Female Repro

Question 1

Signs of menopause

Answer 1

Elevated FSH (due to decreased GC cells, which normally secrete inhibin B) to LH ratio
Decreased estrogen (due to decreased GC cells)
Decreased AMH

No period for 1 year

Question 2

Effects of pregnancy on RAS

Answer 2

• estrogen produced by placenta causes increase in RAS
• increase in AII causes vasoconstriction that is COUNTERACTED by local vasodilators (esp progesterone)
• AII also increases intravascular volume
• AII up-regulates aldosterone to increase intravascular volume

Therefore: elevated AII, decreased vascular smooth muscle tone (probably a decrease in diastolic BP), elevated aldosterone

Question 3

Mechanism for short dose clomiphene

Answer 3

• SERM (selective estrogen receptor modulator)
• blocks ER-alpha to prevent negative feedback by estrogen
• allows for big increase in GnRH and thus FSH
• increase in FSH allows for many follicles to mature to preovulatory stage

Question 4

Activin

Answer 4

• stimulates FSH secretion
• secreted by gonadotropes
• autocrine effect
• secreted once inhibin B drops a few days prior to ovulation

Question 5

CYP11A

Answer 5

Expressed in theca and later granulosa cells

Converts cholesterol to prenenolone (rate limiting step)

Question 6

CYP17

Answer 6

Expressed in theca cells

Converts prenenolone to androstenedione and some testosterone

Question 7

CYP19

Answer 7

Expressed in granulosa cells, peripheral fat, and hypothalamus
Aromatase
Converts androstenedione/testosterone into E1/E2

Question 8

17B-HSD

Answer 8

Converts E1 to E2

Converts androstenedione to testosterone

Question 9

Estriol production

Answer 9

• most abundant steroidal estrogen
• held in check by E2 for most of pregnancy
• it rises in third trimester due to an increase in fetal production of DHEAS (DHEAS converted to DHEA by 16alpha-hydroxase)
• activates uterine receptors to begin contractile activity

Question 10

Effect of pregnancy on CV function

Answer 10

• increased aldosterone counteracted by vasodilatory metabolites in order to vasodilate and DECREASE DIASTOLIC BP (causing a widened pulse pressure)
• increased intravascular volume effects of E2 on RAS, RAS on aldosterone, and progesterone increasing erythropoiesis
• INCREASE HR to increase CO (HR has a bigger effect on CO than the SV)

Question 11

Effects of pregnancy on pulmonary function

Answer 11

• decreases FRC an ERV, mimicking a restrictive disease, because baby is pushing the diaphragm up
• progesterone targets medulla to INCREASE MINUTE VENTILATION (get rid of excess CO2 and make O2 offloading to baby more favorable)
• increased minute ventilation causes RESPIRATORY ALKALOSIS (will compensate by increasing bicarb excretion…metabolic acidosis)

Question 12

Cortisol and pregnancy

Answer 12

• CRH expressed in lungs of fetus to stimulate production of SURFACTANT
• cortisol needed for other organ maturation
• CRH expressed in myometrium to INDUCE CONTRACTIONS