Exam II Flashcards
A hormone is a product of an endocrine gland released directly into the bloodstream that acts how?
Peripherally on distant specific target cells
Exerts trophic effect
What sort of local effect of a hormone regulates processes in neighboring cells?
Paracrine
What sort of local effect of a hormone “acts back” to regulate processes within the same cell?
Autocrine
What sort of local effect of a hormone regulates processes within the cells of origin without being secreted?
Intracrine
What sort of local effect of a hormone originates in the neuron, undergoes axonal transport, and is carried distally by a blood vessel or synaptic transmission?
Neurocrine
What hormone class contain a carbohydrate moiety (helps w assembly, secretion, and biologic activity?
Glycoproteins
What hormone class is derived from AAs and produced from a gene that is transcribed into mRNA?
Peptides
What hormone class is derived from cholesterol and has a cyclo ring?
Steroids
What hormone class is derived from tyrosine?
Amines
Which class do the following hormones belong to? FSH TSH LH hCG
Glycoproteins
Which class do the following hormones belong to? ACTH Angiotensin Calcitonin PTH Melanocyte stimulating hormone (MSH) GF Oxytocin, ADH, AVP Prolactin, GH Somatostatin, insulin, glucagon
Peptides
Which class do the following hormones belong to? Aldosterone Cortisol Estradiol Progesterone Estrogen Testosterone DHEA Vitamin D
Steroids
Which class do the following hormones belong to? Epi/ NE Dopamine Thyroxine (T4) Triiodothyronine (T3)
Amines
How are hydrophilic hormones transported, and which classes do they include?
In the blood stream
Peptide hormones and catecholamines
How are hydrophobic hormones transported, and which classes do they include?
Bound to proteins
Thyroid and steroid based hormones
What type of proteins provide a reserve of hormones that can be called upon to replenish the free pool?
Binding proteins (keeps hormones in blood in inactive state)
What regulates inactivation/ excretion of hormones to contribute to plasma hormone concentration?
Degradation/ inactivation in liver/ kidney via glucuronidation and sulfate conjugation
What does internalization of hormone/ receptor complex in peripheral tissues contribute to?
Plasma hormone concentration
What group of hormones enters the nucleus, binds to receptors on DNA and activates specific thyroid or steroid responsive elements?
Group I
What hormone has the following characteristics?
Membrane located enzyme: adenylyl cyclase
2nd messenger: cAMP
Kinase: cAMP dependent protein kinase
Group IIA
What hormone has the following characteristics?
Membrane located enzyme: guanylyl cyclase
2nd messenger: cGMP
Kinase: cGMP dependent protein kinase
Group IIB
What hormone has the following characteristics?
Membrane located enzyme: phospholipase C
2nd messenger: DAG and IP3
Kinase: protein kinase C, calmodulin dependent protein kinase
Group IIC
What hormone has the following characteristics?
Kinase: serine or threonine kinase
Group IID
Once a peptide hormone is translated into mRNA + amino acid in ribosome, what happens to it?
Preprohormone > cleaved in ER > prohormone > cleaved in Golgi > hormone > stored in granules
What is the site of synthesis for steroid hormones?
Cytosol, ER, mitochondria
What is the site of synthesis for amines?
Enzymatic in cytosol, follicular cell and colloid of thyroid
What is the middle step conversion from testosterone to dihydrotestosterone?
Androgens formed in androgen-dependent tissues
What is the middle step conversion from testosterone to estradiol?
Conversion to E2 in brain/ testes
What type of hormone secretion is activated by blood borne substrate?
Humoral
What type of hormone secretion occurs via extension of CNS that signals a gland to secrete hormone?
Neural
What type of hormone secretion uses hormones to regulate secretion?
Hormonal
What is the most common type of feedback mechanism?
Negative (hormone inhibits further secretion of hormone)
What 2 hormones are regulation by a positive feedback mechanism?
Estrogen, oxytocin
What type of hormone action is described as the following: one hormone cannot exert full effect without presence of another?
Permissiveness
What type of hormone action is described as the following: hormone regulates # and/or affinity of its own receptor?
Autologous up/ down regulation
What type of hormone action is described as the following: hormones regulates # and/or affinity of another hormone’s receptor?
Heterologous up/ down regulation
What type of neurons begin in the hypothalamus, project their axons down the infundibular process and terminate in the posterior pituitary?
Magnocellular neurons
What type of neurons are include a neurovascular link between the hypothalamus and anterior pituitary and ultimately release hormones into systemic circulation?
Parvicellular neurons
Is the anterior or posterior pituitary responsible for metabolism, growth/ development, reproduction, lactation, and response to stress?
Anterior
Is the anterior or posterior pituitary responsible for water balance, parturition/ lactation, regulation of BP, cardiac function, and diuresis?
Posterior
What hormone increases synthesis of GH and exerts its effect on many tissues?
Growth hormone releasing hormone (GHRG)
What hormone increases synthesis of TSH and prolactin and exerts its effects on the thyroid gland and mammary glands?
Thyrotropin releasing hormone (TRH)
What hormone decreases synthesis of GH and TSH?
Somatostatin
What hormone increases synthesis of LH and FSH, is synthesized in the gonadotrophs, and exerts its effects on the gonads?
Gonadotropin releasing hormone (GnRH)
What hormone increases synthesis of ACTH and exerts its effects on the adrenal glands?
Corticotropin releasing hormone (CRH)
What hormone increases synthesis of Prolactin and exerts its effects on the mammary glands?
Prolactin releasing factor (PRF)
What hormone inhibits prolactin synthesis?
Dopamin (Prolactin inhibiting hormone, PIH)
Which hormone is responsible for growth via IGF production in the liver and energy metabolism?
Growth hormone releasing hormone (GHRG)
Which hormone is responsible for growth of the thyroid gland, synthesis of T3/T4, breast development, and milk production?
Thyrotropin releasing hormone (TRH)
Which hormone is responsible for ovulation/ secretion of estrogen, secretion of testosterone from Leydig cells, development of follicle, and initiation of spermatogenesis?
Gonadotropin releasing hormone (GnRH)
Which hormone is responsible for growth of the adrenal gland and synthesis of corticosteroids?
Corticotropin releasing hormone (CRH)
Which hormone is responsible for breast development and milk production?
Prolactin releasing factor (PRF)
Why type of neurons produce ADH/ AVP and oxytocin?
Magnocellular neurons
What hormones and neuropeptides with a short plasma half life?
ADH/ AVP and oxytocin
Is increased osmolarity or a decreased blood volume a stronger stimulator for release of ADH/ AVP?
Increased osmolarity (> 1% above normal Na threshold)
How do ADH/ AVP increase blood volume/ pressure and decrease osmolarity once they are released from the hypothalamus/ magnocellular neuron?
V2 receptor on principal cells of nephron activated
Increased aquaporins 1-4
Water reabsorbed from nephron
What 2 primary actions contribute to stimulation of oxytocin release?
Cervix stretching (parturition) Suckling on lactating breast
What is the highly sensitized OT receptor in the uterus mediated by?
OT/ progesterone
Gap junctions in smooth muscle cells
(200x in pregnant uterus)
Is continued suckling a positive or negative feedback loop?
Positive
Is suckling required for secretion of milk?
No- conditioned response to sight, smell, and sound of infant
What specific OT axis is present in the heart?
OT-natriuretic peptide-nitric oxide axis
How does OT contribute to cardiac function after ANP/ BNP are released from cardiomyocytes?
ANP stimulates release of NO from vascular epithelium
Once OT binds to receptors, what happens in vascular tissue?
NO dependent vasodilation leads to vasodilation/ decreased BP
Once OT binds to receptors, what happens in cardiac tissue?
Synthesis of ANP and NO leads to negative inotropic/ chronotropic effects which leads to ANP binding to NPR-A to cause vasodilation
With respect to renal function, at physiological concentrations, OT stimulates what?
Diuresis and natiuresis via renal OT receptor
Ateriole vasodilation, diuresis, natriuresis, kailuresism and decreased plasma volume are renal function responses to what hormone?
Oxytocin
How does increased plasma/ synthesis of OT affect production of cortisol?
Decreased production via decreased hypothalamic CRF
What is the site of spermatogenesis?
Seminiferous tubules
What is the testosterone mediated process that occurs along the length of the seminiferous tubules?
Spermatogenesis
What process results in the proliferation and differentiation of spermatogonia?
Mitosis
What is the result of meiosis from undifferentiated diploid germ cells?
Haploid spermatocyte that leads to 16 spermatids
What is the name for the packing and maturation of sperm in male reproduction?
Spermiogenesis
What does synctium ensure?
That haploid cells contain either X or Y chromosome
What sets the rate for spermatogenic cycles?
Retinoic acid signaling within Sertoli cells
How long is a spermatogenic cycle?
16 days (~72 days to make sperm, 6 stages)
Around how mature sperm are produced daily?
~100-200 million
At what point in gestation to the testes descend, and why is this important?
~7 months
Allows for cooler temps to prevent lysosomal destruction
What determines the ultimate spermatogenic potential of the testes?
of Sertoli cells that occur in development
What provides the blood-testes barrier?
Tight junctions between Sertoli cells
What allows for the following:
Developing sperm travel to lumen
Prevents immune cells from accessing genetically variant spermatozoa
Required for fertility
Blood-testes barrier
What is the role of gap junctions between spermatocytes and Sertoli cells?
Permits transfer of nutrients
What allows the Y-sperm to transport necessary gene products to the X-sperm?
Cytoplasmic bridges joining early spermatids
What cell is responsible for the protection and physical, metabolic, and nutritional support to the developing sperm?
Sertoli cells
What cell absorbs excess cytoplasm and wastes from developing sperm?
Sertoli cells
What cell is responsible for regulation of internal environment of seminiferous tubule?
Sertoli cells
What cell secretes seminiferous tubule fluid to aid in flushing sperm to epididymis?
Sertoli cells
What cell produces androgen binding protein to sequester T?
Sertoli cells
What hormones stimulate Sertoli cells and what hormone do Sertoli cells release?
Stimulated by T and FSH
Release Inhibin
What cell secretes anti-mellerian factor during development?
Sertoli cells
At what point do Sertoli cells cease production?
At end of puberty
Hypogonadism is a condition in which the testicles are smaller than N size and have what?
Below normal sperm counts
What is the process by which spermatids mature in spermatozoa?
Spermiogenesis
In the maturation of spermatids, what happens to the head?
Elongates and cytoplasm is lost
In the maturation of spermatids, what happens to the nucleus?
Remodels and chromatin condenses
In the maturation of spermatids, what happens to the lysosomes?
Form acrosome
In the maturation of spermatids, when does transcription stop?
2 weeks before maturation
In the maturation of spermatids, what segment is involved with the mitochondria moving to the base to power the sperm?
Midpiece
What is the name of the process in which mature sperm are extruded from Sertoli cells into the lumen of the seminiferous tubules?
Spermiation
In spermiation, what do the sperm pass through for processing/ storage?
Rete testes
What is the name of the maturation area located near the upper portion of each testicle that holds sperm after they are transferred under pressure and smooth muscle contraction?
Epididymis
During spermiation, are sperm capable of movement and/or fertilization?
No
During spermiation, what happens after contraction of myoepithelial cells?
Spermatozoa propelled into vas deferens
What 2 things control spermatogenesis?
Synergistic action of T and FSH
Presence of adequate Sertoli cells
Which hormone involved in spermatogenesis acts by pulsatile release?
GnRH
Which hormone involved in spermatogenesis sensitizes Sertoli cells to T and promotes Inhibin and androgen binding protein (ABP) secretion from Sertoli cells?
FSH
Which hormone involved in spermatogenesis stimulates cholesterol desmolase within Leydig cells to produce testosterone?
LH
In spermatogenesis, what do T and Inhibin regulate?
T regulates LH and FSH
Inhibin selectively regulates FSH
T can be peripherally converted to dihydrotestosterone or estradiol in target tissues via what enzymes?
5a-reductase, aromatase
What is the result of T binding to androgen binding protein (ABP) from Sertoli cells?
T becomes concentrated in seminiferous tubules
T circulates within peripheral circulation bound to what hormone?
Sex hormone binding globulin (SHBG)
What is the role of testosterone in embryonic/ fetal development? (2)
Masculine reproductive tracts/ external genitalia
Descent of testes
What is the role of testosterone in sex-specific tissue after birth? (3)
Maturation of reproductive system at puberty
Spermatogenesis
Maintenance of reproductive tract
What is the role of testosterone in reproduction related effects? (2)
Increased sex drive
Controls gonadotropin secretion
What is the role of testosterone in secondary sex characteristics?
Male pattern hair growth, deepens voice, muscle growth/ male adiposity
What areas of the brain does T contribute to the development of?
Pre-optic area, hippocampus, amygdala
What hormone is responsible for increased protein anabolic effects?
Testosterone
What hormone is responsible for promoting bone growth at puberty and closing epiphyseal plates?
Testosterone
What hormone has the potential to induce aggressive behavior?
Testosterone
How potent is dihydrotestosterone compared to testosterone?
2x
Is T or DHT responsible for differentiation of the Wolffian ducts into the epididymis, vas deferens, and seminal vesicle?
T
Is T or DHT responsible for increased muscle mass, pubertal growth spurt, deepening of voice, and growth of penis and seminal vesicles?
T
Does T or DHT play a role in negative feedback on the anterior pituitary?
T
Is T or DHT responsible for libido?
T
Is T or DHT responsible for differentiation of the penis, scrotum, and prostate?
DHT
Is T or DHT responsible for male hair pattern and male pattern baldness?
DHT
Is T or DHT responsible for sebaceous gland activity?
DHT
Is T or DHT responsible for growth of the prostate?
DHT
What is cryptorchidism and how does it affect fertility?
Undescended testes
Affected men unable to produce viable sperm
If a pt has < 15 million sperm/ mL of semen, along with poor sperm motility and defects in sperm morphology, what condition do they have?
Oligozoospermia
How can pollution such as polychlorinated biphenyls (PCBs) and heavy mental exposure (lead) result in oligozoospermia?
Reduce sperm count and sex hormone
What environmental factors can contribute to oligozoospermia?
Pollution, XR, lifestyle (tobacco, alcohol, steroids), stress
What mechanism can contribute to oligozoospermia via activation of the HPA axis and can influence normal function of the HPG axis?
Stress
What is the treatment for oligozoospermia?
Rx, lifestyle changes, assisted reproduction therapy, testicular sperm in place of ejaculated sperm
How can things like tight clothing, hot tubs, and sitting too long result in low sperm counts?
Interference with ability of scrotum to cool testes
What are the effects of marijuana on fertility?
Reduces fertility by decreasing sperm #’s, altering morphology, and reducing sperm activity
Endocannabinoid receptors in sperm present in the HPG axis have what effect?
Suppressive effect
Use of what can lead to altered male sex hormones?
Marijuana
Androgen Deficiency in Aging Males is aka what?
MANOPAUSE
ADAM is ultimately due to a decreased production of T and sperm during what phase?
Senescence
If a pt presents w the following, what should you tell them they are experiencing?
Changes in mood, energy and appetite
Decreased bone formation, muscle, sex drive, body height, Hct, facial hair
ADADM (manopause)
How does ADAM (manopause) relate to CV disease?
Increased risk
Exogenous testosterone will affect the endocrine system by decreasing what?
LH, FSH, sperm production
Exogenous testosterone will affect the endocrine system by increasing what?
Free estrogens, peripheral conversion of T to estrogen
What are the following risks associated with? CV disease Visceral obesity Erythrocytosis Fluid retention BPH Prostate cancer Acne Hepatotoxicity Infertility Obstructive sleep apnea Gynecomastia and breast CA Behavioral issues Depressed immunity
Exogenous testosterone
What stimulates pubic and axial hair growth?
DHEA via adrenal cortex
What stimulates male hair growth and is the cause of male pattern baldness (male androgenic alopecia)?
DHT
Synergism of DHT and IGF-1 result in what?
Beard growth
Scalp hair growth is reduced by what?
DHT and transforming GF beta1 (TGF-beta1)
What occurs with 5alpha-reductase conversion of T to DHT?
Hair follicle miniaturization
Proof that DHT stimulates male hair growth and is the cause of male pattern baldness (male androgenic alopecia) can be seen via what populations?
Castrated males, eunuchoidal pts with androgen insensitivity syndrome and those with 5alpha-reductase deficiency DO NOT go bald
What drug is used to treat androgenic alopecia or enlarged prostates by blocking DHT?
Propecia/ finasteride
5alpha-reductase antagonists binding irreversibly to an enzyme to prevent conversion from T to DHT is the MOA for what drug?
Propecia/ finasteride
What are the SE’s of Propecia/ finasteride?
ED, loss of libido, reduced ejaculate
Accessory organs collectively produce what % of semen, making the remaining composition as sperm?
90% (remaining 10% is sperm)
What % of ejaculate is contributed by the seminal vesicles?
60%
What % of ejaculate is contributed by the prostate?
20%
What % of ejaculate is contributed by the bulbourethral glands?
10%
What accessory organ in semen production contributes fructose, prostaglandins, and clotting factor?
Seminal vesicles
What is the role of fructose and prostaglandins in ejaculate?
Fructose nourishes sperm
Prostaglandins stimulate M/F reproductive tract
What accessory organ in semen production contributes an alkaline fluid to counter the acidic vaginal environment?
Prostate
What triggers clotting to keep sperm in the vagina?
pH
What accessory organ in semen production contributes lubrication fluid?
Bulbourethral glands
What 3 things stimulate erection?
- Sexual thoughts (higher brain center)
- Mechanical stimulation of glans
- Periodic PNS impulses from sacral erection generating center
What is the integration site for CNS control of erections?
Medial preoptic area (MPOA)
Once the MPOA receives sensory input from the amygdala, where does it send impulses?
Paraventricular nuclei and periaquaductal gray matter in sacral spinal cord
How does mechanical stimulation of the glans stimulate an erection?
Sensory feedback to sacral erection generating center (S2-4)
What results in vasodilation of penis arterioles?
PNS release of NO
NO activation of guanylyl cyclase/ production of cGMP activates myosin phosphatase in SM. What effect does this have on Ca2+ and what is the overall effect on the penis?
Decreases intracellular Ca2+ to promote relaxation and stimulate erection
What role do skeletal muscles play in periodic PNS impulses from sacral erection generating center stimulating an erection?
Skeletal muscles at the base of the penis result in mechanical compression of veins
What degrades cGMP to ultimately block the pathway of erection stimulation?
Phosphodiesterase
Periodic PNS impulses from sacral erection generating center stimulating an erection involves PNS stimulation of what glands?
Bulbourethral glands
Tonic SNS stimulation leads to what?
Flaccid penis
Concurrent SNS inhibition and PNS stimulation allows males to get an erection in how long?
5 seconds
Contraction of what structures limit BF into the penis, ultimately leading to a flaccid state?
Helicine arteries and trabecular smooth muscle
Relaxation of what structure by NO and increased BF into where induces engorgement and leads to an erect state?
Relaxation of helicine arteries
Increased BF into cavernous space
Compression of what structures decreases venous outflow in an erect state?
Subtunical venules
Ejaculation is divided into what 2 stages and is affected by stimulation of what?
Emission and expulsion
SNS and somatic stimulation
During emission, SNS stimulation from L1/2 causes semen to enter the urethra from contraction of what glands?
Accessory glands
During emission, once semen enters the urethra from contraction of the accessory glands, SNS then stimulates what?
Smooth muscle, leading to further contraction of accessory glands
During expulsion, somatic nerve impulses with rhythmic activation of skeletal muscles at the base of the penis is triggered by what?
Filling of urethra
What is the average amount of total ejaculate produced (after several days of abstinence)?
2-6 mL
How many sperm are present in each mL of ejaculate?
~20-100 million
What is the ejaculation pathway? (4 steps)
Vas deferens
Ampulla
Urethra
Exit
What results in the urethral sphincter and semen entering the bladder?
Retrograde ejaculation
Psychic stimuli target what parts of the brain contributing to male sexual response?
Cortex, limbic, hypothalamic
Psychic stimuli + physical stimuli lead to what as part of the male sexual response?
PNS arterial dilation followed by SNS impulses
NO, Ach, vasocongestion, penile engorgement, and stimulation of bulbourethral glands contribute to what aspect of the male sexual response?
PNS arterial dilation
Emission + expulsion of semen, and contraction of pelvic musculature to enhance sperm mobility contribute to what aspect of the male sexual response?
SNS impulses
What are the 4 steps that make up orgasm/ resolution?
- Excitement
- Plateau
- Orgasm
- Resolution
What stage of male sexual response is marked by flushed skin, increased muscle tone, nipples hardening, increased BF to genitals, scrotum tightens, and presence of lubricating emissions from penis?
Excitement
What stage of male sexual response is marked by the testicles withdrawing into the scrotum?
Plateau
Orgasm occurs when what intensifies?
Conditions of excitement phase
What stage of male sexual response is marked by culmination of expulsion of semen, increased emotions, pleasure, HR, and perspiration?
Orgasm
What stage of male sexual response is marked by involuntary muscle contractions and rhythmic contractions at the base of the penis?
Orgasm
Besides SNS vasoconstriction impulses returning the body to normal function, what else occurs during the resolution stage of male sexual response?
BF to penis slows
Temporary variable refractory period
What is failure to achieve erection despite appropriate stimulation?
ED
How is the normal cGMP pathway impacted with ED?
PED degrades cGMP = unable to activate SM, decrease IC Ca2+ and promote relaxation
What is the role of PDE inhibitors (PDE5) in the treatment of ED?
Sustain NO stimulated cGMP levels in the penis
What drugs are PDE inhibitors?
Viagra, Cialis, Levitra
When were PDEIs discovered and what are they currently used for besides ED?
While looking for angina txs, currently used for pulm HTN
High doses of PDEIs activate what enzyme/ have what effect?
Activate PDE6 in retina
Responsible for vision changes
What alternative ED treatment involves needle injection therapy or self-administered intraurethral therapy (Muse)
Prostaglandin E
HRT, penis pumps, vascular surgery, penile implants, and psychological counseling/ sex therapy are alternative options for what condition?
ED
What are the 3 forms of male contraception?
Condoms, “withdrawal method”, vasectomy
What structure is cut/ ligated at the end in a vasectomy?
Vas deferens
What does a vasectomy prevent?
Sperm from moving through ejaculatory tract/ out penis
Does a vasectomy also affect accessory gland function and T levels?
No
semen just contains no sperm
How are sperm removed after a vasectomy?
Phagocytosis
What procedure reverses a vasectomy?
Vasovasostomy
One of the functions of the ovaries is the production of ova, which is known as what?
Oogenesis
Ova secrete what two primary hormones?
Estrogen and progesterone
What hormone contributes to the following:
Secondary sex characteristics
Ova maturation and release
Contributes to transport/ viability of sperm
Contributes to breast development for lactation
Estrogen
What hormone primes tissues to progesterone (increases progesterone receptors)?
Estrogen
What hormone prepares the uterus for nourishment of embryo/ fetus and contributes to the breasts ability to produce milk?
Estrogen
What is the product of fertilization?
Embryo
After how long of intrauterine development does an embryo become a fetus?
2 months
If no fertilization occurs, what happens to the oocyte?
It is discarded in menses (without completing oogenesis)
How long is the ovarian cycle and what are it’s phases?
28 days
Phase 1 = follicular phase
Ovulation = mid-point between phases
Phase 2 = Luteal phase
What happens to the granulosa cells of some primary follicles during the follicular phase of the ovarian cycle?
Become cuboidal and proliferate (outer cells become stratified)
What is secreted by granulosa cells during the follicular phase of the ovarian cycle?
Zona pellucida (gel-like substance that covers oocyte)
During the follicular phase of the ovarian cycle, what do surround ovarian tissues differentiate into?
Is this a hormone dependent or hormone independent process?
Theca cells
Hormone independent
At what point does oogenesis stop and regress in a prepubertal ovary?
After ovarian tissues differentiate into theca cells
What is the role of granulosa and theca cells during the follicular phase of the ovarian cycle?
Secrete increased amounts of estrogen
During the follicular phase of the ovarian cycle, after rapid follicular growth, what estrogen-storing structure is formed?
Atrum (fluid filled cavity)
During the follicular phase of the ovarian cycle, one follicle usually grows more rapidly and matures ~14 days after onset of follicular development. What is this follicle called and what happens to the remaining follicles?
Graafian follicle
Remaining follicles degenerate
Ovulation is the process in which the follicle ruptures by enzyme digestion to release what from where?
Oocyte from ovary
What happens after ovulation to the released oocyte?
Enters oviduct where it may/ may not be fertilized
What is the name of the process for old follicular cells undergoing a structural transformation to become the corpus luteum?
Luteinization
During the luteal phase of the ovarian cycle, what do the enlarged luteal cells become?
Steroid hormone producing tissue (estrogen and progesterone)
What is the name of the “yellow body” due to cholesterol storage?
Corpus luteum
What happens to the corpus luteal after formation?
Becomes highly vascularized and is fully functional within 4 days after ovulation
How long does the corpus luteum continue to increase in size after it is fully functional?
4-5 days
The corpus luteum will degenerate within ~14 days after formation to become the corpus albicans if what does not occur?
Fertilization and implantation
Why is the corpus albicans named as such?
“White body” due to fibrous tissue
If fertilization and implantation do occur during the luteal phase, what happens to the corpus luteum?
Continues to grow/ produce estrogen and progesterone to produce the corpus luteum of pregnancy
Once estrogen is secreted into the blood, what kind of effects does it have?
Systemic
The estrogen that remains within the follicle after its production contributes to what?
Antral formation
After estrogen production, local estrogen and FSH stimulate proliferation of what?
Granulosa cells
What does estrogen bind to for transport?
Sex hormone binding globulin (SHBG)
What does progesterone bind to for transport?
Corticosteroid binding globulin (CBG)
What hormones increase SHBG?
Estrogen and thyroxine
What hormones decrease SHBG?
Progesterone and androgens
Does the amount of free vs bound estradiol vary significantly during the menstrual cycle?
No
What hormone is released in a pulsatile manner during the follicular phase?
GnRH
What makes up 10-15% of the pituitary as a mixed population and is affected by general feedback control by estrogen?
Gonadotropes
Estrogen has general feedback control
What type of gonadotropes are stimulated by low pulse frequency of GnRH?
FSH gonadotropes
What type of gonadotropes are stimulated by high pulse frequency of GnRH?
LH gonadotropes
What hormones stimulate ovarian follicles in the follicular phase?
FSH and LH
What hormone induces inhibin released from granulosa cells in the follicular phase?
FSH
What is the effect of inhibin on FSH release?
Negative feedback
What is the effect of prolactin, stress, exercise, and chronic illness of GnRH release?
Inhibits release
During the follicular phase, increased FSH signals the ovarian follicle to secrete what?
More estrogen
Does the rise of fall of estrogen inhibit FSH secretion which declines as follicular phase rises?
Rise
Does LH rise or fall during the follicular phase?
Rises
During the follicular phase, estradiol from the ovary blocks the anterior pituitary, leading to a decrease in release of what 2 hormones?
FSH and LH
Are estrogen levels high or low during ovulation?
High (dominant follicle has had a + cycle for estrogen synthesis)
What structures increase GnRH frequency and receptors respectively during ovulation?
Hypothalamus and pituitary
With regards to hormones, what happens at ovulation?
Explosive LH surge at mid cycle
Why does FSH not rise as much during ovulation?
Due to inhibin
What event during ovulation has the following effects:
Conversion of antral follicle to Graafian follicle
Resumes meiosis
Stimulates production of proteolytic enzymes in follicle
Increases prostaglandins
Differentiates follicle cells into corpus luteum
LH surge
What is the result of increased prostaglandins from the LH surge during ovulation?
Increases follicular BF, wall distensibility, and proteolytic enzymes
During ovulation, estradiol contributes to a positive feedback loop with the anterior pituitary gland leading to what?
Increased release of FSH and LH
Decrease of what hormone leads to the conversion of a mature follicle to corpus luteum during ovulation?
Estrogen
During the luteal phase, ruptured follicular granulosa and theca cells are transformed into luteal cells by what?
LH surge
Luteal cells make high levels of what 2 hormones?
Estrogen and progesterone
What effect does progesterone have on the hypothalamus and pituitary?
Negative feedback (decreases release of FSH/ LH and suppresses positive estrogen feedback)
Low LH stimulates what during the luteal phase?
Degeneration of corpus luteum
Progesterone levels fall and FSH rises, which begins what if pregnancy does not occur?
A new cycle
When is placental human chorionic gonadotropin (hCG) produced?
Pregnancy
What 3 phases make up with endometrial (uterine) cycle and how long is each phase?
- Menstrual phase (~days 0-4)
- Proliferative phase (~days 5-14)
- Secretory (progestational) phase (days 15-28)
What marks the start of a new endometrial cycle?
1st day of menstruation
How long does menses occur after ovulation regardless of the cycle length?
14 days
In pts with endometrial cycles longer than 28 days, which phase is prolonged?
Proliferative
The menstrual phase coincides with the end and onset of which 2 phases?
End of ovarian luteal phase
Onset of follicular phase
Release of what results in vasoconstriction of endometrial vessels (death of endometrium) and stimulates contractions of uterus to expel blood from uterus to vagina?
Release of uterine prostaglandins
The beginning of the proliferative phase is concurrent with the end of which phase?
Ovarian follicular phase
During the proliferative phase of the endometrial cycle, the endometrium starts to repair itself and proliferative under the influence of what hormone?
Estrogen from newly growing follicles
When does the estrogen-dominant proliferative phase occur?
End of menstruation to ovulation
At what point does the secretory phase of the endometrial cycle begin?
After ovulation when new corpus luteum is formed
What converts the endometrium to highly vascularized, glycogen filled tissue?
Progesterone
What is actively secreted by endometrial glands?
Glycogen
Estrogen is responsible for the growth and development of what 3 female reproductive organs?
Vagina, uterus, oviducts
Effects of estrogen on which female reproductive structure are responsible for increased number of cilia and rate of beating to draw up ovum?
Fallopian tubes
What are the 2 layers of the uterus?
Endometrium and myometrium
Effects of estrogen on the endometrium or myometrium result in increased oxytocin receptors and contractions?
Myometrium
Effects of estrogen on the endometrium or myometrium results in thickening/ increasing permeability and blood supply?
Endometrium
What is the primary effect of estrogen on the endometrium?
Synthesizes receptors for progesterone on uterine cells
Estrogen contributes to the mucous thin, watery and alkaline environment of what structure?
Cervix
Estrogen contributes to increased distensibility of what structure, making birthing easier?
Cervix
Effects of estrogen on what structure result in proliferation of the epithelial layer and increased secretions?
Vagina
Estrogen is required for growth of the mammary glands. How specifically does it contribute to this growth?
Increased ductal growth and increased nipple size/ pigmentation
What general effects does estrogen have on the body?
Increased subq fat to hips/ breasts
What hormone is responsible for epiphyseal closure, facilitates Ca uptake into bone, antagonizes PTH on bone, decreases production of cytokines and inhibits osteoclasts in females?
Estrogen
Estrogen contributes to increased absorption of what 3 molecules, which contributes to bloating during menses?
Na, Cl, H2O
What hormone is responsible for maintaining high HDL, low LDL, is an arterial vasodilator, and helps decrease atherosclerosis?
Estrogen
What effects does estrogen have on the skin?
Promotes pubic and axillary hair, inhibits other body and facial hair growth
What hormone helps adjust body temp, increases memory, and adjusts libido in females?
Estrogen
What hormone helps decrease cholesterol in blood?
Estrogen
What is the effect of progesterone as a pregnancy hormone?
Responsible for implantation of zygote and maintenance of the pregnant state
In which 2 female reproductive structures does progesterone antagonize the effects of estrogen?
Cervix and vagina
In order for progesterone to exert its effects on the uterus, what needs to happen first?
Estrogen primes structure prior to stimulation
What hormone is responsible for increased development/ differentiation of endometrial glands, induces decidua formation and decreases contractility of the uterus?
Progesterone
What hormone is responsible for increased branching of the ductal system and helps stimulate the development of lobules/ alveoli?
Progesterone
What hormone is responsible for increased temp following ovulation and increased appetite?
Progesterone
What is used as an indicator that ovulation has occurred?
Increased temperature (0.5 deg)
What hormone is responsible for decreased Na+ reabsorption by competing with aldosterone?
Progesterone
At what point to cramps occur during menstruation due to the contraction of the uterus via increased prostaglandins?
0-2 days
If a pt presents with severe pain and N/V/D with menstruation, what is this called?
Dysmenorrhea
In which phase does PMS occur?
Luteal phase
If a pt experiences severe PMS sxs accompanied by sxs relating to a severe mood disorder, what should you be concerned for?
PMDD (premenstrual dysphoric disorder)
The following sxs are related to what?
Bloating of abd/ pelvis, weight gain/ increased appetite, breast tenderness, ankle edema, HAs, irritability, mood swings, depression, anxiety, fatigue, and difficulty concentration/ working effectively?
PMS
As a female progresses from perimenopause to menopause, what happens to the follicle pool?
Progressively decreases
During progression from perimenopause to menopause, decreased E2 (estradiol) and delayed pos. feedback leads to what?
A longer cycle
During progression from perimenopause to menopause, insufficient E2 (estradiol) and no feedback leads to what?
Anovulatory
As a patient begins progression from perimenopause to menopause, what happens to inhibin and FSH levels?
Inhibin decreases, FSH increases
As a patient begins progression from perimenopause to menopause, what is the result of acceleration of follicular maturation?
Shorter cycle
As a pt nears menopause, progressively decreased E2 leads to what 2 things?
Cycle arrest (menopause) Increased LH/ FSH
What is the decline in fertility associated with decline in ovarian function?
Menopause
Menopause is related to a drop in critical mass of primordial follicles between what ages?
40-58 yo
Follicular atresia accelerates at the age of ~37.5. What is this point called?
Climacteric
What must your FSH levels be in order to dx menopause?
> 30 mLU/mL
Also typically no menses for 12 mos
Hot flashes, urogenital atrophy, decreased cognitive fxn/ increased Alzheimers risk, osteoporosis, and CV disease are clinical concerns associated with what?
Menopause
Urogenital atrophy results in atrophy of what estrogen dependent tissues as well as what 2 other sxs?
Breast, uterus, vagina
Decreased vaginal secretions, painful intercourse
In a female a tubectomy targets what structures in order to prevent eggs from reaching the uterus for fertilization?
Fallopian tubes clamped and blocked OR severed and sealed
When/ how can a tubectomy be performed?
Laparoscopically or w/ C-section
Hormonal contraception for a female can include oral pills with combo prep or progesterone only. What is the mechanism of action for these methods of contraception?
Prevent ovulation by negative feedback on anterior pituitary preventing LH surge
Thickened cervical mucous leading to decreased sperm motility, decreased motility of uterus and fallopian tubes, and decreased glycogen production are results of what?
Hormonal contraception
What is the result of decreased uterine glycogen production with female hormonal contraception?
Impairs blastocyst survival and interferes with implantation
What part of the Y chromosome makes Testes Determining Factor (TDF) which promotes testes differentiation?
Sex determining region of Y (SRY)
What chromosome is required to activate the genetic pathway for ovarian development?
XX
An XO chromosome is indicative of what condition?
Ovarian dysgenesis (Turner’s syndrome)
At what point during gestational life are the gonads indifferent/ bipotential?
First 5 weeks
If there is no SRY gene/ TDF, at what point to ovaries develop?
Week 9
What are the 3 types of cells in the testes?
Germ, Sertoli, Leydig
What are the 3 types of cells in the ovaries?
Germ, Granulosa, Theca
What is the term for apparent anatomic sex that is determined by gonadal sex?
Phenotypic sex
What hormone results in atrophy of mullerian ducts and prevents development of female GU tract?
AMH (anti mullerian hormone)
When does DHT stimulate differentiation of external genitalia in men?
~9-10 weeks
Are hormones needed for the development of ovaries?
No, but 2 functional X chromosomes required
When mullerian ducts do not regress, they give rise to what?
Fallopian tubes, uterus, upper 1/3 of vagina
Are hormones needed for the development of external genitalia (lower 2/3 of vagina, clitoris, labia major/minor)
No
hormone response for growth of female external genitalia to normal size?
Estradiol
If F is exposed to hight levels of androgens in utero what effect will this have on external genitalia?
Differentiates into male-like phenotype
Loss of function of the androgen receptor gene is what developmental disorder?
Complete androgen insensitivity syndrome (undervirilized XY)
Regression of Wolffian and Mullerian ducts with female external genitalia but a blind ended vagina is what developmental disorder?
Complete androgen insensitivity syndrome
What labs will be high for Complete androgen insensitivity syndrome? (3)
T, LH, AMH
What labs will be normal w/ Complete androgen insensitivity syndrome? (3)
DHT, FSH, Inhibin
Chromosome karyotype for complete androgen insensitivity syndrome?
46XY
US on pt w/ complete androgen insensitivity syndrome will show what?
No ovaries or uterus. Male testes
Genetic skin fibroblast bx for Complete androgen insensitivity syndrome will show what?
Absence of binding affinity of T to androgen receptors
TX for Complete androgen insensitivity syndrome?
laparoscopic gonadectomy & E replacement therapy
Pt w/ XY lacking SRY gene will not have what? And will develop as a M or F?
No gonads.
F
Pt w/ XX w/ SRY translocation will have what? And develop as M or F?
Testes
M
Pt w/ XY w/ defective AMH production/action will have ovaries or testis? M, F, or both internal genitalia, w/ M or F external genitalia?
Testes
M/F int. genitalia
M ext. genitalia
XY w/ absence of T production/action will have what, be missing what, and will have what external genitalia?
Testes
no M/F int. genitalia
F-like ext. genitalia
5a-reductase deficiency (male pseudohermaphroditism) will have testes with M internal genitalia and M or F external genitalia?
F-like external genitalia
Maturation of the HPG occurs during what?
Puberty
Female puberty begins are what age?
8-13 yrs
Onset of female puberty is marked by what?
Thelarche (breast development)
Thelarche
Pubarche (pubic hair)
Menarche
After thelarche is?
Pubarche
Females w/ growth spurt in early puberty due to what 2 hormones?
GH, IGF-1
GnRH releases what two hormones in cyclic bursts? Which is released in greater amounts?
LH > FSH
Males puberty begins at what ages?
9-14 yrs
Onset of male puberty is marked by?
1) Increased testicular size
2) Development of pubic hair
3) Penile enlargement
Sperm production/ejaculatory capacity occurs at what age?
13
Adult testicular volume/penile size is achieved by what age?
16 yrs
Do males have growth spurt at beginning or end end of puberty?
End. Final height reached at 18 yrs
What hormone promotes fusion of epiphyseal plates?
Estrogen
Main factor in determining puberty timing?
Genetics
What is hypothalamic maturation hypothesis?
Increased pulsatile GnRH (LH > FSH) release correlates to onset of early puberty
Are what ages does GnRH peak? (3)
Gestation, early infancy, after 50
What role might Leptin play in puberty?
Metabolic signal from adipose tissue that may control the onset of sexual maturation
How might low levels of melatonin, a hormone secreted by the pineal gland that inhibits GnRH, impact puberty?
May initiate puberty
Precocious puberty is the development of secondary sex characteristic before what ages? (M vs F)
M = 9 F = 8
Gondatoropin-independent precocious puberty has what levels of gonadotropin and gonadal hormones?
N gonadotropins
High gonadal hormones
Failure of fetal migration of GnRH to the hypothalamus resulting in anosmia is what form of Hypogonadotropic hypogonadism?
Kallman’s syndrome
Kallman’s syndrome has both high or low gonadotropins and gonadal?
Low
Klinefelter’s syndrome (47, XXY) is hyper or hypogonadotropic?
Hyper (high gonadotropins, low gonadal hormones)
Female genital tract with no fxn gonads and delayed or absent puberty with amenorrhea is what?
Turner’s syndrome (high gonadotropins, low gonadal hormones)
What % of sperm makes it from the vagina into the cervical canal?
3%
How long does it take for sperm to reach the 1/3 of the oviduct when fertilization occurs?
30-60 min (0.001% sperm make it)
Fertilization must occur within what time frame from ovulation?
24 hrs
How long do sperm live in the reproductive tract?
48-5 days
What is released by the mature egg to attract sperm and aid in sperm migration?
Allurin
Contraction of the myometrium allows for upward contraction of the smooth muscles and estrogen in the cervix is responsible for thinning the mucous, together these aid in what?
Sperm motility
The prostate gland increased pH of semen and prostaglandins in ejaculate promotes uterine contractions, these aid in what?
Sperm motility
What hormone causes milk duct growth?
Estrogen
Progesterone, prolactin, and hCS stimulate growth of what in the breast for lactation?
Lobules and alveoli growth
Prolactin (during gestation) and hCS produce what to aid in lactation?
milk enzymes
What 2 hormones promote lactation?
Cortisol and insulin
During pregnancy X and X block action of prolactin inhibiting lactation. These hormones levels fall after birth so lactation can occur
Progesterone and estrogen
Sucking is a positive or negative feedback mechanism?
Positive
Suckling signals to hypothalamus to release oxytocin/prolactin
What hormones causes milk let down?
Oxytocin (posterior pituitary)
What anterior pituitary hormone stimulates secretion/production of more milk and lactogenesis?
Prolactin
Prolactin release is stimulated by what?
Thyrotropin releasing hormone
Is dopamine stimulatory or inhibitory on prolactin secretion?
inhibitory
Prolactin inhibits GnRH (inhibits LH/FSH) release preventing what?
Ovulation
When does ovulation resumes in non-lactating women?
7-10 wks postpartum
When does ovulation resume in lactating women?
27 weeks (7 mos) postpartum
T or F: Prolactin levels decrease during periods of breastfeeding?
False
T or F: Regular breastfeeding will provide full ovulatory suppression?
True
The first step in sperm penetration involves the sperm penetrating the corona radiata via enzymes in the head and binding to what?
ZP3 proteins on zona pellucida
Binding of the sperm to the ZP3 proteins on the zona pellucida triggers and acrosome reaction in which what are released onto the zona pellucida?
Hydrolytic enzymes in acrosome
What digests the zona pellucida?
Acrosomal enzymes
Acrosomal enzymes digest the zona pellucida which creates a pathway for the sperm to travel where?
To the ovum
Once the sperm reaches the ovum, what happens to the 2 plasma membranes?
They fuse
After the sperm head with DNA enters the ovum cytoplasm, the sperm, the sperm stimulates release of enzymes from where?
Cortical granules of ovum
What is the role of the cortical granules released from the ovum?
Inactivate ZP3 proteins and harden zona pellucida
What does hardening of the zona pellucida prevent?
Polyspermy
What provides sperm the ability to fertilize eggs?
Sperm capacitation
What 3 steps are involved in sperm capacitation?
- Cholesterol withdrawal
- Surface proteins redistributed
- Calcium influx
What does the term whiplashing refer to?
Increased motility of sperm during capacitation
What reaction do capacitated sperm undergo once they penetrate the corona radiata and contact the zona pellucida?
Acrosome reaction
Where does fertilization occur during the acrosomal reaction?
Ampulla of oviduct
During the zona reaction, the sperm fuses to the ovum membrane via what 2 things binding between the sperm head and ovum membrane?
Binding of fertilin on sperm head to integrin receptor on ovum membrane
What describes the structual change in zona pellucida and release of cortical granules containing enzymes that degrade ZP3 proteins and harden glycoproteins on zona pellucida?
Zona reaction
What is the formation of the female and male pronucleus?
Fusion
Prevention of polyspermy involves signaling the ovum for completion of what along with extrusion of the 2nd polar body?
2nd meiotic division
A fertilized ovum divides mitotically and within 1 week differentiates into what?
Blastocyst capable of implantation
moves to uterine cavity 4 days after ovulation
How does the blastocyst implant in the endometrial lining?
Enzymes that digest endometrial tissue
5 days after ovulation
During what days of the endometrial cycle is it optimal for implantation due to progesterone action?
Days 20-24
Levels of what are detectable once implantation is complete ~8-11 days after conception?
hCG
What is the role of placental hCG after implantation occurs?
“Rescue” corpus luteum
With implantation of the blastocyst, the free floating blastocyst adheres to the endometrial lining and what begins to penetrate the endometrium/ disintegrate trophoblastic cells?
Cords of trophoblastic cells
At what point is implantation considered finished?
When blastocyst is completely buried in endometrium
How long after implantation is the placenta functional?
5 weeks
What performs digestive, respiratory, and kidney functions for the fetus as well as prevents immunologic rejection?
Placenta
What acts as a transient endocrine organ, secreting essential pregnancy hormones?
Placenta
When do levels of hCG peak and what does this hormone cause?
9-12 weeks
Morning sickness
hCG stimulates the corpus luteum to secrete progesterone and estrogen until what happens?
Placenta takes over
Levels decline and plateau
At the start of pregnancy, estrogen requires what 2 things for synthesis?
Fetus and placenta
What is the most important estrogen of pregnancy?
Estriol
Levels of estrogen in what are an indication of fetal health?
Maternal urine
The following pathway ultimate leads to what hormone being produced? In mother or fetus?
Synthesis via maternal cholesterol > placenta > pregnenolone > fetus > DHEA sulfate (via fetal adrenal gland) > 16-OH DHEA-sulfate (via fetal liver) > placenta > ??
Estriol in mother
What hormone is responsible for the following functions?
- Increased myometrium growth - muscles for labor
- Ductile system of breasts
- Stimulates prolactin release by ant pituitary
- Relax and soften pelvic ligaments
- Inhibits lactation (antagonizes prolactin effect on breast, inhibits lactalbumin required for lactose synthesis)
Estriol
How long is gestation (on average)?
38 wks
Synthesis of connexons for gap junctions w/in uterine walls due to high levels of estrogen in the beginning of labor allows for what?
Links cells for coordinated contraction
Estrogen increases concentration of myometrial receptors for oxytocin this allows for what?
Increased responsiveness to oxytocin
Production of prostaglandin due to high estrogen levels during early labor increases responsiveness to oxytocin and stimulates enzymes to degrade collagen fibers leading to what?
Contribute to cervical ripening
Oxytocin is produced by what and stored where?
Produced in hypothalamus, stored in posterior pituitary
Do circulating levels of oxytocin remain constant or increase prior to the onset of labor?
Constant
Increased concentration of myometrial oxytocin receptors means what?
Uterine responsiveness is 100X greater at term vs non-pregnant women
Onset of strong coordinated contractions in response to normal levels of oxytocin happens when?
Once oxytocin reception concentration reaches critical threshold
Fetal placenta releases CRH in to fetal circulation this increases what fetal hormone?
Fetal ACTH
Increased levels of ACTH stimulates DHEA in fetal adrenal cortex this increases placental conversion to what hormone?
Estrogen
Increased ACTH stimulates fetal cortisol production this promotes what?
Fetal lung metabolism
High levels of maternal CRH can lead to preemie deliveries or late deliveries?
Preemie
CRH levels reach critical point, triggering labor, when what?
Infant is ready to live outside of the womb
Uterine stretching and increased macrophage production results in the activation of what?
nuclear factor (NF-kB)
NF-kB stimulates what (2) to promote cervical softening?
Inflammatory cytokines (IL-8) and prostaglandins
Activation of NF-kB by bacterial infection, allergic reaction, multiple fetus pregnancy leads to what?
Premature labor
What relaxes pelvic ligaments and softens uterine cervix by loosing the connective tissue b/w pelvic bones?
Relaxin
Relaxin is produced by what? (2)
Corpus luteum of pregnancy and by placenta
During 1st 2 trimesters high levels of what hormone prevents uterine contraction?
Progesterone
What are braxton hicks contractions?
Increasing activity of uterus due to falling progesterone levels (3rd trimester)
Volume of blood increases by what % during pregnancy?
30%
Do maternal kidneys excrete fetal waste?
Yes
Urinary output and increased respiratory activity (~20%) are a result of what?
Maternal body meeting demands of pregnancy
Labor, delivery and birth are considered what?
Partition
What is the synthetic form of oxytocin?
Pitocin
Uterine contractions increase until cervical dilation and delivery are complete. This is an example of what type of feedback?
positive feedback
What is the longest stage of labor (few hours-24 hrs)?
Cervical dilation
Delivery of the baby occurs after the completion of what?
Cervical dilation
What is the shortest stage of labor (15-30 min)?
Delivery of placenta
Final stage of labor?
Lactation
Progesterone and estrogen from the placenta is synthesized from what?
maternal cholesterol
During what weeks of gestation is progesterone secreted?
6-12 weeks and 12+ weeks
What hormone is responsible for:
- conversion of uterus to secretory gland ready for implantation
- formation of cervical plug, inhibition of myometrial contraction
- inhibition of prostaglandin synthesis in uterus
- development of alveolus and lobule in breast, inhibit lactose synthesis?
Progesterone
What disease is lacking 21 hydroxylase enzyme and has adrenal androgen excess
Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX)
Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX) has no, low or high levels of aldosterone and cortisol?
NO
Will Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX) have DHT?
Yes
What disease has decreased cortisol leading to increased ACTH resulting in hyperplasia of steroid producing cells and increased progesterone precursors converted into T
Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX)
What disease have virilized female genitalia, enlarged/penile clitoris, labial fold/empty scrotum, acne and hirsutism?
Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX)
True or false: Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX) is the most commone cause of genital ambiguity?
True
T or F; Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX) can lead to life-threatening adrenal insufficiency w/in first weeks of life?
True
US for Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX) will show what?
Ovaries, uterus, no testes
46 XX (ovaries and internal genitalia) is what disease?
Congenital adrenal hyperplasia 21-hydroxylase deficiency (virilized XX)
