in females - what do they do
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
36
What occurs in a female if fertilization of the egg does not occur?
Uterine lining is shed which results in menses
37
Menstrual cycle is normally between ______ days but with an average of ____.
25-35, average of 28
38
Primary vs secondary amenorrhea
Primary - women has never menstruated by 16
Secondary - women with a menstrual cycle every 3-6 months
39
Oligomenorrhea
irregular menstrual bleeding and prolonged menses stages
40
Type I Amenorrhea (WHO classification)
Hypothalmic hypogonadism - decreased GnRH and decreased FSH/LH (tertiary problem)
41
Type II Amenorrhea (WHO classification)
Estrogenic chronic anovulation (Normal FSH/LH) - due to ovary problem
42
Type III Amenorrhea (WHO classification)
Hyperthalamic hypogonadism (increased GnRH and increased FSH/LH) - tertiary problem
43
Etiology of hypogonadotropic hypogonadism in women
anorexia, excessive exercise, hypothyroidism
44
What is "Athlete's Triad"?
Amenorrhea, low energy, and osteoporosis
45
What hormones increase/decrease during menopause, normally?
Increased FSH/LH, decreased estrogen
46
Polycystic ovarian syndrome
Infertility, hirsutism, chronic anovulation, glucose intolerance, hyperlipidemia, hypertension
47
Hirsutism
Abnormal/abundant terminal hair growth that is not normally found in women due to excess androgens, LH, body fat/obesity, or adrenal gland activity
48
Without the inheritance of the Y chromosome, the _____________ will not be inhibited, and female genitalia development will occur.
Mullerian ducts
49
What hormones does proper fetal development need during first, second, and third trimester?
First - increased hCG
Second and third - decreased FSH and LH, increased estrogen and progesterone
50
What is the one follicle that releases it oocyst during each cycle called?
Graafian follicle
51
After the graafian follicle releases the ovum, what does it become?
Corpus luteum
52
What does corpus luteum do?
Helps to produce progesterone and maintain the uterine wall for implantation
53
Primary estrogen produced by the ovaries
Estradiol
54
What is estrogen necessary for?
Follicular phase to function properly to increase endometrium growth
Development of breasts, uterine, and vaginal development but indirectly affects muscle, bone, and CNS
55
What is progesterone and what produces it?
Steroid hormone produced initially by the corpus luteum after released egg from graafian follicle
56
Function of progesterone
Strengthen and grow the endometrium for embryo implantation following fertilization
57
What is the dominant hormone responsible for the luteal phase?
Progesterone
58
What is "Day 1" of the menstrual cycle?
Menses
59
What are the two parallel developmental events occurring simultaneously during mesntruation?
1. Development of the follicle/ovum (Follicular and luteal phases)
2. Development of the endometrial lining of the uterus (proliferative and secretory phase)
60
Describe when the follicular phase occurs and the hormones levels during this time
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.
61
Describe when the luteal phase occurs and the hormones levels during this time
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
62
What is gravida and parity?
Gravida = number of times pregnant
Parity = number of live births
63
When do secretory and proliferative phases occur?
Secretory occurs Day 1-7 and again Day 14-28
Proliferative occurs day 7-14
64
What are the 3 trimester weeks in pregnancy?
1st = conception through 12th week
2nd = 13th week through 26th week
3rd = 27th week through 40th week
65
Briefly describe the steps of fetal development
Fertilization = zygote
Zygote undergoes rapid mitosis = blastocyst
After implantation of blastocyst = embryo
66
What does the placenta do?
Provides hormones, supplies oxygen and nutrients while removing fetal waste
67
When does a fetus start developing organs and a heartbeat?
10 weeks
68
When does the fetus grow the most in size and you can tell gender on imaging?
13-26 weeks
69
When does the fetus start moving and breathing and storing fat?
27-40 weeks
70
When is a fetus viable on its own? (lung development)
23-26 weeks
71
What is needed to keep a pregnancy viable? What occurs near delivery?
Progesterone - at delivery, progesterone levels drop so that they no longer inhibit smooth muscle contractions of uterus
72
What hormone increases during delivery?
Oxytocin
73
What is used to induce labor and delivery?
Pitocin; synthetic oxytocin
74
What happens to GFR during pregnancy?
Increase
75
What happens to breathing during pregnancy?
Hyperventilation (Increased oxygen demand)
76
What happens to plasma volume during pregnancy?
Increases (swollen body)
77
What does HELLP syndrome stand for?
Hemolysis, elevated liver enzymes, low platelets
78
How does the RAAS system affect pregnant women?
Increases aldosterone and ADH to increase sodium, water, and blood pressure
79
How does cardiac output change during pregnancy?
Increases by 20% as HR increases by 10-20 bpm
80
Estrogen/progesterone/LH/FSH levels during pregnancy
High estrogen, high progesterone
Low LH, Low FSH
81
How does pregnancy affect insulin response?
Increased insulin resistance during second and third trimester
82
How are triglycerides affected by pregnancy?
Increased due to increased liver synthesis
83
How to test when a woman is ovulating?
Test serum LH and progesterone levels
84
B-HcG
Early marker for pregnancy; highest in the first trimester and plateaus for the remainder of pregnancy
85
Fetal Down Syndrome and HcG levels
Increased HcG 2x in amniotic fluid than maternal serum
86
What are Increased alpha-fetoprotein levels associated with?
Neural tube disorders
87
What are decreased alpha-fetoprotein levels associated with?
Down Syndrome and other trisomy
88
AFP levels are usually reported using _______.
MoMs
89
MoM for spinda bifida and anencephaly
7 and 20, respectfully
90
How are unconjugated estriol levels useful?
Increased levels associated with determining gestational age
Decreased levels associated with down syndrome, preeclampsia, poor fetal growth, low birth weight
91
What is included in a triple/quadruple screen?
AFP, hCG, and uE3 (unconjugated estriol)
Quadruple screen includes Inhibin A also
92
What is Inhibin A?
Glycoprotein that suppresses FSH and is used for the evaluation of down syndrome with increased levels
93
What will a triple screen look like for down syndrome babies?
Increased bHCG, decreased uE3, decreased AFP
94
What will a triple screen look like for edwards syndrome babies?
Decreased bHCG, decreased uE3, decreased AFP
95
What will a triple screen look like for anencephaly babies?
Decreased bHCG, decreased uE3, increased AFP
96
What will a triple screen look like for open spina bifida babies?
Normal bHCG, Normal uE3, Increased AFP
97
AChE levels in trisomy disorders?
Decreased
98
AChE levels in spina bifida and anencephaly?
Increased
99
What correlates with AChE levels?
AFP
100
What is PAPP-A and what are DECREASED levels associated with?
Glycoprotein produced by placenta that promotes angiogenesis and dampens maternal immune responses against fetus
Decreased levels = Patua syndrome, edwards syndrome, and down syndrome
101
What does FFN tell us?
Assess risk of pre-term delivery (High FFN is highly likely to delivery early)
102
Describe pre-eclampsia
Hypertension, proteinuria, and edema in the second and third trimester
4X increase in vasopressinase that decreases ADH leading to diabetes insipidus
103
What happens if preeclampsia is left untreated?
Seizures and convulsions
104
Hyperemesis Gravidarum
Morning sickness that occurs until 15th week of gestation
105
What is important to prevent Wernicke's encephalopathy?
B1 (Thiamine)
106
Ectopic pregnancy
Implantation somewhere other than the uterus; can include vaginal bleeding, lower quadrant pain, internal hemorrhage
107
T/F: Ectopic pregnancies can never make a viable fetus
TRUE
108
What prevents neural tube defects in fetuses?
B12 and Folate
109
What is one of the most common birth defects affecting the developing fetus?
Neural tube defects - failure of the neural tube to close
110
Edwards Syndrome vs Down Syndrome
Edwards - Trisomy 18
Down - Trisomy 21
111
Which is more viable - Down syndrome or edwards syndrome?
Down syndrome. 50% of newborns with edwards will die within 5 days
112
What is the thyroid responsible for and what hormones does it secrete?
Cellular metabolism - secretes thyroid hormone and calcitonin
113
What is the affect of calcitonin and what cells secrete it?
Parafollicular cells (C cells) of the thyroid gland
It decreases blood calcium levels
114
What is the role of thyroid hormone and what cells secrete it?
Functions in cellular metabolism and neurological development
Follicular cells of thyroid produce it
115
What is essential for thyroid hormone synthesis and function?
Iodine
116
Ovarian vs uterine phases
Ovarian: follicular and luteal
Uterine: secretory and proliferative
117
Colloid contains ________ which interacts with iodine and is converted to ____ and _____ by ______.
Thyroglobulin; MIT and DIT; TPO (Thyroid peroxidase)
118
What does TPO do?
Plays a role in converting T4 into T3
119
How much T4 is converted into T3? What is the prehormone? What is the prohormone?
80%
prehormone = T4
prohormone = thyroglobulin
120
The thyroid makes more _____, but ____ is more active and potent
T4; T3
121
Where does T3 and T4 travel?
Liver and kidney
122
How much T3/T4 is unbound, where is most of it found?
Only 0.4% unbound/free
Most are bound to proteins
123
What proteins bind thyroid hormones?
thyroxine binding globulin
thyroxine binding prealbumin
albumin
124
What is the most useful hormone for assessing thyroid functionality?
TSH
125
When measuring T4, what is actually measured? Free or bound?
Free T4
126
T/F: The thyroid creates more T4/T3 than the liver and kidney.
FALSE. liver and kidney create 80% of it
127
Where is thyroglobulin stored?
Colloid of thyroid tissue
128
Why are thyroglobulin levels tested?
Ideal tumor marker and post treatment assessment tool for remission/relapse
129
What is Anti-Tg?
Autoantibodies directed against thyroglobulin which will decrease availability of the functional thyroid hormones in the blood
130
What are Anti-Tg autoantibodies associated with?
Hypothyroid disorders such as Hashimoto's thyroiditis
131
What is Anti-TPO?
Activates complement that drives pathogenesis and destruction of the thyroid
132
What is Anti-TPO associated with?
Hashimoto's thyroiditis
133
What is TRAb autoantibodies?
Autoantibodies directed against thyrotropin or TSH receptors associated with Grave's Disease causing autoimmune thyrotoxicosis
134
Symptoms associated with hypothyroidism
Cold intolerance
Low metabolism
Bradycardia
Weight gain
135
Symptoms associated with hyperthyroidism
Heat intolerance
High metabolism
Tachycardia
Weight loss
136
Most goiters result from ____________.
Iodine deficiency
137
Signs and symptoms of Graves disease
Thyrotoxicosis with goiter, eye changes like inflammation, bulging, and rashes
138
Function of serum calcium
Nervous tissue excitability
Muscle contractions
Coagulation
Hormone secretion
139
What is calcium predominantly regulated by?
parathyroid hormone, calcitonin, vitamin d
140
What hormones increase/decrease calcium?
Parathyroid hormone and vitamin D both increase calcium
Calcitonin decreases calcium
141
What hormones does the parathyroid gland secrete?
Parathyroid hormone
142
What is the primary target of PTH and what is its function?
Bone and the kidneys to increase blood calcium
143
What affects does increased PTH have on the body?
Increased bone resorption = increased osteoclasts
Increased PO4 secretion in urine
Increased vitamin D absorption
144
How does excessive Vitamin D affect bone calcium?
Decreases bone calcium and may lead to oseteoporosis, increased fracture
145
What is the active form of Vitamin D?
1,25(OH)2D
146
Vitamin D's impact on PTH, GI system, and bone
PTH: decreases PTH in negative feedback system
GI system: increases calcium absorption
bone: increases osteoclasts to decrease bone calcium
147
Hyperparathyroidism
Most common cause of hypercalcemia
Women 3X more likely than men
Causes cortical bone loss
148
Lab diagnosis of hyperparathyroidism
Hypercalcemia
Hypophosphatemia
Increased PTH
Low 25-OHD and elevated 1,25(OH)2D
Increased urinary calcium
149
25-OH-D vs 1,25(OH)2D
25-OH-D = liver form of vit D
1,25(OH)2D = renal form of vit D
150
What is familial hypocalciuric hypercalcemia?
Benign condition resulting from germline mutation resulting in hypercalcemia
151
PTH levels are _____ in patients with hyperthyroidism.
Low
152
What are two common drugs that can induce hypercalcemia?
HCTZ (diuretic used to treat hypertension) and lithim (bipolar disorder)
153
Excessive intake of vitamin D from supplements may result in _________ calcium levels.
Increased
154
What is hypoparathyroidism most commonly the result of?
Neck surgery
155
Ricketts vs Osteomalacia
Both vitamin D deficiencies
Ricketts - children
Osteomalacia - adults
156
What is the most prevalent bone disorder of adults in the US? More likely in males or females?
Osteoporosis - 4X more likely in females
